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Botulinum Toxin Injection for the Treatment of Delayed Gastric Emptying Following Pylorus-Preserving Gastrectomy: an Initial Experience

  • Lee, Jung Hwan;Kim, Chan Gyoo;Kim, Young-Woo;Choi, Il Ju;Lee, Jong Yeul;Cho, Soo-Jeong;Kim, Young-Il;Eom, Bang Wool;Yoon, Hong Man;Ryu, Keun Won
    • Journal of Gastric Cancer
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    • v.17 no.2
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    • pp.173-179
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    • 2017
  • Purpose: To report our experience of endoscopic botulinum toxin injection in patients who experienced severe delayed gastric emptying after pylorus-preserving gastrectomy (PPG). Materials and Methods: We reviewed the medical records of 6 patients who received the botulinum toxin injection. They presented with severe delayed gastric emptying in the early postoperative period. Endoscopic botulinum toxin was administered as 4 injections of 25-50 IU into each of the 4 quadrants of the prepyloric area. Results: All botulinum toxin injections were successful without any complications, enabling 5 patients to tolerate soft solid diets and one to tolerate a soft fluid diet within 10 days. The endoscopic criteria of 4 patients improved. Symptom recurrence caused 2 patients to undergo repeat injections that were successful. The median follow-up period was 27 months, and all patients could ingest normal regular diets at the last follow-up. Conclusions: Endoscopic botulinum toxin injection is a feasible treatment option for early delayed gastric emptying after PPG.

Visualization of Delayed Gastric Emptying Flows After Esophageal Reconstruction Using a Gastric Graft (위장 이식편을 이용한 식도 재건술에서 위장 배출 지연 현상의 가시화)

  • Jeon, Hye-Jin;Park, Hee-Jin;Sung, Jae-Yong;Lee, Jae-Ik
    • Journal of the Korean Society of Visualization
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    • v.7 no.2
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    • pp.22-27
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    • 2010
  • The delayed gastric emptying flows have been visualized in this study when a gastric graft replaced an esophagus after esophagectomy. To construct visualization models for gastric grafts, the path data of gastric graft were extracted from the CT images for real patients and then the experimental models were made from silicone tube by considering elasticity of real stomach. During experiments, 200 ml of water or glycerin was poured into the gastric graft model and the gastric emptying time for total volume of fluid to pass pylorus was measured from the successive images captured by a high speed CCD. The gastric emptying time was compared according to the change of diameter and path (front or rear path) of gastric graft, and pyloroplasty or not. In case that the pyloroplasty was not conducted, the smaller was the diameter of gastric graft, the shorter was the gastric emptying time. However, if the pyloroplasty was conducted, the larger diameter of gastric graft was better for the gastric emptying. Although the rear path gave rise to longer gastric emptying time than the front path, it did not matter, if the pyloroplasty was conducted.

Effect of partial pyloric obstruction on body weight, gastric juice, gastric surface area and gastric edema in normal intact rats and/or vagotomized rats (정상 및 미주신경절단 흰쥐의 체중, 위액 분비량, 위의 형태변화에 대한 위 유문부 부분폐색과 재개통의 효과)

  • Seon, Jong-Ki;Yoon, Sang-Hyub
    • The Journal of Internal Korean Medicine
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    • v.33 no.1
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    • pp.26-38
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    • 2012
  • Objectives : The aim of this study was to investigate the effect of partial pyloric obstruction on body weight, gastric juice, gastric surface area and gastric edema in normal intact and/or vagotomized rats. Methods : Partial pyloric obstruction was performed by wrapping a non-absorbable rubber ring (D:6 mm, W:4 mm, T:1 mm) around the 1st portion of the duodenum. Vagotomy was performed by resecting the branches around the esophagogastric junction. Pre-post body weight differential, fasting gastric juice volume, gastric surface area and gastric edema were measured at 8 weeks and 20 weeks. For the effect of pyloric reperfusion the rubber ring was removed after 8 weeks and then an additional 12 weeks of observation was performed to the end of the 20-week experimental period. Results : In the initial 8 weeks observation, the effect of pylorus obstruction and/or vagotomy was significantly remarkable in the pylorus obstructed and vagotomized group; slowdown of weight gain, increase of fasting gastric juice volume, dilatation of gastric surface area and severe gastric edema were shown. In the remaining 12 weeks observation, the effect of reperfusion was significantly remarkable in the ring-removed antral dilated group; recovery of weight gain, decrease of gastric surface area and decrease of gastric edema were shown. However, gastric juice volume was not significantly different from the other group. Conclusions : Partial pyloric obstruction plays a aggravating role and the vagus nerve plays a protective role in body weight, gastric juice, gastric surface area, and gastric edema. Furthermore, pyloric valve dysfunction as an aggravating factor strengthened in defect of the vagus nerve. These results suggest that patients with both functional pyloric outlet obstruction and hypofunction of vagus nerve need to be diagnosed in good time and treated properly.

