Jin Hwa Park

Background/Aims: The prevalence of gallstone disease in patients with ulcerative colitis (UC) is higher than in the general population. However, risk factors of gallstone disease in these patients remain unclear. Thus, we investigated the prevalence and risk factors of gallstone disease in Korean patients with UC. Methods: Patients diagnosed with UC who underwent abdominal imaging studies between 1997 and 2020 were investigated using a well-established referral center-based large volume inflammatory bowel disease cohort. The prevalence and clinical characteristics of patients with gallstone disease were evaluated and compared with those without gallstone disease. Results: Overall, 2,811 patients with UC were enrolled. During the follow-up period (mean, 5.7 years), 198 patients (7.0%) were diagnosed with gallstone disease and compared with those without gallstone disease (n = 2,613). The proportion of extensive colitis at maximum extent, primary sclerosing cholangitis (PSC), history of cytomegalovirus, corticosteroid use, immunomodulatory use, colectomy, and appendectomy were significantly higher in the gallstone group (all P< 0.05). In multivariate analyses, age ≥ 60 years at gallstone evaluation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002–1.052; P= 0.033), PSC (OR, 6.304; 95% CI, 3.162–12.565; P< 0.001), and history of colectomy (OR, 2.494; 95% CI, 1.222–5.087; P= 0.012) were significant risk factors for gallstone disease in patients with UC. Conclusions: The prevalence of gallstone disease in Korean patients with UC was 7.0%, and age ≥ 60 years at gallstone evaluation, PSC, and history of colectomy were significant risk factors for UC patients with gallstone disease.

The increasing global emphasis on sustainability has extended its influence to the field of medicine, including endoscopy. Green endoscopy aims to minimize the environmental footprint of endoscopic practices while maintaining high standards of patient care. This review examines the current status of green endoscopy, focusing on its environmental impact, strategies for waste reduction, and adoption of sustainable practices. The key topics include the environmental challenges posed by single-use devices, the role of sterilization and recycling, and innovations in energy-efficient endoscopic equipment. Furthermore, we highlight policy recommendations and actionable strategies for healthcare systems to transition toward green practices. By integrating these approaches, the field of endoscopy can meaningfully contribute to global sustainability efforts without compromising clinical outcomes.

Background/Aims: Repeat examination of the right colon increases adenoma detection rates (ADRs) in the right colon. This study aimed to investigate whether a second examination of the right colon using narrow‐band imaging (NBI) increases ADRs in the right colon compared with repeat examinations using white light imaging (WLI).Methods: Consecutive patients with routine indications for colonoscopy were enrolled and randomly assigned to two groups. The control arm underwent two repeat forward examinations of the right colon using WLI only (repeat‐WLI group), and the intervention arm underwent the first examination of the right colon using WLI and the second examination using NBI (WLI‐NBI group). Lesions detected during the first and second examinations in each group were analyzed. The primary outcome was ADR in the right colon.Results: A total of 476 colonoscopies were analyzed, including 240 and 236 in the repeat‐WLI and WLI‐NBI groups, respectively. The overall ADR in the right colon was significantly higher in the WLI‐NBI group than that in the repeat‐WLI group (27.1% vs. 17.9%; p = 0.022). The number of adenomas per colonoscopy in the right colon was also significantly higher in the WLI‐NBI group than in the repeat‐WLI group (mean number of adenomas, 0.36 vs. 0.24; p = 0.042). However, there were no significant differences in the detection rates of advanced adenomas and sessile serrated lesions between the WLI‐NBI and repeat‐WLI groups (advanced adenoma, 4.7% vs. 2.9%; sessile serrated lesion, 2.5% vs. 3.3%).Conclusion: A second forward examination of the right colon using NBI increased ADRs in the right colon.

