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Globus pharyngeus:A review of its etiology,diagnosis and treatment

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World Journal of Gastroenterology 2012年第20期18卷 2462-2471页

作者： Bong Eun Lee gwang ha kim Department of Internal Medi cine Pusan National University School of Medicine and Biomedical Research InstitutePusan National University Hospital Busan 602-739South Korea

Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the *** is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency to ***,due to the uncertain etiology of globus,it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus,careful history taking and nasolaryngoscopy are *** the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus,empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical *** patients are nonresponsive to this therapy, definitive assessments such as endoscopy,multichannel intraluminal impedance/pH monitoring,and ma-nometry should be *** and language therapy,anti-depressants,and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.

关键词： Diagnosis Gastroesophageal reflux disease Globus Proton pump inhibitor Treatment

Chicken soup for teaching and learning ESD

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World Journal of Gastroenterology 2011年第21期17卷 2618-2622页

作者： Eun Young kim Seong Woo Jeon gwang ha kim Division of Gastroenterology Department of Internal MedicineCatholic University of Daegu School of Medicine Division of Gastroenterology Department of Internal MedicineKyungpook National University School of Medicine Department of Internal Medicine Pusan National University School of Medicine and Medical Research InstitutePusan National University Hospital

Endoscopic submucosal dissection(ESD) is becoming a popular procedure for the diagnosis and treatment of superficial mucosal lesions,and has the advantage of en bloc resection which yields a higher complete resection and remission rate compared to endoscopic mucosal resection(EMR).However,the learning process of this advanced endoscopic procedure requires a lengthy training period and considerable experience to be proficient.A well framed training protocol which is safe,effective,easily reproducible and cost-effective is desirable to teach *** addition,the training course may need to be tailored around settings such as ethnicity,culture,workload,and disease *** Asian countries with a large volume of early gastric lesions which need endoscopic treatment,endoscopists would be able to learn ESD expanding their skills from EMR to ESD under the supervision of ***,in Western countries due to the low incidence of superficial gastric tumors,trials have utilized simulator models to improve *** Korea,the Korean Society of Gastrointestinal Endoscopy(KSGE) is playing an important role in training many gastroenterologists who have shown an interest in performing ESD by providing an annual live demonstration and a nationwide tutoring *** purpose of this article is to introduce our ESD tutoring experience,review the published papers related to this topic,and propose several suggestions for future directions in teaching and learning ESD.

关键词： Endoscopic submucosal dissection Learning Teaching

Learning models for endoscopic ultrasonography in gastrointestinal endoscopy

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World Journal of Gastroenterology 2015年第17期21卷 5176-5182页

作者： gwang ha kim Sung Jo Bang Joo ha Hwang Department of Internal Medicine Pusan National University School of Medicine Biomedical Research Institute Pusan National University HospitalBusan 602-739South Korea Department of Internal Medicine Ulsan University Hospital University of Ulsan College of Medicine Ulsan 682-714South Korea Division of Gastroenterology Department of MedicineUniversity of WashingtonSeattleWA 98104United States

Endoscopic ultrasonography(EUS) has become a useful diagnostic and therapeutic modality in gastrointestinal ***,EUS requires additional training since it requires simultaneous endoscopic manipulation and ultrasonographic *** adequate EUS training can be challenging since EUS is highly operator-dependent and training on actual patients can be associated with an increased risk of complications including inaccurate ***,several models have been developed to help facilitate training of *** models currently available for EUS training include computer-based simulators,phantoms,ex vivo models,and live animal *** each model has its own merits and limitations,the value of these different models is rather complementary than ***,there is a lack of objective data regarding the efficacy of each model with recommendations on the use of various training models based on expert opinion ***,objective studies evaluating the efficacy of various EUS training models on technical and clinical outcomes are still needed.

关键词： Endoscopic ultrasonography Training Phantom Computer simulation Animal model

Unveiling lymph node metastasis in early gastric cancer

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World Journal of Gastroenterology 2014年第18期20卷 5389-5395页

作者： Nari Shin Tae-Yong Jeon gwang ha kim Do Youn Park Department of Pathology Pusan National University Hospital and Pusan National University School of MedicineBusan 602-739South Korea Biomedical Research Institute Pusan National University HospitalBusan 602-739South Korea Departments of Surgery Pusan National University Hospital and Pusan National University School of MedicineBusan 602-739South Korea Departments of Gastroenterology Pusan National University Hospital and Pusan National University School of MedicineBusan 602-739South Korea