Convolution Neural Network Based Auto Classification Model Using Endoscopic Images of Gastric Cancer and Gastric Ulcer (내시경의 위암과 위궤양 영상을 이용한 합성곱 신경망 기반의 자동 분류 모델)

  • Park, Ye Rang;Kim, Young Jae;Chung, Jun-Won;Kim, Kwang Gi
    • Journal of Biomedical Engineering Research
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    • v.41 no.2
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    • pp.101-106
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    • 2020
  • Although benign gastric ulcers do not develop into gastric cancer, they are similar to early gastric cancer and difficult to distinguish. This may lead to misconsider early gastric cancer as gastric ulcer while diagnosing. Since gastric cancer does not have any special symptoms until discovered, it is important to detect gastric ulcers by early gastroscopy to prevent the gastric cancer. Therefore, we developed a Convolution Neural Network (CNN) model that can be helpful for endoscopy. 3,015 images of gastroscopy of patients undergoing endoscopy at Gachon University Gil Hospital were used in this study. Using ResNet-50, three models were developed to classify normal and gastric ulcers, normal and gastric cancer, and gastric ulcer and gastric cancer. We applied the data augmentation technique to increase the number of training data and examined the effect on accuracy by varying the multiples. The accuracy of each model with the highest performance are as follows. The accuracy of normal and gastric ulcer classification model was 95.11% when the data were increased 15 times, the accuracy of normal and gastric cancer classification model was 98.28% when 15 times increased likewise, and 5 times increased data in gastric ulcer and gastric cancer classification model yielded 87.89%. We will collect additional specific shape of gastric ulcer and cancer data and will apply various image processing techniques for visual enhancement. Models that classify normal and lesion, which showed relatively high accuracy, will be re-learned through optimal parameter search.

Acute Gastric Necrosis Due to Gastric Outlet Obstruction Accompanied with Gastric Cancer and Trichophytobezoar

  • Lee, Do-Sang;Sung, Ki-Young;Lee, Jun-Hyun
    • Journal of Gastric Cancer
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    • v.11 no.3
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    • pp.185-188
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    • 2011
  • Gastric necrosis due to gastric outlet obstruction is a very rare condition, but it might be fatal if missed or if diagnosis is delayed. Our patient was a 73-year-old male complaining of abdominal pain, distension and dyspnea for 1 day. In plain radiography and computed tomography, a markedly distended stomach and decreased enhancement at the gastric wall were noted. He underwent explo-laparotomy, and near-total gastric mucosal necrosis accompanied by sludge from the soaked laver was noted. A total gastrectomy with esophagojejunostomy was performed, and he recovered without sequelae. Final pathologic examination revealed advanced gastric cancer at the antrum with near-total gastric mucosal necrosis.

A Protective Effect for Panax ginseng in the Rat Stomach

  • Omar M.E.Abdel Salam;Batran, Seham-El;Shenawy, Siham-El;Mahmoud S.Arbid
    • Journal of Ginseng Research
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    • v.25 no.4
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    • pp.141-149
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    • 2001
  • The effect of ginseng on gastric ulcer and gastric acid secretion was investigated in pylorus-ligated rats. Methods: Sprague-Dawley strain rats were used after 24 hours fast. Pylorus-ligation was performed under light ether anaesthesia, then gastric mucosal damage was evoked in conscious pylorus-ligated rats by the administration of subcutaneous (s.c.) indomethancin (20mg/kg), s.c. histamine (150mg/kg) or by pylorus-ligation (Shay ulcer). Ginseng was given by intragastric (i.g.) or intraperitoneal (i.p.) route simultaneously with the ulcerogens. Rats were killed after 3h (indomethacin) and histamine models) or after 18h (Shay ulcer), when the gastric secretory responses, the number and severity of gastric mucosal lesions and mucosal mucus content deetermined. the effect of i.p. ginseng on basal gastric acid secretion and on gastric acide secretion in indomethacin (20mg/kg, s.c.)-treated rats was also investigated in urethane anesthetized rats. Gastric acid secretion was measured by flushing of the gastric lumen with saline every 15min through an oesophageal cannula. Results: In conscious pylorus-ligated rats, i.g. ginseng(12.5-50mg/$m\ell$; 50-200mg/kg) protected against gastric mucosal lesions evoked by s.c. indomethacin or s.c. histanmine in the d3-h pylorus-lighted rat, withoutmodifying gastric acid secretory responses. Ginseng given i.p. (150 or 200mg/kg) did not reduce the gastric lesions produced by histamine or by ligating the pylorus (Shay ulcer) Ginseng given orally in 50mg/$m\ell$ (200mg/kg) increased gastric mucus secretion in saline- and indomethacin-treated conscious pylorus-ligated rats. In anaesthetized rats ginseng (50 or 200mg/kg) did not modify basal gastric acid secretion or gastric acid secretion in the indomethacin-treated rats. Conclusions: ginseng given orally exerts gastroprotective effects in the rat stomach. Such anti-ulcer effect does not involve changes in gastric acid secretory responses. In addition, ginseng possesses stimulatory effect on gastric mucus secretion, which could be one mechanism by which the compound exerts its antiulcer effect. Our data are in favor for a beneficial effect for topically applied ginseng on the gastric mucosa.