Background and Aims: A low-volume (1 L) polyethylene glycol plus ascorbic acid (PEG-A) solution and an oral sodium sulfate tablet (OST) formulation are recently introduced agents for colonoscopy bowel preparation. This study investigated the efficacy, safety, and tolerability of 1 L PEG-A vs. OST. Methods: This single-center, prospective, randomized, endoscopist-blinded study randomly assigned patients into 2 groups: 1 L PEG-A (group A); and OST (group B). Efficacy of bowel preparation was evaluated using the Boston Bowel Preparation Scale (BBPS). Tolerability and safety were investigated with a standardized questionnaire. Results: A total of 174 patients were included in the final analysis (group A, n = 92; group B, n = 82). Successful bowel preparation was achieved in 91.3% and 95.1% of patients in groups A and B, respectively (p = 0.324). Overall mean satisfaction with bowel preparation was greater among those in group B vs. those in group A (8.2 ± 1.7 vs. 6.8 ± 2.0, respectively; p < 0.001). Although abdominal distension was less common in group A than group B (3/92 [3.3%] vs. 9/82 [11.0%], respectively; p = 0.045), overall adverse events developed similarly in both groups (27/92 [29.3%] vs. 21/82 [25.6%], p = 0.583). In subgroup analysis of older patients (≥65 years of age), efficacy, overall satisfaction, and safety profiles were not different between groups A and B. Conclusions: Both 1 L PEG-A and OST demonstrated efficacy, tolerability, and safety for colonoscopy bowel preparation. OST was slightly better tolerated, whereas 1 L PEG-A resulted in less abdominal distension. Both agents were effective and safe in older patients.

Background and Aim: Low‐volume bowel preparation solutions, including 1‐L polyethylene glycol plus ascorbate (PEG‐A), have been developed to improve tolerability. The oral sodium sulfate tablet (OST) is a new agent with simethicone as a preloaded component. We investigated the efficacy, safety, and tolerability of OST compared to 1‐L PEG‐A.Methods: A single‐center, prospective, controlled study was performed with randomization into the OST (group A) and 1‐L PEG‐A (group B) groups. Bowel preparation efficacy was assessed on the Boston Bowel Preparation Scale (BBPS) and Bubble Scale. Safety and tolerability were evaluated using a questionnaire and laboratory examination.Results: Final analysis was performed on 171 patients (group A: 87, group B: 84). The proportion of bowel preparation success (BBPS ≥ 2 for each colonic segment) in group A was not inferior compared to group B (95.4% vs 96.4%, P = 0.736, 1‐sided 97.5% lower confidence limit −7.0%). The adenoma detection rate was not different (59.6% vs 41.9%; P = 0.087). The bubble scale was better in group A (0.2 ± 0.9 vs 1.9 ± 1.7, P < 0.001). All adverse events were mild in both groups. Nausea was less frequent in group A (14.9% vs 38.1%, P = 0.001). Overall satisfaction was better in group A (8.1 ± 2.1 vs 6.4 ± 2.8, P < 0.001). No clinically significant laboratory abnormality developed in both groups. These findings were similarly shown in old patients ≥65 years.Conclusions: Both OST and 1‐L PEG‐A were efficacious, safe, and tolerable for bowel preparation of colonoscopy. The OST showed fewer bubbles and slightly better tolerability.

