The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi最新文献

Background/aims: This study examined the incidence, causes, and survival outcomes of follow-up loss (FUL) after a gastrectomy for gastric cancer.

Methods: Patients who underwent a curative gastrectomy between January 2016 and May 2019 at a regional tertiary hospital were divided into two groups based on their follow-up (FU) adherence. Patients who maintained a regular FU throughout the five-year period were classified as the FU group, and those who failed to attend their scheduled visits for more than 12 consecutive months were grouped as the FUL group. Telephone interviews were conducted to identify the reasons for FU discontinuation and survival status. The sociodemographic and clinical variables were compared, and the independent predictors and survival outcomes were compared.

Results: Among the 435 patients, 137 (31.5%) were in the FUL group, and contact was successful in 131 patients (95.6%). The leading cause of FUL was death from non-gastric cancer causes (40.1%). Independent predictors of FUL were older age (hazard ratio [HR]=1.044, p<0.001), lower body mass index (BMI, HR=0.927, p=0.015), absence of familial support (HR=2.666, p=0.005), and total gastrectomy (HR=1.660, p=0.012). The BMI lost significance in sensitivity analysis (p=0.293). The overall survival (OS) was lower in the FUL group (p=0.0370), particularly for the stage I patients (p=0.046). The independent predictors of OS were FUL (HR=2.148, p=0.006) and pathologic stage (p<0.001).

Conclusions: FUL after a gastrectomy was associated with older age, absence of familial support, total gastrectomy, and was related to a poorer OS, particularly in stage I patients.

Esophagogastroduodenoscopy (EGD) is the standard diagnostic modality for upper gastrointestinal (UGI) diseases, but its invasive nature and the risk of sedation-related adverse events limit its applicability in certain patients. Magnetically controlled capsule endoscopy (MCE) is a promising noninvasive alternative, enabling precise active locomotion and complete visualization of the gastric mucosa through external magnetic control. MCE systems have evolved into hand-held and robotic systems, with clinical studies showing diagnostic performance comparable to EGD, along with generally better patient tolerance. Recent studies have shown that a single MCE examination can simultaneously evaluate the UGI tract and small bowel. Advances such as three-dimensional imaging and artificial intelligence have improved diagnostic accuracy and workflow efficiency. Although cost-effectiveness remains a challenge in Korea's healthcare environment, MCE provides a meaningful alternative for patients who are unsuitable for sedated EGD or who prefer a noninvasive modality. With the ongoing technological advances, MCE is expected to evolve into an autonomous, "One-stop pan-enteric endoscopy" platform in the near future.

Isolated neurofibromas of the gallbladder (GB) and common bile duct (CBD) are exceptionally rare benign tumors, often mimicking malignancies and posing diagnostic challenges. This paper reports the unique case of a 32-year-old male presenting with right upper quadrant pain, jaundice, and clay-colored stools. Imaging revealed a septate GB with mural thickening, a gallstone, and distal CBD annular thickening, indicating a dual malignancy (GB carcinoma and cholangiocarcinoma). A hepato-pancreatic-duodenectomy was performed because of a suspected malignancy. The histopathology examination unexpectedly revealed spindle cell lesions positive for S100 and neurofilament protein, confirming a primary neurofibroma of the GB and CBD. This first reported case of simultaneous dual-site involvement highlights the diagnostic difficulty because of malignancy mimicry, advocating for intraoperative frozen sections to guide surgical management and avoid overtreatment.

Background/aims: Programmatic screening for colorectal cancer (CRC) could maximize the impact of screening in the average-risk population, but the diagnostic performance of a stool DNA-based Syndecan-2 methylation (meSDC2) test has only been reported in case-control studies or high-risk populations. This study examined the performance of a stool DNA-based meSDC2 test for CRC in an average-risk population from a real-world setting.

Methods: This retrospective, multicenter study included consecutive asymptomatic, average-risk individuals for CRC who completed a meSDC2 stool test at 18 hospitals. The clinical performance of the meSDC2 stool test, including the positive rate, adherence to confirmatory colonoscopy, and the positive predictive value (PPV) for colorectal neoplasia (CRN), was assessed.