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Microsatellite Instability Is Associated with the Clinicopathologic Features of Gastric Cancer in Sporadic Gastric Cancer Patients

  • Kim, Shin-Hyuk;Ahn, Byung-Kyu;Nam, Young-Su;Pyo, Joo-Youn;Oh, Young-Ha;Lee, Kang-Hong
    • Journal of Gastric Cancer
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    • v.10 no.4
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    • pp.149-154
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    • 2010
  • Purpose: Replication error is an important mechanism in carcinogenesis. The microsatellite instability (MSI-H) of colorectal cancers is associated with the development of multiple cancers. The influence of MSI-H on the development of multiple gastric cancers in sporadic gastric cancer patients has not been defined. This study was performed to reveal the association between the clinicopathologic features and MSI in sporadic gastric cancers. Materials and Methods: Between July 2004 and March 2009, the clinicopathologic characteristics, including MSI status, were evaluated in 128 consecutive patients with sporadic gastric cancers. None of the patients had hereditary non-polyposis colorectal cancer of familial gastric cancer. The markers that were recommended by the NCI to determine the MSI status for colorectal cancers were used Results: MSI-H cancers were found in 10.9% of the patients (14/128). Synchronous gastric cancers were shown in 4 patients (3.1%). Synchronous cancers were found in 2 of 14 patients with MSI-H gastric cancer (14.3%) and 2 of 114 patients with MSS gastric cancer (1.8%; P=0.059, Fisher's exact test). Among the patients with synchronous cancer 50% (2/4) had MSI-H cancer, but 9.7% of the patients (12/124) without synchronous cancer had MSI-H cancer. MSI-H (RR, 24.7; 95% CI, 1.5~398.9; P=0.024) was related with to synchronous gastric cancer, but age, gender, family history, histologic type, location, gross morphology, size, and stage were not related to synchronous gastric cancer. Conclusions: MSI is associated with the intestinal-type gastric cancer and the presence of multiple gastric cancers in patients with sporadic gastric cancer. Special attention to the presence of synchronous and the development of metachronous multiple cancer in patients with MSI-H gastric cancer is needed.

Gastric Adenocarcinoma Secondary to Primary Gastric Diffuse Large B-cell Lymphoma

  • Sakr, Riwa;Massoud, Marcel Antoine;Aftimos, Georges;Chahine, Georges
    • Journal of Gastric Cancer
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    • v.17 no.2
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    • pp.180-185
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    • 2017
  • Despite the decreasing incidence and mortality from gastric cancer, it remains a major health problem worldwide. Ninety percent of cases are adenocarcinomas. Here, we report a case of gastric adenocarcinoma developed after successful treatment of prior primary gastric diffuse large B-cell lymphoma (DLBCL). Our patient was an elderly man with primary gastric DLBCL in whom complete remission was achieved after R-CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone plus rituximab) chemotherapy. Helicobacter pylori infection persisted despite adequate treatment leading to sustained chronic gastritis. The mean time to diagnose metachronous gastric carcinoma was seven years. We believe that a combination of many risk factors, of which chronic H. pylori infection the most important, led to the development of gastric carcinoma following primary gastric lymphoma. In summary, patients who have been successfully treated for primary gastric lymphoma should be followed up at regular short intervals. H. pylori infection should be diagnosed promptly and treated aggressively.

Combined Detection of Serum MiR-221-3p and MiR-122-5p Expression in Diagnosis and Prognosis of Gastric Cancer

  • Zhang, Yan;Huang, Huifeng;Zhang, Yun;Liao, Nansheng
    • Journal of Gastric Cancer
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    • v.19 no.3
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    • pp.315-328
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    • 2019
  • Purpose: To investigate the clinical value of serum miR-221-3p and miR-122-5p expression levels in the diagnosis and prognosis of gastric cancer. Materials and Methods: Serum samples from 141 gastric cancer cases (gastric cancer group), 110 gastric polyps (gastric polyp group), and 75 healthy people (healthy control) were used to detect miR-221-3p and miR-122-5p expression using real-time reverse transcription polymerase chain reaction. Results: Serum miR-221-3p expression was significantly higher in the gastric cancer group than in the gastric polyp group, and it was significantly lower than that before operation. The miR-221-3p expression was significantly higher in the death group than in the survival group. The proliferation and migration ability significantly increased and the apoptosis rate significantly decreased by miR-221-3p transfection in gastric cancer cells. In contrast, the function of miR-122-5p in gastric cancer cells was opposite of miR-221-3p. Serum miR-221-3p expression was negatively correlated with that of miR-122-5p in gastric cancer. Serum miR-221-3p and miR-122-5p expressions were significantly correlated with the degree of differentiation, tumor, node, metastasis stage, lymph node metastasis, and invasion depth. miR-221-3p and miR-122-5p expression levels were independent prognostic factors for postoperative gastric cancer. In the diagnosis and predicting prognosis of gastric cancer, receiver operating characteristic analysis revealed that the area under curve of combined detection of serum miR-221-3p and miR-122-5p expression had a greater diagnostic effect than either single maker. Conclusions: The miR-221-3p and miR-122-5p are involved in the development of gastric cancer, and they have important clinical values in gastric cancer diagnosis and prognosis.