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Clinical outcomes and safety of high-resolution manometry guided superficial partial circular muscle myotomy in per-oral endoscopic myotomy for Jackhammer esophagus: Two cases report

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World Journal of Clinical Cases 2019年第16期7卷 2322-2329页

作者： Youn I Choi kyoung oh kim Dong Kyun Park Jun-Won Chung Yoon Jae kim Kwang An Kwon Department of Gastroenterology Gil Medical Center Gachon University

BACKGROUND Jack hammer esophagus is a relatively rare disease and to date,there is no dramatic treatment ***,conventional per-oral endoscopic myotomy (POEM) have expanded their area into Jackhammer ***,several complications such as post procedure motility disorders (e.g.,passage disturbance) are issues after *** overcome these issues,we here introduced high-resolution manometry (HRM)-guided superficial partial circular muscle myotomy,which involves cutting only the superficial layer of the esophageal circular *** SUMMARY We report two cases of patients with Jackhammer esophagus who were treated with HRM-guided extremely superficial partial circular muscle myotomy during *** 1 was a 53-year-old female with medication-refractory odynophagia and case 2 was a 47-year-old man who presented with chest *** were diagnosed with Jackhammer esophagus using HRM,and the hypercontractile segments of the esophagus were ***-guided extremely superficial partial circular muscle myotomy was performed while preserving the lower esophageal ***,the circular and longitudinal muscle layers are preserved but hypercontractile movements are reduced,even after ***’ clinical symptoms dramatically improved right after POEM,and 6-mo follow-up HRM revealed completely resolved *** a 1-year follow-up period,patients were still in good health and remained symptom *** HRM-guided superficial partial circular muscle myotomy may be a promising alternative to conventional POEM for treating Jackhammer esophagus with improved efficacy.

关键词： Jackhammer esophagus Hypercontractile Partial circular muscle myotomy Case report

Tailored eradication vs empirical bismuth-containing quadruple therapy for first-line Helicobacter pylori eradication: A comparative,open trial

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World Journal of Gastroenterology 2019年第46期25卷 6743-6751页

作者： Youn I Choi Jun Won Chung Dong Kyun Park kyoung oh kim Kwang An Kwon Yoon Jae kim Ja Young Seo Department of Gastroenterology Gil Medical CenterGachon UniversityIncheon 21565South Korea Department of Laboratory Medicine Gil Medical CenterGachon UniversityIncheon 21565South Korea

BACKGROUND Few studies have compared the efficacy and safety profile of a tailored eradication(TR)strategy based on the presence of a 23S ribosomal RNA point mutation with those of empirical bismuth-based quadruple therapy(EBQT)for first-line eradication of Helicobacter pylori(***)in Korean *** To compare the efficacy and safety of a TR strategy and those of EBQT regimen as first-line eradication therapy for *** This is an open-label,comparative study in which we prospectively enrolled patients over 18 years of age with *** infection and retrospectively reviewed their ***-positive patients diagnosed by rapid urease test,Giemsa staining,or dual priming oligonucleotide polymerase chain reaction(DPO-PCR)were enrolled from May 2016 to September 2018 at Gil Medical *** with *** infection received either a TR regimen or the EBQT *** the tailored therapy group that underwent DPO-PCR testing,patients with A2142G and/or A2143G point mutations were treated with a bismuth-containing quadruple *** eradication rate,patient-reported side effect rate,and *** eradication success rate were evaluated and compared between the *** A total of 150 patients were assigned to the TR(n=50)or EBQT group(n=100).The first-line eradication rate of *** did not differ between the groups(96.0%vs 95.7%,P=0.9).The rate of eradication-related side effects for TR was 12.0%,which differed significantly from that of EBQT(43.0%)for first-line treatment(P<0.001).CONCLUSION DPO-PCR-based TR for *** eradication may be equally efficacious,with less treatment-related complications,compared to EBQT in Korea,where clarithromycin resistance is high.

