Delayed Perforation After Endoscopic Resection of Upper Gastrointestinal Tumors: CT Findings to Identify Patients Requiring Surgery.

PURPOSE: To determine the clinical and imaging factors associated with surgical treatment in patients with delayed perforation after endoscopic resection of upper gastrointestinal tumors. METHODS: We retrospectively included patients with delayed perforation after endoscopic tumor resection for gastric or duodenal tumors between January 2007 and December 2021 in a tertiary hospital. We compared the clinical, endoscopic, and CT findings of the surgical and conservative treatment groups. Univariable and multivariable analyses were performed to identify significant factors associated with surgery. RESULTS: Among 10,423 patients who had undergone endoscopic tumor resection, 52 (0.50%) experienced delayed perforation, with 20 patients (35.5%) treated surgically and 32 patients (64.5%) treated conservatively. The CT findings of gross perforation (adjusted odds ratio [OR]=6.75, 95% confidence interval [CI], 1.04-43.89; P=0.045) and presence of peritonitis (OR=34.26, 95% CI, 5.52-212.50; P<0.001) were significantly associated with surgical treatment. Other clinical factors as well as CT-measured amount of pneumoperitoneum were not significant factors. CONCLUSIONS: CT findings of gross perforation and peritonitis are significant factors associated with surgery in delayed perforation after endoscopic tumor resection. These factors can aid in guiding the patients towards an appropriate treatment plan.

Bowel function and quality of life after minimally invasive colectomy with D3 lymphadenectomy for right-sided colon adenocarcinoma.

BACKGROUND: Changes in bowel function after right-sided colectomy are not well understood compared to those associated with left-sided colectomy or rectal resection. In particular, there are concerns about bowel function after right-sided colectomy with complete mesocolic excision, which has become popular in the West. AIM: To evaluate the functional outcomes of patients who underwent right-sided colectomy with D3 lymphadenectomy for colon cancer. METHODS: Functional data from patients who underwent minimally invasive right-sided colectomy for colon cancer from October 2017 to September 2018 were prospectively collected. Functional outcomes were evaluated preoperatively and at 3, 6, 12, and 18 mo postoperatively. RESULTS: Prior to surgery, 57 patients answered the questionnaire, and 47 responded at three months, 52 at 6 mo, 52 at 12 mo, and 25 at 18 mo postoperatively. Most scales of quality of life and bowel function improved significantly over time. Urgency persisted to a high degree throughout the period without a significant change over time. The use of medications for defecation was about 10% over the entire period. Gas (P = 0.023) and fecal frequency (P < 0.001) increased, and bowel dysfunction group (P = 0.028) was more common among patients taking medication. At six months, resected bowel and colon lengths were significantly different as a risk factor between the dysfunction group and the no dysfunction group [odd ratio (OR): 1.095, P = 0.026; OR: 1.147, P = 0.031, respectively] in univariate analysis, but not in multivariate analysis. CONCLUSION: Despite D3 lymphadenectomy, most bowel symptoms improved over time after right-sided colectomy using a minimally invasive approach, and continuous medication was needed in only approximately 10% of patients.

Focal eosinophilic infiltration versus metastasis in the liver: comparison of MRI findings.

BACKGROUNDS/AIMS: This article was studied to compare the MRI findings of focal hepatic eosinophilic infiltration and hepatic metastasis. METHODOLOGY: Contrast enhanced MR images of 40 lesions in 15 patients with focal hepatic eosinophilic infiltration and 34 lesions in 17 patients with liver metastasis were reviewed retrospectively. The size, number and location of focal lesions were analyzed. The lesion-to-liver contrast difference of each lesion was recorded using region of interest (ROI) curve on T1- and T2-weighted images. Enhancement pattern was classified into homogenous, rim-enhancement and heterogeneous enhancement. All the images were reviewed by two gastrointestinal radiologists in consensus. RESULTS: Focal eosinophilic infiltration and hepatic metastasis showed predominantly low signal intensity on T1WI and high signal intensity on T2WI. However, focal eosinophilic infiltration manifested as iso signal intensity, more frequently than hepatic metastasis on T1WI (42.5% vs. 0%). Metastasis showed more frequently high signal intensity on portal (94.1% vs. 57.5%) and delayed phase (94.1% vs. 45.0%) comparing with focal eosinophilic infiltration. The lesion-to-liver contrast was greater in metastasis on both images (19 +/- 17 vs. 8 +/- 6 on T1WI and 21 +/- 19 vs. 13 +/- 10 on T2WI). Rim enhancement pattern is more frequently seen in metastasis on all phases. Seventeen (43%) focal eosinophilic infiltrations showed rim enhancement on arterial or portal venous phase and homogenous enhancement on delayed phase. CONCLUSION: MRI findings to favor eosinophilic infiltration include subcapsular location, lesser lesion-to-liver contrast on T1 and T2 weighted image and early rim enhancement with layed homogenous enhancement.