Results: Over 54 months, 4,910 individuals completed the meSDC2 stool test, with 249 (5.1%) testing positive. The colonoscopy compliance rate after a positive test was 61.0% (n=152). Among 121 individuals with available colonoscopy data, the PPV for any CRN, advanced neoplasia, and CRC were 39.7%, 12.4%, and 2.5%, respectively. Colonoscopy after a positive meSDC2 test ensured a high-quality examination, as reflected by the 100% cecal intubation rate, 97.5% adequate preparation quality, and an average withdrawal time of 11.2 min. Among those with a positive meSDC2 test, a family history of CRC was a significant predictor of any CRN (p=0.029) and advanced neoplasia (p=0.003).

Conclusions: A stool DNA-based meSDC2 test in average-risk individuals for CRC revealed a high PPV for any CRN in a real-world setting, highlighting its potential as a screening modality in programmatic CRC screening.

Artificial intelligence (AI) for gastrointestinal endoscopy has shown remarkable performance in detecting and characterizing lesions. A randomized controlled trial reported that AI significantly reduced the miss rates for gastric neoplasms, but real-world implementation studies have shown inconsistent results. This discrepancy cannot be explained solely by technical limitations. Regardless of the AI capabilities, the visualization quality and systematic inspection remain fundamental prerequisites, and traditional apprenticeship training cannot be replaced by technology. This review examines AI implementation in endoscopy from a human-AI interaction perspective. Two cognitive phenomena are relevant: 'automation neglect,' where experienced endoscopists dismiss AI recommendations due to overconfidence or distrust, and 'automation bias,' where users over-rely on AI outputs, potentially missing unhighlighted lesions. Recent evidence raises concerns regarding deskilling, with studies showing decreased diagnostic performance after exposure to AI. A systematic analysis of 52 human-AI teaming studies showed that none achieved ideal complementarity, and collaboration sometimes decreased accuracy compared to humans alone. AI effectiveness varies according to operator expertise. High-performing endoscopists gain minimal benefit, while those with intermediate experience show the greatest improvement. Nevertheless, excessive false-positive alerts can negate benefits. Strategies to address these challenges include explainable AI, human-centered design, structured education, trust calibration, and expertise-tailored AI systems. Maintaining human expertise remains paramount. AI is a powerful tool, but clinicians must remain the final decision maker. Periodic AI-free practice may be necessary to preserve clinical competence.

Chronic pancreatitis (CP) is a progressive fibroinflammatory disease characterized by pancreatic ductal obstruction, calcification, and fibrosis, leading to chronic pain and exocrine or endocrine insufficiency. Endoscopic management plays a central role in selected patients with painful obstructive CP, providing ductal decompression and drainage while avoiding the morbidity of surgery. Endoscopic retrograde cholangiopancreatography with pancreatic sphincterotomy, stenting, and stone extraction is the mainstay of therapy. Extracorporeal shock wave lithotripsy or pancreatoscopy-guided lithotripsy is recommended for radiopaque or large main pancreatic duct stones, whereas a single large-caliber plastic stent has been suggested for dominant ductal strictures. An endoscopic ultrasound guided celiac plexus block may be considered in patients with refractory pain unresponsive to medical or endoscopic therapy, even though its effect is usually transient. Endoscopic drainage is preferred over surgical or percutaneous approaches for uncomplicated pancreatic pseudocysts. A multidisciplinary approach involving endoscopists, surgeons, and pain specialists is essential, and early surgical consultation should be considered when endoscopic therapy fails or when complete ductal clearance is unlikely. This review summarizes current evidence and international guideline recommendations on the role of endoscopy in the management of chronic pancreatitis.