关键词： Helicobacter pylori Eradication Tailored Empirical Quadruple

Two-week bismuth-containing quadruple therapy and concomitant therapy are effective first-line treatments for Helicobacter pylori eradication: A prospective open-label randomized trial

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World Journal of Gastroenterology 2019年第46期25卷 6790-6798页

作者： So Jeong kim Jun-Won Chung Hyun Sun Woo Su Young kim Jung Ho kim Yoon Jae kim kyoung oh kim Kwang An Kwon Dong Kyun Park College of Medicine Gachon University Graduate School of MedicineIncheon 21936South Korea Division of Gastroenterology Department of Internal MedicineGachon University Gil Medical CenterIncheon 21565South Korea Division of Gastroenterology Department of Internal MedicineYonsei University Wonju College of MedicineWonju 26426South Korea

BACKGROUND Increasing levels of antibiotic resistance have reduced the Helicobacter pylori(***)eradication rates afforded by the standard triple ***,2-wk firstline four-drug regimens must be *** To analyze the eradication rates of modified bismuth-containing quadruple therapy(mBCQT)and concomitant therapy(CT),the associated adverse events,and *** Patients infected with *** were prospectively randomized to receive mBCQT or CT for 2 *** featured a proton pump inhibitor(PPI),bismuth,metronidazole,and tetracycline,taken twice *** included a PPI,clarithromycin,metronidazole,and amoxicillin,taken twice *** 13C-urea breath test was performed no earlier than 4 wk after therapy concluded to confirm *** either the histological or rapid urease test was positive,*** infection was *** The demographic characteristics of 68 patients who received mBCQT and 68 who received CT did not differ *** intention-to-treat analysis,the eradication rate was 88.2%(60/68)in the mBCQT group and 79.4%(54/68)in the CT group(P=0.162).By per-protocol analysis,the respective eradication rates were 98.4%(60/61)and 93.1%(54/58)(P=0.199).More CT than mBCQT patients experienced adverse events[33.8%(23/68)mBCQT vs 51.5%(35/58)CT patients,respectively,P=0.037].All patients showed good compliance[85.3%(58/68)mBCQT vs 82.4%(56/68)CT patients,P=0.641].CONCLUSION The *** eradication rates of the 2-wk mBCQT and CT regimens are *** patients show good compliance,and more CT than mBCQT patients experience adverse events.

关键词： Helicobacter pylori Therapy Bismuth-containing quadruple therapy Concomitant therapy

Tailored eradication strategy vs concomitant therapy for Helicobacter pylori eradication treatment in Korean patients

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World Journal of Gastroenterology 2021年第31期27卷 5247-5258页

作者： Youn I Choi Jun-Won Chung kyoung oh kim Kwang An Kwon Yoon Jae kim Jung Ho kim Ja Young Seo Dong Kyun Park Division of Internal Medicine Department of GastroenterologyGachon University College of MedicineGil Medical CenterInchoen 21565South Korea Department of Laboratory Medicine Gil Medical CenterGachon UniversityInchoen 21565South Korea Health IT Research Center Gachon University Gil HospitalIncheon 21565South Korea

BACKGROUND Antibiotic resistance to Helicobacter pylori(***)infection,which ultimately results in eradication failure,has been an emerging issue in the clinical ***,to overcome this problem,an antibiotic sensitivity-based tailored therapy(TT)for *** infection has received *** To investigate the efficacy and safety profiles of TT for *** infection treatment compared to a non-bismuth quadruple therapy,concomitant therapy(CT)*** We included patients(>18 years)with an *** infection and without a history of Helicobacter eradication who visited the Gil Medical Center between March 2016 and October *** being randomly assigned to either the TT or CT treatment group in 1 to 1 manner,patient compliance,eradication success rate(ESR),and patient-reported side effects profiles were assessed and compared between the two *** infection was diagnosed using a rapid urease test,Giemsa stain,or dual priming oligonucleotide polymerase chain reaction(DPO-PCR).Tailored eradication strategy based through the presence of a 23S ribosomal RNA point *** the TT group,a DPO-PCR test,which detected A2142G and/or A2143G point mutations,and a clarithromycin resistance test were *** in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy,while those with sensitive results were treated with the standard triple *** Of the 217 patients with a treatment naive *** infection,110 patients[mean age:58.66±13.03,men,n=55(50%)]were treated with TT,and 107 patients[mean age:56.67±10.88,men,n=52(48.60%)]were treated with *** compliance(TT vs CT,100%vs 98.13%,P=0.30),and follow-up loss rates(8.18%vs 9.35%,P=0.95)were not significantly different between the *** ESR after treatment was also not statistically different between the groups(TT vs CT,82.73%vs 82.24%,P=0.95).However,the treatment-related and patient-reported side effects were signifi

