Gil Ho Lee

Kwang Jae Lee, Gil Ho Lee, and Jong Sun Park. J Neurogastroenterol Motil 2026;32:615-24. https://doi.org/10.5056/jnm25252

There is currently no consensus on long-term risk stratification for metachronous gastric neoplasms (MGNs) occurring beyond 5 years following endoscopic submucosal dissection (ESD). This study aimed to investigate the time-dependent changes in predictive factors for MGN after curative ESD for early gastric cancer (EGC) and analyze the clinicopathological features of late MGNs. We retrospectively reviewed patients who underwent ESD for early gastric neoplasms between March 2005 and June 2020. MGN was defined as a new gastric neoplasm detected at a different site >12 months after ESD. Survival data were collected and analyzed using multivariable and time-split Cox hazard regression models. Among 5571 patients treated with ESD, 876 were included, with a median follow-up of 58 months. The cumulative incidence of MGN was 10.8% at 5 years and continued to accumulate beyond 5 years (26.7% at 10 years). All MGNs were stage I and there was no gastric cancer-related mortality. Cox regression analysis identified family history of gastric cancer (adjusted hazard ratio [aHR] 2.12, 95%CI 1.32–3.41) and extensive intestinal metaplasia (aHR 6.50, 95%CI 3.73–11.36) as independent predictors of MGN. Histological upgrade was not associated with MGN during the first 5 years, but emerged as a significant risk factor in the late period (interaction P = 0.005). MGNs may develop even beyond 5 years following ESD with curative resection in patients with EGC. These findings highlight the long-term risk of MGN after ESD, providing a framework for clinical risk estimation.

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of peptic ulcers. Tegoprazan, a novel potassium-competitive acid blocker, provides rapid and potent inhibition of acid production. This study evaluated whether tegoprazan 25 mg is non-inferior to lansoprazole 15 mg in preventing NSAID-induced peptic ulcer. In this double-blind, randomized, active-controlled, multicenter phase III trial, patients requiring NSAIDs for up to 24 weeks were randomized (1:1) to the tegoprazan or the lansoprazole group. The primary endpoint was the incidence of peptic ulcer at week 24 in the per-protocol population. Secondary endpoints were NSAID-induced gastrointestinal symptom-free rates. Safety outcomes included adverse drug reactions (ADRs) and serious adverse events (SAEs). A total of 392 patients were randomized, and 269 patients were analyzed in the perprotocol set. Tegoprazan was non-inferior to lansoprazole for the prevention of gastroduodenal ulcers (p=0.0004). The heartburn-free rate at week 12 was higher in the tegoprazan group (p=0.0421), while other symptom-free rates did not differ significantly. In terms of safety, ADR and SAE rates were comparable and not significantly different. Tegoprazan was non-inferior to lansoprazole in preventing NSAID-induced peptic ulcers with excellent tolerance. Tegoprazan represents a clinically effective alternative gastroprotective therapy (ClinicalTrials.gov identifier NCT04840550).

Purpose Safe and effective sedation are important factors when performing gastrointestinal endoscopy. However, clinicians should be cautious when using sedatives in older patients because of their decreased physiological reserves. Remimazolam is an ultrashort active benzodiazepine that has attracted attention because of its efficacy. This study aimed to determine the safety and efficacy of remimazolam compared with midazolam as a sedative for diagnostic upper gastrointestinal endoscopy in older patients aged ≥ 65 years. Methods We randomly assigned patients aged ≥ 65 years who were scheduled for diagnostic upper gastrointestinal endoscopy. The average induction time, average recovery time, and side effect profile of patients who received remimazolam as a sedative were compared with those of patients who received midazolam. Results A total of 120 patients underwent randomization (60 in the remimazolam group and 60 in the midazolam group). Patients who received remimazolam had shorter average induction (mean ± standard deviation, 102.0 ± 77.2 s vs. 327.5 ± 125.3 s, p < 0.001) and recovery times (mean ± standard deviation, 5.8 ± 3.1 min vs. 13.4 ± 7.8 min, p < 0.001) than those who received midazolam. No significant difference in side effect profiles was observed between the groups. Conclusions In performing upper gastrointestinal endoscopy in older patients, remimazolam can be a good alternative sedative to midazolam, whether used as monotherapy or in combination therapy.

