• 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.

• Journal of Veterinary Clinics
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• v.34 no.2
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• pp.108-111
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• 2017

A 4-year-old, weighing 7.6 kg, castrated male, Pug presented with ingestion of gastric cavity foreign body. Physical examination revealed panting, retching and hyper-salivation. Blood chemistry and complete blood cell count were normal, but hypophosphatemia was observed. An abdominal radiograph revealed the foreign body (FB), round shape and 2 cm length, at the pyloric region of stomach. A thoracic radiograph revealed an incidental metal FB, 3.5 cm length, at the cranial portion of the diaphragm. An upper gastrointestinal endoscopy was performed to remove the FB in the stomach and then a peach-pit was removed. However the metal FB was not found in the esophagus therefore a lateral thoracotomy was performed. A right lateral thoracotomy through the $7^{th}$ intercostal space was accomplished to expose the right caudal lung lobe. After open the thoracic cavity, foreign body was not observed by gross evaluation and caudal lung lobe was attached to the diaphragm. The FB was identified inside the lung lobe and surrounded by granulation tissue. The metal FB (sewing needle) was removed with blunt dissection and incised lung lobe was sutured using absorbable suture material PDS 4-0 with interrupted suture. A thoracotomy tube was inserted into the thoracic cavity during surgery. Patient's respiration became stable after surgery. A chest tube was removed 3 days after surgery. No complications were noted and the dog was discharged 4 days after surgery. In small animal, foreign body ingestion is a common reason for emergency. After ingestion of the FB, perforation through the esophagus and migration to inside the lung lobe is not common in small animals. In this case, thoracic metal FB was identified incidentally and removal of a thoracic FB with thoracotomy was performed successfully.

• Korean Journal of Transplantation
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• v.32 no.4
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• pp.104-107
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• 2018

Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Gastrointestinal (GI) mucormycosis is very rare and occurs primarily in highly malnourished patients, especially in infants and children. A 55-year-old man with end-stage renal disease due to diabetic nephropathy, who had undergone deceased donor kidney transplantation 2 years prior, complained of abdominal pain and distension with a 3-day duration. Computed tomography revealed diffuse gastric wall thickening, and a huge amount of grey colored necrotic debris surrounded by erythematous erosive mucosa was observed at the antrum to upper body by GI endoscopy. The microscopic examination obtained from a GI endoscopic specimen demonstrated peptic detritus with numerous non-septate mucor hyphae in the mucosa and submucosa. Mucormycosis was diagnosed based on the clinical findings and morphological features. A total gastrectomy was performed and an antifungal agent was administered. A microscopic examination of the surgical specimen demonstrated invasive mucormycosis with numerous fungal hyphae with invasion into the mucosa to subserosa. The patient and graft were treated successfully by total gastrectomy and antifungal therapy.

• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.3
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• pp.217-224
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• 2019

Purpose: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. Methods: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. Results: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). Conclusion: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.157-160
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• 2018

Chronic silica nephropathy has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease, and end-stage renal disease. On the other hand, acute intentional exposure is extremely rare. The authors' experienced a 44-year-old man who took rapid cement hardener (sodium silicate) in a suicide attempt whilst in a drunken state. He visited the emergency department approximately 1 hour after ingestion. Information on the material was obtained after 3 L gastric lavage. The patient complained of a sore throat, epigastric pain, and swollen to blood tinged vomitus. Proton pump inhibitors, hemostats, steroid, and fluids were administered. Nine hours after ingestion, he was administered 200 mL hematochezia. Immediately after, a gas-troenterologist performed an endoscopic procedure that revealed diffuse hyperemic mucosa with a color change and variable sized ulceration in the esophagus, whole stomach, and duodenal $2^{nd}$ portion. Approximately 35 hours later, persistent oligouria and progressive worsening of the renal function parameters (BUN/Cr from 12.2/1.2 to 67.5/6.6 mg/dL) occurred requiring hemodialysis. The patient underwent 8 sessions of hemodialysis for 1 month and the BUN/Cr level increased to 143.2/11.2 mg/dL and decreased to 7.6/1.5 mg/dL. He was discharged safely from the hospital. Follow up endoscopy revealed a severe esophageal stricture and he underwent endoscopic bougie dilatation. Acute cement hardener (sodium silicate) intoxication can cause renal failure and strong caustic mucosal injury. Therefore, it is important to consider early hemodialysis and treatment to prevent gastrointestinal injury and remote esophageal stricture.