关键词： Helicobacter pylori Eradication Tailored therapy Conco-mitant therapy regimen

Anti-inflammatory and anti-apoptotic effects of rosuvastatin by regulation of oxidative stress in a dextran sulfate sodium-induced colitis model

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World Journal of Gastroenterology 2017年第25期23卷 4559-4568页

作者： Seung Kak Shin Jae Hee Cho Eui Joo kim Eun-Kyung kim Dong Kyun Park Kwang An Kwon Jun-Won Chung kyoung oh kim Yoon Jae kim Division of Gastroenterology and Hepatology Department of Internal Medicine Gachon University Gil Medical Center

To evaluate the anti-inflammatory and anti-apoptotic effects of rosuvastatin by regulation of oxidative stress in a dextran sulfate sodium (DSS)-induced colitis model. METHODSAn acute colitis mouse model was induced by oral administration of 5% DSS in the drinking water for 7 d. In the treated group, rosuvastatin (0.3 mg/kg per day) was administered orally before and after DSS administration for 21 d. On day 21, mice were sacrificed and the colons were removed for macroscopic examination, histology, and Western blot analysis. In the in vitro study, IEC-6 cells were stimulated with 50 ng/mL tumor necrosis factor (TNF)-α and then treated with or without rosuvastatin (2 μmol/L). The levels of reactive oxygen species (ROS), inflammatory mediators, and apoptotic markers were measured. RESULTSIn DSS-induced colitis mice, rosuvastatin treatment significantly reduced the disease activity index and histological damage score compared to untreated mice (P < 0.05). Rosuvastatin also attenuated the DSS-induced increase of 8-hydroxy-2’-deoxyguanosine and NADPH oxidase-1 expression in colon tissue. Multiplex ELISA analysis revealed that rosuvastatin treatment reduced the DSS-induced increase of serum IL-2, IL-4, IL-5, IL-6, IL-12 and IL-17, and G-CSF levels. The increased levels of cleaved caspase-3, caspase-7, and poly (ADP-ribose) polymerase in the DSS group were attenuated by rosuvastatin treatment. In vitro, rosuvastatin significantly reduced the production of ROS, inflammatory mediators and apoptotic markers in TNF-α-treated IEC-6 cells (P < 0.05). CONCLUSIONRosuvastatin had the antioxidant, anti-inflammatory and anti-apoptotic effects in DSS-induced colitis model. Therefore, it might be a candidate anti-inflammatory drug in patients with inflammatory bowel disease.

关键词： Oxidative stress Inflammatory bowel disease Rosuvastatin Apoptosis

Endoscopic stenting for recurrence-related colorectal anastomotic site obstruction:Preliminary experience

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World Journal of Gastroenterology 2014年第38期20卷 13936-13941页

作者： Jung Ho kim Jong Joon Lee Jae Hee Cho kyoung oh kim Jun-Won Chung Yoon Jae kim Kwang An Kwon Dong Kyun Park Ju Hyun kim Department of Internal Medicine Gachon University Gil Medical Center

AIM: To evaluate the efficacy of stents in treating patients with anastomotic site obstructions due to cancer recurrence following colorectal surgery.