Background and Objectives: Initial surveillance strategy and subsequent monitoring for small gastric subepithelial lesions (SELs) lack a consensus. This study aimed to investigate the risk factors and performance of predictive markers for lesions requiring surgical intervention in patients with small gastric SELs. Methods: We retrospectively reviewed data of patients who underwent EUS at least twice between 2010 and 2023. Group S1 was defined as patients with a ≥20% increase in size from the initial EUS. The S1 was further divided into 2 groups according to requiring surgical intervention (S2 and S3). Results: Of the 476 patients, 106 (22.2%) had increase in size by ≥20% compared with the initial EUS (S1). The mean follow-up duration in the S1 was 70.2 months. Seven (1.5%) and 38 (8.0%) lesions were observed to have increased in size and were confirmed as gastrointestinal stromal tumors, respectively (S2). Lesions in the lesser curvature (odds ratio [OR]: 6.0, 95% confidence interval [CI]: 2.087–17.148, P < 0.001) and size of ≥12.8 mm (OR: 4.2, 95% CI: 2.083–8.542, P < 0.001) were risk factors for S2. Lesion size ≥12.8 mm is a key risk factor requiring timely intervention based on the Kaplan–Meier analysis. An increasing rate (0.7 mm/yr) showed superior performance as a predictive risk factor for S2 than having a lesion size ≥12.8 mm (area under the receiver-operating characteristic curve: 0.887 vs. 0.734, P < 0.001). Conclusions: Although the size of the SELs increased, the classification for group S2 was very important. These results emphasize the necessity for effective follow-up strategies, including timely interventions, for small gastric SELs.

Background/Aims: Surveillance strategies for small grade 1 rectal neuroendocrine tumors (G1 rNETs) after incomplete endoscopic resection (ER) remain controversial. We evaluated the long-term outcomes of patients with G1 rNET ≤1 cm after ER who did and did not undergo complete resection.Methods: We retrospectively evaluated 441 patients with G1 rNETs measuring ≤1 cm after ER between 2011 and 2022. Patients were divided into complete and incomplete resection groups according to histopathological evaluation. Logistic regression analysis identified the risk factors for incomplete resection after ER.Results: The mean follow-up intervals were 38.6 and 45.7 months in all patients and the incomplete resection group, respectively. No recurrences were observed during the follow-up period. The mean lesion size was 5.5 mm and the complete resection rate was 80.5% (n=355). In the logistic regression analysis, lesion size 5.1 to 10 mm (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.245–4.203; p=0.008), multiple lesions (OR, 8.3; 95% CI, 1.247–54.774; p=0.029), and retroflexion view during the procedure (OR, 4.0; 95% CI, 1.668–9.615; p=0.002) were independent risk factors for incomplete resection.Conclusions: The prognosis of G1 rNET ≤1 cm after ER was very good, regardless of the histopathological results.

Although emergency endoscopic evaluation of patients presenting with corrosive ingestion may facilitate prognosis prediction, the role of early endoscopic evaluation remains unclear. Therefore, we aimed to select patients who required emergency endoscopic evaluation based on the initial admission information and to investigate the factors associated with Zargar grade ≥2b in patients with corrosive ingestion. We retrospectively reviewed patients with corrosive ingestion who visited the emergency department between 2010 and 2023. We investigated short- and long-term endoscopic outcomes after corrosive ingestion. Using logistic regression analysis, we investigated the factors associated with endoscopic mucosal damage of Zargar grade ≥2b. A total of 211 patients were enrolled. The most common reason for and type of corrosive ingestion were suicidal intent (n=138, 65.4%) and alkaline substrates (n=181, 85.5%), respectively. The median (interquartile range, IQR) of endoscopy time after admission was 455 min (235-890 min), and 92.9% (n=196) of patients underwent endoscopic evaluation within 48 h. At the initial endoscopic evaluation, 47.9% (n=101) of the patients had no mucosal injury. Stricture was observed in 2.4% (n=5) during the follow-up period, and three (1.4%) deaths occurred. In multivariate logistic analysis, bleeding events [odds ratio (OR)=12.2, 95% confidence interval (CI)=1.619-164.581, p=0.024] and leukocytosis (OR=2.9, 95%CI=1.138-7.331, p=0.023) were significant risk factors for Zargar grade ≥2b. However, the amount ingested was not revealed to be a risk factor for Zargar grade ≥2b. Mucosal injury was mild in most patients admitted to the emergency department after corrosive ingestion, regardless of the amount ingested.

Ji Hyun Kim, Ji Min Kim, Bumhee Park, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee, Gil Ho Lee, Choong-Kyun Noh. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl240470

Refractory duodenal ulcer caused by portal stent graft exposure

Yeunji Lee, Eunyoung Lee, Bumhee Park, Gil Ho Lee, Sun Gyo Lim, Sung Jae Shin, Choong-Kyun Noh, Kee Myung Lee. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl240111