With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been ***,EMR/ESD procedures are widely accepted treatment modalities for early gastric cancer(EGC).These procedures are most widely accepted in Asia,including in Korea and *** the present era of endoscopic resection,accurate prediction of lymph node(LN)metastasis is a critical component of selecting suitable patients for EMR/***,indications for EMR/ESD are based on large Japanese datasets,which indicate that there is almost no risk of LN metastasis in the subgroup of EGC ***,there is some controversy among investigators regarding the validity of these ***,there are currently no accurate methods to predict LN metastasis in gastric cancer(for example,radiologic methods or methods based on molecular biomarkers).We recommend the use of a 2-step method for the management of early gastric cancer using endoscopic *** first step is the selection of suitable patients for endoscopic resection,based on endoscopic and histopathologic *** endoscopic resection,additional surgical intervention could be determined on the basis of a comprehensive review of the endoscopic mucosal resection/endoscopic submucosal dissection specimen,including lymphovascular tumor emboli,tumor size,histologic type,and depth of ***,evaluation of clinical application data is essential for validating this ***,gastroenterologists,surgeons,and pathologists should closely collaborate and communicate during these decisionmaking processes.

关键词： Early gastric cancer Endoscopic submucosal dissection Lymph node metastasis Biomarker Clinicopathologic features

Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?

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World Journal of Gastroenterology 2009年第27期15卷 3376-3381页

作者： gwang ha kim Do Youn Park Suk kim Dae Hwan kim Dong Heon kim Cheol Woong Choi Jeong Heo Geun Am Song Department of Internal Medicine Pusan National University School of Medicine and Medical Research Institute Pusan National University HospitalBusan 602-739 South Korea Department of Pathology Pusan National University School of MedicineBusan 602-739 South Korea Department of Radiology Pusan National University School of MedicineBusan 602-739 South Korea Department of Surgery Pusan National University School of MedicineBusan 602-739South Korea

AIM: To evaluate the ultrasonog raphy (EUS) features of gastric gastrointestinal stromal tumors (GISTs) as compared with gastric leiomyomas and then to determine the EUS features that could predict malignant ***: We evaluated the endoscopic EUS features in 53 patients with gastric mesenchymal tumors conf irmed by histopathologic diagnosis. The GISTs were classif ied into benign and malignant groups according to the histological risk classif ***: Immunohistochemical analyses demon-strated 7 leiomyomas and 46 GISTs. Inhomogenicity, hyperechogenic spots, a marginal halo and higher echogenicity as compared with the surrounding muscle layer appeared more frequently in the GISTs than in the leiomyomas (P had a sensitivity of 89.1% and a specifi city of 85.7% for predicting GISTs. Except for tumor size and irregularity of the border, most of the EUS features were not helpful for predicting the malignant potential of GISTs. On multivariate analysis, only the maximal diameter of the GISTs was an independent predictor. The optimal size for predicting malignant GISTs was 35 mm. The sensitivity and specificity using this value were 92.3% and 78.8%, ***: EUS may help to differentiate gastric GISTs from gastric leiomyomas. Once GISTs are suspected, surgery should be considered if the size is greater than 3.5 cm.

关键词： Endoscopic ultrasonography, Gastrointestinal stromal tumor Stomach

Diffusion-weighted imaging of biliopancreatic disorders:Correlation with conventional magnetic resonance imaging

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World Journal of Gastroenterology 2012年第31期18卷 4102-4117页

作者： Nam Kyung Lee Suk kim gwang ha kim Dong Uk kim Hyung Il Seo Tae Un kim Dae Hwan Kang Ho Jin Jang Department of Radiology Biomedical Research InstitutePusan National University HospitalSchool of MedicinePusan National UniversityBusan 602-739South Korea Department of Internal Medicine Biomedical Research InstitutePusan National University HospitalSchool of MedicinePusan National UniversityBusan 602-739South Korea Department of Surgery Biomedical Research InstitutePusan National University HospitalSchool of MedicinePusan National UniversityBusan 602-739South Korea Department of Radiology Yangsan Pusan National University HospitalSchool of MedicinePusan National UniversityYangsan 626-770South Korea Department of Internal Medicine Yangsan Pusan National University HospitalSchool of MedicinePusan National UniversityYangsan 626-770South Korea Department of Obstetrics and Gynecology Armed Forces Seoul HospitalSeoul 110-200South Korea

Diffusion-weighted magnetic resonance imaging(DWI)is a well established method for the evaluation of intracranial diseases,such as acute *** for extracranial application is more difficult due to physiological motion artifacts and the heterogeneous composition of the ***,thanks to the newer technical development of DWI,DWI has become increasingly used over the past few years in extracranial organs including the abdomen and *** previous studies of DWI have been limited to the evaluation of diffuse parenchymal abnormalities and focal lesions in abdominal organs,whereas there are few studies about DWI for the evaluation of the biliopancreatic *** further studies are needed to determine its performance in evaluating bile duct,gallbladder and pancreas diseases,DWI has potential in the assessment of the functional information on the biliopancreatic tract concerning the status of tissue cellularity,because increased cellularity is associated with impeded diffusion,as indicated by a reduction in the apparent diffusion *** detection of malignant lesions and their differentiation from benign tumor-like lesions in the biliopancreatic tract could be improved using DWI in conjunction with findings obtained with conventional magnetic resonance ***,DWI can be useful for the assessment of the biliopancreatic tract in patients with renal impairment because contrast-enhanced computed tomography or magnetic resonance scans should be avoided in these patients.

