Ga Hee Kim

Jin Won Chang, Jun Chul Park, Da Hyun Jung, Eun Hwa Kim, Ga Hee Kim, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl250484

Gastric and duodenal neuroendocrine tumors (NETs) are rare but have been increasingly detected due to the increased use of upper endoscopy in South Korea. Of these malignancies, small, superficial upper gastrointestinal NETs can be treated with endoscopic resection (ER). This study aimed to evaluate the clinicopathological characteristics of a single-center cohort with gastric NETs (G-NETs) and duodenal NETs (D-NETs) and their long-term outcomes following ER. We retrospectively analyzed the data of a prospectively assessed cohort of patients with G-NETs and D-NETs treated with ER between January 2006 and December 2023. A total of 144 patients were included, including 131 cases of G-NETs and 56 cases of D-NETs. We evaluated the clinicopathological characteristics of these patients and assessed their long-term outcomes following ER. Among the patients with G-NETs, the proportions of type I, II, and III G-NETs were 47.3%, 0.8%, and 29.0%, respectively. The median follow-up period was 54.0 months (range, 0 to 161 months). The curative resection rates were 81.0% for type I/II and 60.5% for type III G-NETs (p=0.025). Ten patients underwent additional surgery after ER; however, no lymph node metastases were observed. The disease-specific survival rate was 100%. Ten cases experienced intragastric recurrence, and all were managed with repeat ER. Among the 56 patients with D-NETs, the curative resection rate was 41.1%. Two patients recurred, one with intraduodenal recurrence and the other with liver metastasis. No disease-specific deaths were reported. ER is a safe and effective method for treating gastric NETs, including type III, and for grade 1 D-NETs and results in favorable long-term outcomes.

Yuri Kim, Heonwoo Lee, Ga Hee Kim, Ji Yong Ahn, Young Soo Park, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Hwa Jung Kim. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl250623

Background and aims: The characteristics and incidence of esophagogastroduodenal involvement in Crohn disease remain unclear in Korea. In this study we aimed to investigate the prevalence and clinicopathological characteristics of Crohn disease with esophagogastroduodenal involvement. Methods: A total of 115 patients with Crohn disease who underwent esophagogastroduodenoscopy (EGD) with esophageal, gastric, and duodenal biopsies were prospectively enrolled in 2020-2021 at a tertiary care center. Five specimens were obtained—1 each from the esophagus, gastric body, gastric antrum, duodenal bulb, and second duodenal portion—and histologically reviewed. Results: The median patient age was 30.0 years, and 74.8% of patients were male. Based on histological features, 56 patients (48.7%) had esophagogastroduodenal involvement (15 esophageal, 44 gastric, 36 duodenal). Notable histopathological findings included non-caseating granulomas in 8 cases (7.0%), focally enhanced gastritis in 38 cases (33.0%), and lymphocytic esophagitis in 13 cases (10.7%). Endoscopic findings suggestive of esophagogastroduodenal involvement were detected in 94 of 115 patients (81.7%). Typical findings included longitudinal or aphthous erosions (esophagus, 3/115 [2.6%]; stomach, 45/115 [39.1%]; duodenum, 19/115 [16.5%]), longitudinal or aphthous ulcers [duodenum: 4/115 (3.5%)], bamboo-joint–like appearance [stomach: 81/115 (70.4%); duodenum: 3/115 (2.6%)], and scar changes [stomach: 2/115 (1.6%); duodenum: 3/115 (2.6%)]. In multivariable analysis, elevated fecal calprotectin (≥100 μg/g) was associated with esophagogastroduodenal involvement in Crohn disease (odds ratio, 6.57; 95% CI, 1.99-21.66; P <.001). Conclusions: The proportion of esophagogastroduodenal involvement was relatively high among Korean patients with Crohn disease who underwent EGD. In patients with elevated fecal calprotectin, EGD with histopathological examination is recommended to identify esophagogastroduodenal involvement.

Kim GH, et al. Yonsei Med J. 2025 Nov;66:e105. https://doi.org/10.3349/ymj.2024.0404

Endoscopic mucosal resection of a large duodenal polyp

Background and study aims: Endoscopic submucosal dissection is used to treat early gastric neoplasms. Compared with other endoscopic procedures, it requires higher doses of opioids, leading to adverse events during monitored anesthesia care. We investigated the correlations between clinicopathological characteristics and intraprocedural opioid requirements in patients who underwent endoscopic submucosal dissection under monitored anesthesia care. Patients and methods: The medical records of patients who underwent endoscopic submucosal dissection under monitored anesthesia care were retrospectively reviewed. The dependent variable was the total dose of fentanyl administered during the dissection, while independent variables were patient demographics, the American Society of Anesthesiologists physical status classification, preoperative vital sign data, and the pathological characteristics of the neoplasm. Correlations between variables were examined using multiple regression analysis. Results: The study included 743 patients. The median total fentanyl dose was 100 mcg. Younger age (coefficient −1.37; 95% confidence interval [CI] −1.78 to −0.95), male sex (16.12; 95% CI 6.99–25.24), baseline diastolic blood pressure (0.44; 95% CI 0.04–0.85), neoplasm length (1.63; 95% CI 0.90–2.36), and fibrosis (28.59; 95% CI 17.77–39.42) were positively correlated with the total fentanyl dose. Total fentanyl dose was higher in the differentiated (16.37; 95% CI 6.40–26.35) and undifferentiated cancers group (32.53; 95% CI 16.95–48.11) than in the dysplasia group; no significant differences were observed among the others. The mid-anterior wall (22.69; 95% CI 1.25–44.13), mid-posterior wall (29.65; 95% CI 14.39–44.91), mid-greater curvature (28.77; 95% CI 8.56–48.98), and upper groups (30.06; 95% CI 5.01–55.12) had higher total fentanyl doses than the lower group, whereas doses did not significantly differ for the mid-lesser curvature group. Conclusions: We identified variables that influenced opioid requirements during monitored anesthesia care for endoscopic submucosal dissection. These may help predict the needed opioid doses and identify factors affecting intraprocedural opioid requirements.

Jin Kyung Bae and Ga Hee Kim. Korean J Gastroenterol 2023;82:151-3. https://doi.org/10.4166/kjg.2023.115