• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.4
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• pp.319-328
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• 2020

Purpose: To examine the prevalence and clinical manifestations of eosinophilic esophagitis (EoE) in Korea children. Methods: The study was designed as a 1:2 matching case-control study. Using information from the endoscopic database of a tertiary center, we retrospectively reviewed the medical records of patients aged 18 years or younger who underwent upper gastrointestinal endoscopy between January 2014 and December 2017. A total of 21 patients were diagnosed with EoE based on current diagnostic criteria. In addition, 42 controls with normal esophageal biopsy findings matched to each EoE case by sex, age (±1 months), and season were randomly selected during the study period. Results: The mean age of EoE diagnosis was 12.1±4.0 years and the male-to-female ratio was 2:1. The proportion of allergic diseases in patients with EoE (28.6%) was higher than that in the controls (6.8%) (p=0.04). Most EoE patients tested for allergy were positive for at least one antigen, which was significantly different to the controls (88.2% vs. 47.4%, p=0.01). Characteristic endoscopic findings of EoE were noted in 19 patients (90.5%), but 2 patients (9.5%) showed normal esophageal mucosa. The clinical symptoms of EoE were improved by a proton-pump inhibitor in 10 patients (50.0%), and by an H₂ blocker in 9 patients (45.0%). Only one patient (5.0%) required inhaled steroids. Conclusion: While EoE is rare in the Korean pediatric population, the results of this study will improve our understanding of the clinical manifestations of the disease.

• Journal of Veterinary Clinics
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• v.34 no.3
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• pp.193-196
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• 2017

A 14-year-old, castrated male, domestic shorthair cat was referred for gastrointestinal (GI) signs, including nausea, regurgitation, anorexia, and weight loss. Abdominal ultrasonography revealed thickening of the wall of the gastric and proximal duodenum, moderately enlarged mesenteric lymph nodes, and coarse echotexture of the splenic parenchyma. The results of the feline leukemia virus test were positive. Based on gastrointestinal endoscopic characteristics and histopathological examinations, low-grade alimentary lymphoma was identified in multiple regions of the gastrointestinal tract. The patient was treated with oral prednisolone and chlorambucil chemotherapy, and the clinical signs resolved gradually. During serial follow-up, ultrasonographic findings demonstrated decreases in the duodenal wall thickness and size of the abdominal lymph nodes over a period of 550 days. Survival time was 886 days with prednisolone and chlorambucil chemotherapy. This report describes clinical features, imaging findings, endoscopic characteristics, histopathological features, and long-term management with chlorambucil chemotherapy in a case of feline low-grade alimentary lymphoma.

• Journal of Gastric Cancer
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• v.15 no.1
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• pp.58-63
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• 2015

Gastric duplication cyst is a rare congenital anomaly of the gastrointestinal tract and is especially uncommon in adults. Most cases in adults are discovered incidentally on radiological examination or gastric endoscopy. Accurate diagnosis of these cysts before resection is difficult. Differential diagnoses are varied. Malignant transformation of a gastric duplication cyst is very rare. We present three cases of asymptomatic noncommunicating gastric duplication cysts in adults.

• Journal of Veterinary Clinics
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• v.33 no.5
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• pp.286-289
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• 2016

Two dogs (Case 1: Poodle, 4 years old, spayed female; Case 2: Bulldog, 3 years old, intact female) were referred to us for treatment of vomiting; Case 1 had a history of acute vomiting that started 1 day prior to presentation, and Case 2 had a history of chronic vomiting that started 2 years prior to presentation. The vomiting did not respond to medication in the local animal hospital. Results from abdominal ultrasound examinations showed that case 1 had gastric wall thickening, and case 2 had no remarkable findings. For both cases, we performed gastrointestinal endoscopic examinations, and several biopsy samples were obtained from different gastric areas. On the basis of the results of histopathological examinations, both dogs were diagnosed with atrophic gastritis concurrent with a Helicobacter infection. Clinical signs improved after antibiotic therapy. This case report describes the clinical, endoscopic, and histopathological findings of atrophic gastritis concurrent with a Helicobacter infection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.1
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• pp.57-62
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• 2019