关键词： Magnetic resonance imaging Diffusion-weighted imaging Biliary tract Gallbladder Pancreas

Adult intussusception caused by cystic lymphangioma of the colon:A rare case report

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World Journal of Gastroenterology 2006年第13期12卷 2130-2132页

作者： Tae Oh kim Jung Hyun Lee gwang ha kim Jeong Heo Dae Hwan Kang Geun Am Song Mong Cho Division of Gastroenterology Department of Internal Medicine College of MedicinePusan National University College of MedicineBusanKorea

We experienced a case of intussusception caused by cystic lymphangioma of the colon in a 32 years old female who was admitted to our hospital for the chief complaint of bloody stool. In the colonoscopic examination, cystic mass with stalk which had smooth mucosal surface was noted at the descending colon. Abdominal ultrasonography and computed tomography revealed left colon intussusception with a multilocular cystic tumor as a leading point. Emergent operation was performed. On the histopathologic examination, the cystically dilated spaces lined by endothelium and septated by fibrous septa were present. The pathological diagnosis was cystic lymphangioma of the colon. Although intussusception due to lymphangioma in an adult are rare, it should be taken into consideration that it is possible diagnosis.

关键词： Cystic lymphangioma of the colon Adult intussusception

Effect of pronase as mucolytic agent on imaging quality of magnifying endoscopy

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World Journal of Gastroenterology 2015年第8期21卷 2483-2489页

作者： gwang ha kim Yu Kyung Cho Jae Myung Cha Sun-Young Lee Il-Kwun Chung Department of Internal Medicine Pusan National University School of Medicine Department of Internal Medicine The Catholic University of Korea Department of Internal Medicine Kyung Hee University Hospital at Gang Dong Department of Internal Medicine Konkuk University Medical Center Department of Internal Medicine Soonchunhyang University

AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying ***:The study was of a blinded,randomized,prospective *** were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was *** quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better *** endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic *** main study outcomes were the visibility scores during magnifying endoscopy and the number of water ***:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were *** visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,Phagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P<0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.

关键词： Pronase Narrow-band imaging,EndoscopyImage enhance

Spectrum of mucin-producing neoplastic conditions of the abdomen and pelvis:Cross-sectional imaging evaluation

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World Journal of Gastroenterology 2011年第43期17卷 4757-4771页

作者： Nam Kyung Lee Suk kim Hyun Sung kim Tae Yong Jeon gwang ha kim Dong Uk kim Do Youn Park Tae Un kim Dae Hwan Kang Department of Radiology Pusan National University Hospital Medical Research Institute Pusan National University School of Medicine Pusan National University Department of Surgery Pusan National University Hospital Department of Internal Medicine Pusan National University Hospital Department of Pathology Pusan National University Hospital Department of Radiology Yangsan Pusan National University Hospital Medical Research Institute Pusan National University School of Medicine Department of Internal Medicine Yangsan Pusan National University Hospital

Various mucin-producing neoplasms originate in different abdominal and pelvic *** neoplasms differ from non-mucinous neoplasms because of the differences in clinical outcome and imaging *** carcinoma,in which at least 50%of the tumor is composed of large pools of extracellular mucin and columns of malignant cells,is associated with a worse *** ring cell carcinoma is characterized by large intracytoplasmic mucin vacuoles that expand in the malignant cells with the nucleus displaced to the *** prognosis is also generally *** contrast,intraductal papillary mucinous neoplasm of the bile duct and pancreas,which is characterized by proliferation of ductal epithelium and variable mucin production,has a better prognosis than other malignancies in the pancreaticobiliary *** modalities play a critical role in differentiating mucinous from non-mucinous *** to high water content,mucin has a similar appearance to water on ultrasound(US) ,computed tomography(CT) ,and magnetic resonance imaging,except when thick and proteinaceous,and then it tends to be hypoechoic with fine internal echoes or have complex echogenicity on US,hyperdense on CT,and hyperintense on T1and hypointense on T2-weighted images,compared to ***,knowledge of characteristic mucin imaging features is helpful to diagnose various mucinproducing neoplastic conditions and to facilitate appropriate treatment.

关键词： Mucin Neoplasm Ultrasound Computed tomography Magnetic resonance Abdomen and pelvis