关键词： Colorectal neoplasms Endoscopy Intestinal obstruction Stents Surgical anastomosis

Peroral endoscopic myotomy for treatment of Guillain-Barre syndrome-associated achalasia: A rare case

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World Journal of Gastroenterology 2017年第5期23卷 926-930页

作者： Seung Kak Shin kyoung oh kim Eui Joo kim Su Young kim Jung Ho kim Yoon Jae kim Jun-Won Chung Kwang An Kwon Dong Kyun Park Department of Internal Medicine Gachon University Gil Medical CenterIncheon 21565South Korea

Guillain-Barre syndrome (GBS)-associated achalasia is a very rare disease of uncertain cause. We report the case of a patient diagnosed with GBS-associated type I achalasia who was successfully treated with peroral endoscopic myotomy (POEM). A 30-year-old man who was diagnosed with GBS 3 mo before was referred to our department with dysphagia and meal-related regurgitation. The results of esophagography, endoscopy, and high-resolution manometry (HRM) revealed type I achalasia. POEM that utilized a submucosal tunneling technique was performed to treat the GBS-associated type I achalasia. After POEM, smooth passage of a contrast agent into the stomach was shown in follow-up esophagography, and follow-up HRM revealed a decrease in the mean integrated relaxation pressure 22.9 mmHg to 9.6 mmHg. The patient remained without dysphagia for 7 mo, even though the patient’s neurological problems were not fully resolved. POEM may be a safe and effective treatment for GBS-associated type I achalasia.

关键词： Peroral endoscopic myotomy Achalasia Guillain-Barre syndrome

Endoscopic en bloc resection of an exophytic gastrointestinal stromal tumor with suction excavation technique

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World Journal of Gastroenterology 2016年第23期22卷 5454-5458页

作者： Hyuk Soon Choi Hoon Jai Chun kyoung-oh kim Eun Sun kim Bora Keum Yoon-Tae Jeen Hong Sik Lee Chang Duck kim Division of Gastroenterology and Hepatology Department of Internal MedicineInstitute of Gastrointestinal Medical Instrument ResearchKorea University College of MedicineKorea University Medical Center Department of Internal Medicine Gachon University Gil Medical CenterGachon University of Medicine and Science

Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor (GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further management of a gastric subepithelial tumor on the lesser curvature of the lower body, originally detected via routine upper gastrointestinal endoscopy. Abdominal computed tomography and endoscopic ultrasound showed a 4-cm extraluminally protruding mass originating from the muscularis propria layer. The patient firmly refused surgical resection owing to potential cardiac problems, and informed consent was obtained for endoscopic removal. Careful dissection and suction of the tumor was repeated until successful extraction was achieved without serosal injury. We named this procedure the suction excavation technique. The tumor’s dimensions were 3.5 cm × 2.8 cm × 2.5 cm. The tumor was positive for C-KIT and CD34 by immunohistochemical staining. The mitotic count was 6/50 high-power fields. The patient was followed for 5 years without tumor recurrence. This case demonstrated the use of endoscopic resection of an exophytic GIST using the suction excavation technique as a potential therapy without surgical resection.

关键词： Gastrointestinal stromal tumor Endoscopic resection Submucosal tumor Subepithelial tumor En bloc resection

Endoscopic features suggesting gastric cancer in biopsy-proven gastric adenoma with high-grade neoplasia

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World Journal of Gastroenterology 2014年第34期20卷 12233-12240页

作者： Jung Ho kim Yoon Jae kim Jungsuk An Jong Joon Lee Jae Hee Cho kyoung oh kim Jun-Won Chung Kwang An Kwon Dong Kyun Park Ju Hyun kim Department of Internal Medicine Gachon University Gil Medical CenterNamdong-guIncheon 405-760South Korea Department of Pathology Gachon University Gil Medical Center21 Namdong-daero 774 beon-gilNamdong-guIncheon 405-760South Korea

AIM: To elucidate the endoscopic features that predict the cancer following endoscopic submucosal dissection (ESD) in patients with high-grade neoplasia (HGN).

关键词： Stomach Neoplasms Carcinoma Adenoma Endoscopy Dissection Risk factors