Purpose: This study was performed to assess the clinical usefulness of transabdominal ultrasonography (TUS) in detecting peptic ulcer disease (PUD) in children. Methods: Twenty-four patients (19 boys, 5 girls; mean age, $10.6{\pm}4.5years$ [range, 3.0-17.9 years]) who were admitted to the hospital for acute abdomen or gastrointestinal bleeding and diagnosed with PUD by endoscopy and who underwent TUS were included. Clinical data were retrospectively collected by reviewing patient medical records. Gastric ulcer (GU) was suspected when the gastric wall exceeded 8 mm in thickness and had lost its five-layer structure on TUS. Duodenal ulcer (DU) was suspected if the duodenal wall thickness exceeded 5 mm. Results: Sensitivity of TUS in diagnosing PUD was 66.7% for GU and 38.9% for DU. Mean age and body weight of the 11 patients suspected with PUD on TUS were $10.9{\pm}4.4years$ and $38.1{\pm}17.2kg$, respectively. For 13 patients without suspected PUD, they were $12.1{\pm}4.1years$ and $39.6{\pm}17.0kg$, respectively. There was a significant difference in height, weight, and body mass index between patients who were suspected to have PUD and those who were not suspected on TUS (p=0.014, 0.008, and 0.005, respectively). A significant difference in the sensitivity of TUS in diagnosing PUD was found between patients under 30 kg and those over 30 kg (88.9% and 20.0%, respectively; p=0.003). Conclusion: TUS investigation of the stomach and duodenum is an efficient method for PUD detection in children with low body weight. TUS can be used in preliminary diagnostic work-up before further invasive tests.

• Journal of Veterinary Clinics
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• v.39 no.5
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• pp.258-263
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• 2022

An eight-year-old, intact female, Shih-Tzu, weighing 4.5 kg presented with complaints of anorexia, pale mucous membrane, and vomiting for the past 5 days. On physical examination, nausea, abdominal pain, and melena were noted. On hematologic examination, severe anemia and thrombocytosis were identified. On radiographs examination, soft tissue opacity with small faint mineral opacity mass in the mid-abdomen and two mineral opacity regions in the cranial aspect of mass were identified. Ultrasonographic findings showed thickening of descending duodenal wall with loss of layering and mineralization within the duodenal wall and mesentery adjacent to the duodenal lesion. Computerized tomography showed circumferential wall thickening of descending duodenum with mineralization. Mineralization of the mesentery and mesenteric lymph nodes was identified. Based on the diagnostic imaging, the tentative diagnosis was descending duodenal tumor with dystrophic mineralization. Endoscopy revealed mucosal hemorrhage and erythema within the descending duodenum and stomach. Surgery was performed, and mineralization in the pancreatic tail to duodenum and mesentery was found. Resection of the duodenum, regional lymph node, and mineralized pancreatic region and the duodenal anastomosis were performed. The histologic examination revealed a high-grade undifferentiated duodenal carcinoma with metastases to the regional lymph node and mesentery. The patient was managed with supportive therapy for 8 days and discharged. The patient was followed up for 5 months and there were no complications.

• Journal of Gastric Cancer
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• v.23 no.3
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• pp.375-387
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• 2023

Stomach cancer has a high annual mortality rate worldwide necessitating early detection and accurate treatment. Even experienced specialists can make erroneous judgments based on several factors. Artificial intelligence (AI) technologies are being developed rapidly to assist in this field. Here, we aimed to determine how AI technology is used in gastric cancer diagnosis and analyze how it helps patients and surgeons. Early detection and correct treatment of early gastric cancer (EGC) can greatly increase survival rates. To determine this, it is important to accurately determine the diagnosis and depth of the lesion and the presence or absence of metastasis to the lymph nodes, and suggest an appropriate treatment method. The deep learning algorithm, which has learned gastric lesion endoscopyimages, morphological characteristics, and patient clinical information, detects gastric lesions with high accuracy, sensitivity, and specificity, and predicts morphological characteristics. Through this, AI assists the judgment of specialists to help select the correct treatment method among endoscopic procedures and radical resections and helps to predict the resection margins of lesions. Additionally, AI technology has increased the diagnostic rate of both relatively inexperienced and skilled endoscopic diagnosticians. However, there were limitations in the data used for learning, such as the amount of quantitatively insufficient data, retrospective study design, single-center design, and cases of non-various lesions. Nevertheless, this assisted endoscopic diagnosis technology that incorporates deep learning technology is sufficiently practical and future-oriented and can play an important role in suggesting accurate treatment plans to surgeons for resection of lesions in the treatment of EGC.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.2
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• pp.79-87
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• 2024