Advances in gastrointestinal endoscopy have expanded its role from diagnosis to definitive therapy, leading to a paradigm shift in the management of gastrointestinal diseases. As therapeutic endoscopic procedures become increasingly complex, there is a growing demand for enhanced precision, stability, and control beyond the capabilities of conventional endoscopes. In response, various robotic endoscopic platforms have been developed to improve visualization, dexterity, and procedural safety, particularly for technically demanding interventions such as endoscopic submucosal dissection (ESD). Robotic therapeutic endoscopy systems can be broadly categorized into multitasking robotic platforms and robotic add-on platforms. Multitasking platforms enable bimanual manipulation, triangulation, and effective tissue traction but are often limited by high cost, system complexity, and workflow constraints. In contrast, robotic add-on platforms are designed to integrate with conventional endoscopes, offering improved maneuverability and traction with minimal disruption to clinical practice. Recent preclinical and early clinical studies, including first-in-human and randomized pilot trials, have demonstrated the feasibility and safety of robotic-assisted ESD, with potential benefits in procedural efficiency, learning curve reduction, and operator workload. Despite ongoing challenges related to cost-effectiveness, device integration, and widespread commercialization, robotic endoscopy represents a promising therapeutic platform. Continued technological refinement and accumulation of clinical evidence are expected to further define its role in advancing precision, standardization, and accessibility in therapeutic gastrointestinal endoscopy.

Upper gastrointestinal bleeding (UGIB) is defined as bleeding from the esophagus, stomach, and duodenum, whereas lower gastrointestinal bleeding originates from below the ligament of Treitz, including the small bowel and colon. The incidence of UGIB has decreased globally over the past 20 years, reaching approximately 50-150 and 47 cases per 100,000 of the global population per year for variceal and non-variceal bleeding, respectively. The eradication of Helicobacter pylori and the widespread introduction of proton pump inhibitors have contributed to the current improvement in epidemiological outcomes. Regarding the etiology of UGIB, peptic ulcer disease is the most common cause, accounting for 43.6% of cases, followed by gastritis and duodenitis (27.6%), esophageal variceal bleeding (8.0%), and esophagitis (5.6%). Other causes, including malignancy, Dieulafoy's lesions, and Mallory Weiss tears, collectively account for 10-12% of UGIB. In conclusion, the outcomes of H. pylori eradication and the widespread introduction of proton pump inhibitors have offset the effects of an aging population. In addition, the increasing indications for non-steroidal anti-inflammatory drugs, anticoagulation, and antiplatelet agents have resulted in a decrease in the incidence of UGIB.

Functional dyspepsia (FD) is defined as a clinical condition in which pain or discomfort arises from the gastroduodenal area in the absence of any organic, systemic, or metabolic disease that could explain the symptoms. Dyspeptic symptoms must be present for the previous three months with symptom onset at least six months before the diagnosis, according to the Rome IV criteria. Several factors have been suggested to induce the symptoms of FD, including disturbed gastroduodenal motility, visceral hypersensitivity, brain-gut interactions, duodenal low-grade mucosal inflammation, immune alteration, genetic susceptibility, and gut microbiota dysbiosis. Moreover, many patients with FD complain that specific foods trigger their symptoms, but the relationship between dietary or lifestyle factors and FD must be fully elucidated. Against this background, the Diet, Obesity, and Metabolism Research Study Group of the Korean Society of Neurogastroenterology and Motility developed visual materials outlining dietary and lifestyle factors relevant to functional gastrointestinal disorders to provide practical guidance for both clinicians and patients. This review introduces the FD section of these materials and provides a comprehensive summary of their contents.

The widespread use of screening endoscopy has increased the detection rate of ampullary neoplasms. Most of these lesions are adenomas or carcinomas. The recurrence rates after an endoscopic papillectomy have been reported to range from 5% to 40%, even in cases with pathologically confirmed complete resection. An endoscopic mucosal resection (EMR) is commonly performed for residual or recurrent lesions, and endoscopic ablation therapies, such as argon plasma coagulation, may be used either as an alternative to or in conjunction with EMR. Recently, radiofrequency ablation (RFA) has garnered attention as a potential alternative to surgical treatment for intraductal residual or recurrent ampullary neoplasms after an endoscopic papillectomy, showing a 75.7% clinical success rate. In cases of recurrence after initial RFA, additional RFA has enabled oncologic control in nearly all patients without the need for surgery. Nevertheless, further prospective studies and accumulation of evidence are necessary to establish the efficacy and safety of RFA in this setting.