Factors Affecting Insertion Time during Colonoscopy

Background/Aims: The goal of this study was to examine whether certain variables are associated with insertion time during colonoscopy. Methods: A total of 703 consecutive subjects underwent colonoscopy by a single endoscopist from April of 1998 to August of 1998. The insertion time during colonoscopy was checked and the factors that may affect insertion time were analyzed. Results: The indications for colonoscopy were bowel habit change (34.8%), the diagnosis of and follow up for colonic neoplastic disease (31.6%), abdominal pain (22.8%), thin stool caliber (19.2%), hematochezia (16.1%), routine examination (10.7%), inflammatory bowel disease (9.4%), tenesmus (8.8%) and a family history of colonic disease (3.1%). Of 703 subjects, complete colonoscopy was possible in 678 (96.4%). Reasons for incomplete insertion included inadequate bowel cleaning (n=11), pain (n=6), a history of operations (n=3), and others (n=5). Therefore, the adjusted completion rate was 97.9% (678/692). The mean insertion time in complete colonoscopy was 7.07 4.26 min (range; 2∼35 min). Multivariable analysis revealed that inadequacy of bowel preparation was significantly associated with prolonged (＞10 min) insertion time (p=0.005), whereas the history of colorectal resection was inversely associated with prolonged insertion time (p=0.010). Conclusions: Among the factors affecting insertion time during colonoscopy, cleanness of the bowels is the only correctable factor.ope

A Case of Primary Systemic Amyloidosis Presenting Submucosal Hematoma and Bleeding in the Lower Gastrointestinal Tract

A case of systemic amyloidosis involving the upper and lower gastrointestinal tract is presented. The initial manifestation of this case was bloody diarrhea. On colonoscopy, multiple submucosal hematomas and irregular ulcerations of the sigmoid and descending colon were found. The pathologic diagnosis was confirmed by an endoscopic mucosal biopsy of the gastrointestinal tract and the specimen revealed massive amyloid deposits in the wall of the upper and lower intestinal tract. With intensive medical treatment, the submucosal hematoma disappeared and the ulcerations decreased in size. However, on the 29th day, the patient was expired due to unexpected sepsis.ope

Crohn’s disease associated with pachydermoperiostosis

Pachydermoperiostosis is a rare hereditary syndrome characterized by finger clubbing, periosteal change, pachydermia and autonomic nervous system symptoms such as facial flushing and hy perhidrosis. This syndrome is known to be associated with a variety of diseases such as cranial suture defect, female escuchen, bone marrow failure, hypertrophic gastropathy and Crohn' s disease. Crohn' s disease is a chronic idiopathic inflammatory disease of the intestine and frequently presents many kinds of extraintestinal manifestations including finger clubbing. Recently, Compton et al. reported 3 patients with Crohn' s disease associated with pachydermoperiostosis in a family as a new syndrome Recently, we have also experienced 3 patients with pachydermoperiostosis in a family. One of them developed Crohn' s disease at 45 years of age. The elder sister of the proband had protein loosing enteropathy without a significant morphological change of gastrointestinal tract. The younger brother had experienced repeated gastrointestinal bleeding caused by multiple ileal ulcer.ope

Phenotypic Characteristics and CD2- and CD3-mediated Signal Transduction in HLA DR Positive and Negative Subse ts of Lamina Propria-like T-ce lls

Background/Aims: Peripheral blood T-cells co-cultured with Daudi (a irradiated B-cell line) and interleukin (IL)-2 attain a CD2 dominant cytokine secretion pattern and show tyrosine phosphorylation profile identical to freshly isolated lamina propria (LP) T-cells. Since the phenotypic characteristics and signal transduction pathway of these LP-like T-cells are largely unknown yet, we have explored the expression pattern of T-cell markers and CD2 ligation-induced tyrosine phosphorylation profile of LP-like T-cells and their HLA DR+ and DR- subsets. Methods: The LP-like T-cells were sorted into DR+ and DR- subsets by magnetic sorting. Surface markers were measured by flow cytometry. Tyrosine phosphorylation profile was investigated by Western blot. Results: The LP-like T-cells consisted of two distinct populations: approximately 55% of the cells express both HLA DR and IL-2R (DR+ LP-like T-cells) and the remainder express neither HLA DR nor IL-2R (DR- LP-like T-cells). Approximately 80% of DR+ LP-like T-cells were memory cells expressing CD45RO and 2/3 of them were activated T-cells expressing CD69, CD71 and CD30. In contrast, 50% of DR- LP-like T-cells expressed CD45RO and only 10-20% of them expressed activation markers. Tyrosine phosphorylation of p72 protein after CD2 ligation was identified only in DR- LP-like T-cells. Conclusions: The LP-like T-cells consist of two distinct subpopulation in terms of phenotype and tyrosine phosphorylation pattern according to CD2 ligation.ope