Purpose: Recently, the prevalence of eosinophilic gastrointestinal disease (EGID) has shown an increasing trend worldwide. As the diagnosis of EGID requires invasive endoscopy with biopsy, noninvasive markers for detecting EGID in suspected patients, particularly children, are urgently needed. Therefore, this study aimed to evaluate the diagnostic accuracy of serum eosinophil cationic protein (ECP) beyond peripheral eosinophil counts in pediatric patients with EGID. Methods: Overall, 156 children diagnosed with EGID were enrolled and 150 children with functional abdominal pain disorder (FAPD) were recruited as controls. All participants underwent endoscopic biopsy in each segment of the gastrointestinal (GI) tract and serum ECP measurement, as well as peripheral eosinophil percent and absolute eosinophil count. Results: Comparing EGID (n=156) with FAPD (n=150) patients, serum ECP levels were significantly higher in pediatric patients with EGID than in those with FAPD (25.8±28.6 ㎍/L vs. 19.5±21.0 ㎍/L, p=0.007), while there was no significant difference in peripheral eosinophil percent and absolute eosinophil counts between the two groups. Serum ECP levels were correlated with peripheral eosinophil percent (r=0.593, p<0.001) and the absolute eosinophil count (r=0.660, p<0.001). The optimal cutoff value of serum ECP for pediatric EGID was 10.5 ㎍/mL, with a sensitivity of 69.9% and a specificity of 43.4% with an area under the receiver operating characteristic curve of 0.562. Conclusion: The combination of serum ECP levels and peripheral eosinophil counts, when employed with appropriated thresholds, could serve as a valuable noninvasive biomarker to distinguish between EGID and FAPD in pediatric patients manifesting GI symptoms.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.1
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• pp.53-58
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• 2024

Backgrounds/Aims: Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of malignancy. This study aimed to evaluate 5-year outcomes of I-DDS. Methods: Patients were categorized according to their risk of malignancy. 'Low-risk' patients, including those with I-DDS between 2010 and 2015, were analyzed in this study. The primary outcome was incidence of PHPAT within five years of identification of DDS. Histology results from endoscopic ultrasound-guided biopsy were considered diagnostic. Secondary outcomes were incidence of benign causes, extent of follow-up investigations, and clinical indicators of malignancy in patients with DDS. Results: Among 103 patients with DDS, 20 had I-DDS. Subsequent follow-up of these 20 patients found no patient with PHPAT, two (10%) patients with chronic pancreatitis, and 18 (90%) patients with no cause found. The median follow-up duration for 'low-risk' patients was 7.3 years (range, 6-11 years). The mean number of follow-up investigations per patient was two (range, 0-9). Investigations included computed tomography (n = 27), magnetic resonance cholangiopancreatography (n = 23), endoscopy (n = 16), and ultrasound (n = 14). Patients with jaundice were more likely to have malignancy (p < 0.01). Those with abdominal pain were more likely to have a benign cause (p < 0.01). Hyperbilirubinemia and/or deranged liver enzymes and raised CA19-9 were more likely to be associated with PHPAT (p < 0.01). Conclusions: Patients with I-DDS have a low risk of developing PHPAT within five years.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.446-452
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• 2009

Purpose : This study was performed to demonstrate the usefulness of early endoscopy for predicting the development of stricture following corrosive ingestion in children. Methods : We conducted a retrospective study on 34 children who were brought to Seoul National University Childrens Hospital and Seoul National University Bundang Hospital for corrosive ingestion from 1989 to 2007. Results : The corrosive burns were classified as grade 0 in 8 patients, grade 1 in 2, grade 2a in 7, grade 2b in 13, and grade 3 in 4. There was no significant correlation between the presence of esophageal injury and symptoms including vomiting, dysphagia, and drooling. There was a statistically significant relation between the presence of oropharyngeal injury and esophageal injury (P=0.014). There were no complications including hemorrhage and perforation related to endoscopy. Strictures of the esophagus or the stomach developed in 12 patients (36.4%). Esophageal stricture was observed in 11 patients and pyloric stenosis in 1 patient. The endoscopic grade of mucosal injury was significantly related to the frequency of development of esophageal stricture (P=0.002). Two of eleven patients with esophageal stricture responded to repeated dilation. The remaining seven patients underwent surgery. Conclusion : Early esophagogastroduodenoscopy is not only a safe and useful diagnostic tool for children with accidental caustic ingestion but also a necessity for determining the degree and the extent of caustic burns and for predicting the development of late complications.