• Clinical and Experimental Pediatrics
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• 제53권9호
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• pp.824-829
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• 2010

The safety and effectiveness of colonoscopy in the investigation of lower gastrointestinal tract pathology in children has been established for more than 2 decades in Korea. The skill and experience have since advanced to the point that both diagnostic and therapeutic colonoscopy are now routinely performed by most pediatric gastroenterologists. Pediatric colonoscopy differs significantly from its adult parallels in nearly every aspect including patient and parent management and preparation, selection criteria for sedation and general anesthetic, bowel preparation, expected diagnoses, instrument selection, imperative for terminal ileal intubation, and requirement for biopsies from macroscopically normal mucosa. Investigation of inflammatory bowel disease, whether for diagnosis or follow-up evaluation, and suspected colonic polyps are the most common indication for pediatric colonoscopy. The child who presents with signs and symptoms of lower gastrointestinal disorder should undergo colonoscopy with biopsy to make the diagnosis, as well as to help determine the appropriate therapy. This review introduces practical information on pediatric colonoscopy, the author's experiences, and the role of colonoscopic examination in the diagnosis and treatment of pediatric lower gastrointestinal disorders.

• 대한상부위장관⦁헬리코박터학회지
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• 제18권3호
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• pp.174-179
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• 2018

Gastric cancer remains a big problem in terms of incidence or mortality; various mechanisms to explain its development and progression have been studied. Recently, long non-coding RNAs (lncRNAs) have been spotlighted in the epigenetic mechanism of cancer development. Although lncRNAs have been consistently reported to be involved in the development and progression of various cancers, there is still a lot more to be studied about them. In this article, we would like to introduce lncRNAs related to gastric cancer in order to encourage gastroenterologists to study them.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권1호
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• pp.1-14
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• 2023

Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithiumion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.

• Journal of Digestive Cancer Research
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• 제2권1호
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• pp.11-14
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• 2014

Competency for practicing gastroenterology in the United States requires accredited training in Internal Medicine, followed by accredited training in gastroenterology and hepatology. The structured training encompasses a 3-year period after graduation with a medical degree for internal medicine, followed by a 3-year period for gastroenterology and hepatology. Within the gastroenterology training period, competency in oncology knowledge and procedural approaches to luminal and solid gastrointestinal organ cancers is required, whereas knowledge competency but not procedural competency is required in areas of advanced endoscopic procedures for cancer care. Only general knowledge, but not competency, is required for areas such as chemotherapy, which can be obtained with further optional training in a structured 2-year oncology fellowship program. Although there is no standardization to date for including full oncology training within a gastroenterology training program in the United States, there is great interest from gastroenterology professional societies to include a pathway for trainees within the gastroenterology training program.

• Journal of Digestive Cancer Research
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• 제4권2호
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• pp.77-82
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• 2016

The 26^th World Congress of the International Association of Surgeons, Gastroenterologists and Oncologists (IASGO) was held in Seoul, Korea from September 8 to 10, 2016. In this congress, I gave a State-of-the-Art Lecture II entitled "Mesenteric Approach in Pancreatoduodenectomy." The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy, which involves en bloc resection using a non-touch isolation technique. My team has been developing isolated pancreatoduodenectomy for pancreatic cancer since 1981, when we developed an antithrombogenic bypass catheter for the portal vein. In this operation, the first and most important step is the use of a mesenteric approach instead of Kocher's maneuver. The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free margins and resectability, followed by systematic lymphadenectomy around the superior mesenteric artery. This approach enables early ligation of the inferior pancreatoduodenal artery and total mesopancreas excision. It is the ideal surgery for pancreatic head cancer from both oncological and surgical viewpoints. The precise surgical techniques of the mesenteric approach are herein described.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권1호
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• pp.1-11
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• 2018

The emergence of mucosal healing as a treatment goal that could modify the natural course of Crohn's disease and the accumulating evidence showing that biologics are most effective in achieving mucosal healing, along with the success of early treatment regimens for rheumatoid arthritis, have led to the identification of early Crohn's disease and development of the concept of catching the therapeutic window during the early disease course. Thus, an increasing number of pediatric gastroenterologists are adopting an early biologic treatment strategy with or without an immunomodulator. Although early biologic treatment is effective, cost and overtreatment are issues that limit its early use. Currently, there are insufficient data on who will benefit most from early biologics, as well as on who will not need early or even any biologics. For now, top-down biologics should be considered for patients with currently known high-risk factors of poor outcomes. For other patients, close, objective monitoring and accelerating the step-up process by means of a treat-to-target approach seems the best way to catch the therapeutic window in early pediatric Crohn's disease. The individual benefits of immunomodulator addition during early biologic treatment should be weighed against its risks and decision on early combination treatment should be made after comprehensive discussion with each patient and guardian.