Background and Aims Reduced body muscle mass is a poor prognostic factor for inflammatory bowel disease (IBD). In this study, we investigated the prevalence of sarcopenia at diagnosis and its clinical significance in Korean patients with IBD. Methods The prevalence of sarcopenia in IBD patients between June 1989 and December 2016 was investigated using a well-characterized referral center-based cohort. Abdominopelvic computed tomography within six months from IBD diagnosis was used for the evaluation. Sarcopenia was defined as an L3 skeletal muscle index of < 49 cm²/m² for male and < 31 cm²/m² for female. The clinical characteristics and outcomes were evaluated with respect to sarcopenia. Results A total of 1,027 patients (854 Crohn’s disease [CD]; 173 ulcerative colitis [UC]) were evaluated. Sarcopenia was found in 56.8% of the population (CD, 57.5%; UC, 53.2%), and male were more likely to be sarcopenic (CD, 94.3%; UC, 91.6%). There were no significant differences in the cumulative risk of using steroids, immunomodulators, biologics, and bowel resections (or colectomy) with or without sarcopenia during follow-up (median: CD, 5.8 years; UC, 3.7 years). In sarcopenic patients with CD, there was a significantly higher cumulative risk of perianal surgeries than in non-sarcopenic patients with CD (Log-rank test; P = 0.001). However, the risk of perianal surgeries was not significant in multivariate analysis (Odds ratio 1.368; 95% confidence interval 0.782–2.391; P = 0.272). Conclusion Sarcopenia at diagnosis may have no significant prognostic value for medical treatment and bowel resection, but it may be associated with perianal CD.

Inflammatory bowel disease (IBD) is a chronic inflammatory disease that occurs in the gastrointestinal tract that includes Crohn’s disease (CD) and ulcerative colitis (UC), and that may sometimes present with extraintestinal manifestations [1,2]. The prevalence of IBD is increasing in Asian countries including Korea [3-5]. Symptoms such as abdominal pain, diarrhea, weight loss, and a bloody stool are common to IBD. If the inflammation is not well controlled in affected patients, complications including intestinal stricture, fistula, perforation, and cancer can occur [6-8]. IBD is also a progressive disease, and it is important therefore to maintain appropriate medical interventions to prevent disease progression and reduce complications [9,10]. Adherence to medication regimens is thus vital and several studies have indicated in this regard that the prognosis is poorer in non-adherent IBD patients [11].

Idiopathic pneumoperitoneum has an unknown etiology despite exploratory laparotomy. However, it may occur without definite abdominal symptoms; thus, adequate management could be in clinical dilemma. We experienced three cases of idiopathic nonsurgical pneumoperitoneum in healthy individuals during a health check-up. Their cases were not accompanied by any relevant etiology or definite abdominal symptoms. All of the three cases exhibited a benign clinical course. The three patients underwent an abdominal computed tomography (CT) scan as part of a health check-up program, which incidentally revealed free air in the right paracolic gutter without evidence of visceral perforation or inflammation. Among the three cases, two patients underwent colonoscopy before abdominal CT, whereas one patient did not. Two cases were completely asymptomatic and were observed without any treatment in the outpatient clinic. Only the third case with minimal symptoms was treated conservatively for a short time. If a small amount of free air typically located in the right paracolic gutter is detected in the absence of perforation during colonoscopy, close observation without unnecessary treatment would be sufficient.

Backgrounds: It is not clear when and how frequently surveillance endoscopy should be performed after colorectal endoscopic submucosal dissection (ESD). We aimed to suggest a surveillance endoscopy strategy by investigating the cumulative local recurrence rates and identifying risk factors for local recurrence after colorectal ESD. Methods: We reviewed the medical records of 770 patients who underwent colorectal ESD for 778 lesions at our institution from 2005 to 2016. We investigated the cumulative local recurrence rates and risk factors for local recurrence. Results: Local recurrence developed in 12 (1.5%) of 778 lesions during the follow-up period of 37.4 ± 31.7 months. The one-, three-, and five-year cumulative local recurrence rates were 0.4%, 1.7%, and 2.2%, respectively. The risk factors for local recurrence were piecemeal resection (odds ratio (OR) 3.948, 95% confidence interval (CI) 1.164–13.385; p = 0.028) and histological incomplete resection (OR 8.713, 95% CI 2.588–29.334; p < 0.001). Local recurrence tended to develop frequently after ESD of early cancers. Conclusions: Short-term surveillance endoscopy should be recommended after piecemeal ESD, histological incomplete resection, and ESD of early colorectal cancers. Surveillance endoscopy with longer intervals can be suggested after en bloc ESD with the histological complete resection of benign colorectal tumors.