[A case of Salmonella liver abscess].

Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.

Dieulafoy's lesion of jejunum: presenting small bowel mass and stricture.

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. Hemorrhage occurs through mucosal erosion from an abnormally dilated submucosal artery. Although Dieulafoy's lesion is usually located in the stomach, it may occur anywhere in the gastrointestinal tract. We report here on a case of jejunal Dieulafoy's lesion presenting as a mass and short segment stricture on CT and enteroclysis.

[Effect of infliximab in the treatment of refractory inflammatory bowel disease with complication].

BACKGROUND/AIMS: Many studies on infliximab have confirmed its efficacy in the remission induction and even maintenance in refractory and fistulizing Crohn's disease. We report the treatment efficacy of infliximab in Crohn's disease and ulcerative colitis refractory to steroid treatment and the complications of infliximab treatment. METHODS: We performed infliximab administration in 5 cases (3 Crohn's disease, 2 ulcerative colitis) refractory to systemic steroid treatment and 5 cases of Crohn's disease with fistula. Patients received an intravenous infusion of infliximab at 3-5 mg/kg body weight. RESULTS: In 3 cases of refractory Crohn's patients, clinical response and remission induction were obtained in 2 (67%) and 1 cases (33%). After infusion of infliximab, the occlusion of internal fistula could be found in all 2 cases. Two out of 3 cases of anal fistula were completely healed. In two cases of refractory ulcerative colitis, one case who showed clinical manifestation of toxic megacolon had improved and avoided the colectomy, but the other case did not respond to the infusion of infliximab and underwent colon resection. CONCLUSIONS: We found that administration of infliximab is an effective alternative for refractory and fistulizing Crohn's disease but further studies are necessary for refractory ulcerative colitis.

Management of the complications of endoscopic submucosal dissection.

Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has technical difficulties and a longer procedure time than conventional endoscopic resection. So it may have a higher risk of complications than conventional endoscopic resection techniques. We, the ESD study group of Korean Society of Gastrointestinal Endoscopy, have experienced many complications, mostly treated by endoscopic or conservative management. Here, we introduce and share our experiences for management of post ESD complications and review published papers on the topic.

MR findings in eosinophilic infiltration of the liver.

OBJECTIVE: This study describes the findings of magnetic resonance imaging (MRI) of focal eosinophilic infiltration of the liver. METHODS: Contrast-enhanced MR images of 8 patients with focal hepatic eosinophilic infiltration were reviewed retrospectively. We evaluated the signal intensity of focal lesions in T1-weighted and T2-weighted images and the pattern of enhancement in a dynamic contrast study. RESULTS: A total 22 focal hepatic lesions were observed; the lesions were isointense (55%) or hypointense (45%) on T1-weighted images and isointense (14%) or hyperintense (86%) on T2-weighted images. The arterial phase of the contrast study revealed 11 hyperintense lesions (50%). During the portal and delayed phases, 18 (82%) and 17 lesions (77%) were hyperintense, respectively. CONCLUSION: The focal eosinophilic infiltrations showed homogeneous enhancement in the portal and delayed phases in the dynamic contrast MR study. These findings should help to distinguish focal eosinophilic infiltration, especially from metastasis in patients with malignancy.