• 대한골대사학회지
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• 제25권4호
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• pp.213-217
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• 2018

Patients with gastrointestinal disease (GI) are at risk for osteopenia or osteoporosis, which can lead to fractures. Although these patients may be at risk from a young age, gastroenterologists often overlook this fact in practice. There are well-known GI diseases associated with osteopenia and osteoporosis, such as the post-gastrectomy state, inflammatory bowel disease (IBD), and celiac disease. As there is an increase in the prevalence of IBD patients, newly diagnosed celiac disease in adulthood, and gastric cancer survivors following gastrectomy, bone disease in these patients becomes an important issue. Here, we have discussed osteoporosis and fractures in GI disease, especially in the postgastrectomy state, IBD, and celiac disease. Although the pathogenesis of bone loss in each disease has not been fully identified, we have confirmed that the prevalence of osteoporosis and fractures in each of these diseases is high. There are scarce studies comparing the prevalence of osteoporosis or osteoporotic fractures in GI disease patients with studies in postmenopausal women, and specific guidelines for their management in each disease have not been established. Intensive surveillance and management are needed to ensure that these patients attain peak bone mass for age and sex to prevent fractures.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제19권3호
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• pp.168-174
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• 2016

Purpose: The management and clinical course in pediatric patients who had ingested foreign body were investigated retrospectively to evaluate the frequency and factor associated with successful removal of fishbone foreign body. Methods: Based on the medical records of patients younger than 15 years old who visited emergency room because of foreign body ingestion from January 1999 to December 2012, the authors reviewed clinical characteristics including type of ingested foreign bodies, time to visits, managements and complications. Results: Fishbone (50.1%) was the most common ingested foreign body in children. Among 416 patients with ingested fishbone, 245 (58.9%) were identified and removed using laryngoscope, rigid or flexible endoscope from pharynx or upper esophagus by otolaryngologists and pediatric gastroenterologists. The kind of ingested fish bone in children was diverse. The mean age of identified and removed fishbone group was 7.39 years old, and higher than that of unidentified fishbone group (5.81 years old, p<0.001). Identified and removed fishbone group had shorter time until hospital visit than the unidentified fishbone group (2.03 vs. 6.47 hours, p<0.001). No complication due to ingested fishbone or procedure occurred. Conclusion: Older age and shorter time from accident to hospital visit were the different factors between success and failure on removal of ingested fish bone in children.

• Journal of mucopolysaccharidosis and rare diseases
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• 제4권1호
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• pp.14-20
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• 2018

Mucopolysaccharidoses (MPSs) are a group of rare inherited metabolic disorders caused by specific lysosomal enzyme deficiencies leading to the sequential degradation of glycosaminoglycans, causing substrate accumulation in various cells and tissues and progressive multiple organ dysfunction. The rare disease medical care team at Mackay Memorial Hospital in Taiwan has been dedicated to the study of MPSs for more than 20 years. Since 1999, more than 50 academic papers focusing on MPSs have been published in international medical journals. Topics of research include the following items regarding MPSs: incidence, natural history, clinical manifestations, gene mutation characteristics, cardiac function, bone mineral density, sleep studies, pulmonary function tests, hearing assessments, percutaneous endoscopic gastrostomy, anesthetic experience, imaging analysis, special biochemical tests, laboratory diagnostics, global expert consensus conferences, prenatal diagnosis, new drug clinical trials, newborn screening, and treatment outcomes. Of these published academic research papers, more than half were cross-domain, cross-industry, and international studies with results in cooperation with experts from European, American and other Asian countries. A cross-specialty collaboration platform was established based on high-risk population screening criteria with the acronym "BECARE" (Bone and joints, Eyes, Cardiac and central nervous system, Abdomen and appearance, Respiratory system, and Ear, nose, and throat involvement). Through this platform, orthopedic surgeons, rheumatologists, ophthalmologists, cardiologists, rehabilitation physicians, gastroenterologists, otorhinolaryngologists, and medical geneticists have been educated with regards to awareness of suspected cases of MPSs patients to allow for a further confirmative diagnosis of MPSs. Because of the progressive nature of the disease, an early diagnosis and early multidisciplinary therapeutic interventions including surgery, rehabilitation programs, symptom-based treatments, hematopoietic stem cell transplantation, and enzyme replacement therapy, are very important.

• Clinical and Experimental Pediatrics
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• 제63권11호
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• pp.447-450
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• 2020

Background: Esophageal stricture (ES) is an uncommon clinic entity in pediatrics that may be congenital or acquired in childhood. Acquired noncaustic ES is very rare, and clinical features of affected patients are unknown. Purpose: We aimed to evaluate the clinical findings, and outcomes of patients with acquired noncaustic ES to aid physicians in the early referral of patients to gastroenterologists. Methods: The medical data of patients with acquired noncaustic ES who were followed in our gastroenterology clinic between January 2009 and December 2019 were reviewed. Results: Acquired noncaustic ES was found in 12 of the 4,950 patients (0.24%) who underwent endoscopy during the study period. The main symptoms were dysphagia (58.3%), vomiting (33.3%), and chronic anemia (8.3%). Chronic malnutrition and underweight were found in 66.6% of the patients. The most common etiological factors were radiotherapy, peptic reflux, and achalasia (16.6%, each), while chemotherapy, squamous-cell carcinoma (SC) of the esophagus, eosinophilic esophagitis (EoE), esophageal web, epidermolysis bullosa, and esophageal diverticulum (8.2%, each) were the other etiological factors. Patients with EoE underwent endoscopic bougie dilation in addition to steroid use and elimination diet. Patients with epidermolysis bullosa and esophageal web underwent bougie dilation. Patients with peptic reflux-related ES were initially put on antireflux therapy, but during follow-up, one patient required esophageal replacement with colonic interposition. Patients with radiotherapy-related ES recovered with medical therapy. The patient with initially underwent surgical gastrostomy and tumoral mass excision. The patient then received chemotherapy and radiotherapy and underwent jejunal interposition. Patients with achalasia underwent surgical esophagomyotomy. Conclusion: The presence of solid dysphagia, malnutrition, and an associated disease may alert physicians to the presence of ES.