Crohn’s Disease Clinical Network and Cohort (CONNECT) Study: The First Step Toward Nationwide Multicenter Research of Crohn’s Disease in Korea

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A Clinical Investigation of Clostridium difficile-Associated Disease

Background/Aims: Clostridium difficile-associated disease (CDAD) is a common cause of anti biotics-associated diarrhea. The purpose of this study is to understand the clinical, microbiological endoscopic and pathological features of CDAD. Methods: The analysis was performed for 31 patients who were diagnosed as CDAD by positive stool culture from Jan, 1988 to Dec, 1997 and subsequently underwent flexible sigmoidoscopy or colonoscopy. Results: Generally, CDAD occurred in elderly patients who were admitted and treated with antimicrobial agents for a long time. Majo symptoms were watery diarrhea, fever, hematochezia, abdominal pain, and vomiting. On endoscopy pseudo membranous colitis (PMC) and nonspecific colitis were observed in 58.1% and in 22.6% o the patients, respectively. Noraml findings was observed in 19.4% of them. Pathologic finding sho wed PMC in 19.4% of the patients, nonspecific colitis in 48.4%, normal finding in 22.6%. Most o CDAD were cured when the use of the presumptive causative antimicrobials was quitted and van comycin, metronidazole, or cholestyramine was used. Eight recurred cases were also cured by using vancomycin or metronidazole. Conclusions: CDAD is a common cause of antibiotics-associated diar rhea and shows a spectrum of endoscopic and pathologic findings from normal to PMC. CDAD i treated well by oral vancomycin or metronidazole, even in the recurred cases.ope

Lactobacillus plantarum CBT LP3 ameliorates colitis via modulating T cells in mice

Lactobacillus plantarum has been identified as a probiotic bacterium owing to its role in immune regulation and maintenance of intestinal permeability. Here, we investigated the anti-colitic effects and mechanism of L. plantarum CBT LP3 (LP3). This in vivo study was performed using dextran sodium sulfate (DSS) to induce colitis in mice. Mice were randomly divided into three groups: a control supplied with normal drinking water, a DSS-treated group followed by oral administration of vehicle, and a DSS-treated group gavaged with LP3 daily for 7 days following DSS administration. An analysis of macrophages and T cell subsets harvesting from peritonium cavity cells and splenocytes was performed using a flow cytometric assay. Gene expression and cytokine profiles were measured using quantitative reverse transcriptase polymerase chain reaction. The administration of LP3 significantly attenuated disease activity and histolopathology compared to control. LP3 had anti-inflammatory effects, with increased induction of regulatory T cells and type 2 helper T cells in splenocytes and restoration of goblet cells accompanied by suppression of proinflammatory cytokine expressions. These findings suggest that L. plantarum CBT LP3 can be used as a potent immunomodulator, which has significant implications for IBD treatment.ope

Clinical Value of Distal Colon Polyps for Prediction of Advanced Proximal Neoplasia:The KASID Prospective Multicenter Study