Rescue of Helicobacter pylori-induced cytotoxicity by red ginseng.

Helicobacter pylori has been known to provoke gastric inflammation, ulceration, and DNA damage, based on which WHO defined H. pylori as a class I carcinogen. Although ginseng, the root of Panax ginseng C.A. Meyer, has been reported to possess antiadhesion or antimicrobial activity against H. pylori, in this study, we examined the protective effect of red ginseng extracts (RGE) against H. pylori-induced cytotoxicity and DNA damage. RGE significantly attenuated both H. pylori-induced DNA damage assessed by comet assay and apoptosis measured by DNA fragmentation. Inactivation of ERK1/2 signaling and attenuation of caspase-3 activation and PARP cleavage were revealed with RGE against H. pylori infection. RGE decreased H. pylori-stimulated IL-8 gene expression, which resulted from the transcriptional regression of NF-kappaB. In conclusion, RGE showed significant gastroprotective effects against H. pylori-associated gastric mucosal cell damage, suggesting that red ginseng could be used as a medicinal phytonutrient against H. pylori infection.

Blockage of HSP 90 modulates Helicobacter pylori-induced IL-8 productions through the inactivation of transcriptional factors of AP-1 and NF-kappaB.

Helicobacter pylori infection leads to significant inflammations in the gastric mucosa, which is closely associated with development of gastric cancer. Heat shock protein 90 (HSP 90) has been revealed to be critical for intracellular signaling that participates in inflammatory response as well as carcinogenesis. In this study, we investigated a regulatory role of HSP 90 in H. pylori-induced IL-8 production. Our results showed that H. pylori stimulated significant phosphorylation of HSP 90 and the phosphorylation was diminished by administration of HSP 90 inhibitor, geldanamycin (GA). Treatment of GA completely inhibited H. pylori-induced IL-8 production due to deactivation of ERK1/2 and NF-kappaB. These results subsequently lead to inactivation of AP-1 and NF-kappaB, which are known to be major transcriptional factors of IL-8. Our data provide important insights that HSP 90 is involved as a crucial regulator in H. pylori-induced IL-8 production and its inhibitor could be potentially used for the inhibition of H. pylori-provoked inflammation.

[Suppressive effects of antioxidant DA-9601 on hepatic fibrosis in rats].

BACKGROUND/AIMS: Oxidative stress is one of the important underlying mechanisms of hepatic fibrosis. DA-9601, the ethanol extracts of Artemisia asiatica, has been reported to possess strong antioxidative and cytoprotective actions. We tried to evaluate whether antioxidant can ameliorate dimethylnitrosamine (DMN)-induced hepatic fibrosis. METHODS: Rat hepatic fibrosis was induced by intraperitoneal administrations of 10 mg DMN six times. Additionally, rats of one group were started daily with DA-9601 30 mg/kg containing diets and another group was fed a pellet diet containing DA-9601 100 mg/kg. The immunohistochemical studies for collagen, alpha-smooth muscle actin (alpha-SMA), and fibronectin, the measurements of hepatic malondialdehyde (MDA) and collagens, and the changes of liver function profiles were performed. Hepatic stellate cells (HSC) were isolated and in vitro effects of DA-9601 on HSC activations were measured. RESULTS: DA-9601 significantly attenuated the loss of body weights (p<0.05), the reduction of liver wet weights (p<0.05), and the elevation of liver enzymes provoked by DMN administrations. DMN injections caused the severe fibrosis of portal tract, hepatic inflammation, and significant oxidative damages, but DA-9601 treatment significantly reduced the mean scores of hepatic fibrosis, the amounts of hepatic collagens, and hepatic MDA levels. The prominent decreases in the expressions of collagens type I & III, alpha-SMA, and fibronectin or hepatic inflammations were observed in DA-9601-treated groups dose-dependently and similar efficacy was also proven in in vitro HSC experiment. CONCLUSIONS: DA-9601 effectively protected rat liver tissues against the DMN-induced hepatic fibrosis. Antioxidant could be considered as a supplementary therapeutic for alleviating the hepatic fibrosis.