• Journal of Gastric Cancer
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• v.22 no.1
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• pp.47-55
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• 2022

Purpose: The use of direct oral Xa inhibitors (DXaIs) to prevent venothrombotic events is increasing. However, gastrointestinal bleeding, including that related to endoscopic resection, is a concern. In this study, we evaluated bleeding and coagulation times during the perioperative period of gastric endoscopic submucosal dissection (ESD). Materials and Methods: Patients who consecutively underwent gastric ESD from August 2016 to December 2018 were analyzed. Bleeding rates were compared among the 3 groups (antiplatelet, DXaIs, and control). DXaI administration was discontinued on the day of the procedure. Prothrombin time (PT), activated partial thromboplastin time, and the ratio of inhibited thrombin generation (RITG), which was based on dilute PT, were determined before and after ESD. Results: During the study period, 265 gastric ESDs were performed in 239 patients, where 23 and 50 patients received DXaIs and antiplatelets, respectively. Delayed bleeding occurred in 17 patients (7.4%) and 21 lesions (7.1%). The bleeding rate in the DXaI group was significantly higher than that in the other groups (30.4%, P<0.01), and the adjusted odds ratio of bleeding was 5.7 (95% confidence interval, 1.4-23.7; P=0.016). In patients using DXaIs, there was a significant (P=0.046) difference in the median RITG between bleeding cases (18.6%) and non-bleeding cases (3.8%). Conclusions: A one-day cessation of DXaIs was related to a high incidence of bleeding after gastric ESD, and monitoring of residual coagulation activity at trough levels might enable the predicted risk of delayed bleeding in patients using DXaIs.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.4
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• pp.293-299
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• 2022

Purpose: Data on eosinophilic esophagitis (EoE) in South America is scarce. Moreover, no studies are available in Ecuador. We evaluated the clinical, endoscopic, and histological characteristics of Ecuadorian children with EoE. Methods: Medical records of 2,711 children who underwent upper gastrointestinal endoscopy (UGE) between 2009 and 2020 at Hospital Metropolitano de Quito, Ecuador were reviewed. Esophageal mucosal biopsies were obtained from 72 patients and the features of 35 children with EoE were described. EoE was diagnosed when there were more than 15 eosinophils in the esophagus, per high power field. Results: EoE was diagnosed in 35 children (9.4±4.5 years) with a male predominance (74%). Abdominal pain (51.4%) and vomiting (31.4%) were dominant symptoms. A history of allergic diseases was noted in 47.1% of the children, which mainly included allergic rhinitis (37.1%) and atopic dermatitis (11.4%). The most common endoscopic findings were furrowing (82.9%) and edema (74.3%). All patients were initially treated with proton-pump inhibitors (PPIs). Those who did not respond to PPIs received steroids (5.7%) and diet therapy (5.7%), and five patients were referred to an allergist. Clinical and histological resolution was observed in 65% of the patients who underwent a second UGE after 6-8 weeks of PPI. Conclusion: Our study describes the clinical features of pediatric EoE in Ecuador. This is the first retrospective study in Ecuador that describes the clinical, endoscopic, and histological manifestations of EoE in a small pediatric population. Almost half of the children who underwent a biopsy had EoE.

• Journal of Gastric Cancer
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• v.22 no.4
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• pp.264-272
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• 2022

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted cancer screening services worldwide. We aimed to measure the impact of COVID-19 on gastric cancer screening rates based on age, sex, household income, and residential area. Materials and Methods: We analyzed data from the Korean National Cancer Screening Survey from 2017 to 2021 for adults aged 40-74 years. We evaluated the gastric cancer screening rate within two years in accordance with the National Cancer Screening Program protocol recommendations and that within the previous year. We compared the trends in the pre- and post-COVID-19 outbreak periods. Results: Before the COVID-19 outbreak, there was little change in the gastric cancer screening rates until 2019. After the COVID-19 outbreak, the screening rate as per recommendation decreased from 70.8% in 2019 to 68.9% in 2020 and that for one year decreased from 32.7% in 2019 to 27.2% in 2020. However, as the COVID-19 pandemic continued after 2020, both gastric cancer screening rates as per recommendations and for one year rebounded. Although a similar trend was observed for the upper endoscopy screening rate, the upper gastrointestinal series screening rate decreased from 7.8% in 2020 to 3.1% in 2021. During the pandemic, the screening rate decreased among younger adults (40-49), those residing in metropolitan regions, and those with high incomes. Conclusions: Despite a decline in gastric cancer screening rate during the COVID-19 pandemic, the rate surged in 2021. Further studies are needed to estimate the impact of cancer screening delays on future cancer-related mortalities.

• Journal of Digestive Cancer Research
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• v.6 no.1
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• pp.40-44
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• 2018

A 77-year-old man presented with abdominal discomfort and was diagnosed as Borrmann type 3 advanced gastric cancer with multiple lymph node metastases. An abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed AGC, clinical stage IIIC (T4aN3M0). We started neo-adjuvant chemotherapy with FOLFOX (5-fluorouracil (5-FU))+Leucovorin+Oxaliplatin). After 3 cycles of FOLFOX chemotherapy, follow-up endoscopy showed remarkable improvement. Primary lesion and metastatic lymph nodes decreased size on follow up computed tomography (CT). The patient underwent radical total gastrectomy with esophagojejunostomy and histopathology revealed no remnant malignant cells at previous primary cancer lesion. The patient has currently completed his 3 cycle of adjuvant chemotherapy without recurrence. After an abdominal CT response assessment, further course of therapy will be decided.