Backgroud/Aims: Proximal lesion without distal finding is weak point in colon cancer screening. Clinical significance of distal finding for advanced proximal neoplasia (APN) is uncertain. Aims of this study were to assess distal finding for prediction of APN. Methods: Asymptomatic 826 adults (age≥50) were collected in KASID prospective study, who underwent colonoscopy and polypectomy. Polyps located distal to splenic flexure were defined as distal polyps. Age, gender, size, appearance, histology of distal polyps were analyzed as risk factor of APN (adenoma≥10 mm or villous histology or high grade dysplasia or invasive cancer). Sensitivity and positive predictive value of distal polyp on APN were assessed. Results: APN were found in 98 patients and 45 (45.9%) patients of them were not associated with any distal findings. Risk factors of APN were male, size of distal polyp and advanced distal polyp. Sensitivity of distal polyp size≥10 mm on APN was 38.8% and advanced distal polyp also 38.8%. Positive predictive value of distal polyp size≥10 mm and advanced distal polyp were 13.3%, 14.4% respectively. Conclusions: Although distal colon findings were helpful to predict APN in asymptomatic 50 years of age or order patients screening, more careful examination is required considering APN without distal polyps.ope

The Characteristics of Colorectal Adenoma with Colonoscopic Polypectomy in Population under 50 Years Old:The KASID Prospective Multicenter Study

Background/Aims: The current practice of colonoscopic polypectomy reduce the risk of colorectal cancer. However, clinicopathologic charateristics of colorectal adenoma in population under 50 years old are uncertain. This study was performed to investigate clinicopathologic characteristics of colorectal adenoma and to determine colonoscopic indication of advanced adenoma in this population. Methods: A large scale, multicenter, prospective study was conducted from July 2003 through June 2004. Of the total 19,288 patients performed colonoscopy at 11 tertiary medical centers, we analysed 3,366 patients who undergone polypectomy and divided two groups by age of 50. Results: Among colonoscopic polypectomy, 10.7 percent (831/7,789) was younger patients and 22.0 percent (2.535/11,499) was older patients (p＜0.001), and the detection rate of advanced adenoma was significantly lower in younger patients than older patients (17.7% vs. 21.1%, p＜0.0050). In younger patients, the indications of colonoscopy were asymptomatic screening (32.7%), bowel habit change (24.0%), abdominal pain (16.8%), hematochezia (9.2%) and so on. The risk factors for advanced adenoma as colonoscopic indications in younger patients were hematochezia (OR 1.9, 95% CI 1.1-3.3) and referred patients from primary clinic (OR 2.0, 95% CI 1.3-3.0). Conclusions: This study documents lower prevalence of adenoma requiring polypectomy in younger patients compared with older patients and the low detection rate of advanced adenoma. Also, in this younger population, the colonoscopic polypectomy should be the first consideration in polyps with hamatochezia patients or referred patients from primary clinicope

Characteristics of Colon Cancer Diagnosed in Patients Taking Aspirin or Warfarin

Background/Aims: Warfarin and aspirin are commonly used to prevent cardiovascular diseases. Aspirin was recently found to have chemopreventive effects on colon cancer and polyps by inhibiting cyclooxygenase-2. Therefore, we evaluated whether the symptoms of bleeding related with aspirin or warfarin could be a clue in early detection of colon cancer. We also assessed the effect of aspirin on the development of synchronous polyps. Methods: A total of forty-one and 16 patients diagnosed as colon cancer, taking aspirin or warfarin respectively were enrolled. In addition, 171 patients with colon cancers were age and gender matched as a control group. We investigated the difference of clinical features and laboratory findings among three groups. Results: The incidence of bleeding was 81.3% (warfarin), 53.7% (aspirin), 40.4% (control). Among three groups, location and size of cancer, number of lymph nodes involvement and stages were not different, but the number of patients in Duke stage D in warfarin group (n=1, 6.3%) were less than that of the control (n=44, 25.7%) (p=0.049). The extent of circumferencial involvement by cancer was lower in aspirin group (67%) than in the control group (80%) (p=0.035). The percentage of patients with synchronous polyps and mean number of synchronous polyps in aspirin group (34.1%, 0.68, respectively) was lower than that of control group (53.6%, 1.69, respectively) (p=0.029, 0.008, respectively). Conclusions: Bleeding related with aspirin or warfarin usage had no effect on the early diagnosis of colon cancer. However, lower incidence of Duke stage D in warfarin group might be related to anti-metastatic effect of warfarin. In addition, aspirin may have a role in suppressing the development of synchronous polyps.ope