Sung Sil Park

Background: Extraintestinal manifestations (EIMs) significantly contribute to morbidity in individuals with inflammatory bowel disease (IBD); however, population-based East Asian data remain limited. We evaluated EIM burden in a nationwide Korean IBD cohort. Methods: This nationwide retrospective cohort study was conducted using data from the Korean National Health Insurance Service between 2005 and 2017. Individuals with ulcerative colitis (UC) or Crohn’s disease (CD) were identified using the International Classification of Diseases–10th Edition and rare intractable disease codes. EIM incidence, associated risk factors, interval from IBD diagnosis to EIM onset, and trends by sex and age were examined. Results: Among 69 414 individuals with IBD (48 689 UC, 20 725 CD), 42.23% developed at least 1 EIM. Dermatologic manifestations were the most common (17.02%), followed by musculoskeletal (16.36%), hepatopancreaticobiliary (15.48%), and ophthalmologic (7.83%) manifestations. Low socioeconomic status, smoking history, female sex, and higher Charlson Comorbidity Index scores independently correlated with EIM development in UC (hazard ratios of 2.14, 1.18, 1.15, and 1.08, respectively) and CD (hazard ratios of 1.98, 1.20, 1.18, and 1.09, respectively). Most EIMs developed within 4 to 6 years postdiagnosis, with musculoskeletal EIMs occurring earliest (median 42.9 months [interquartile range: 10.3-89.5 months]). Annual EIM incidence increased steadily over time across all age groups. Conclusions: EIMs affected 42.23% of Korean individuals with IBD, most frequently appearing 4 to 6 years postdiagnosis. Low socioeconomic status, smoking history, female sex, and higher Charlson Comorbidity Index scores consistently correlated with EIM occurrence, and incidence increased steadily over time, highlighting the need for sustained, personalized monitoring and timely intervention.

Purpose: The incidence of rectal neuroendocrine tumors (NETs) is increasing owing to a rise in colonoscopy screening. For the endoscopic removal of NETs, complete resection including the submucosal layer is essential. Therefore, appropriate endoscopic resection techniques are of critical importance. This study aimed to analyze data on rectal NETs and help provide guidance for their endoscopic treatment.Methods: A retrospective analysis was conducted on data from patients who underwent resection for rectal NETs at 6 institutions between 2010 and 2021.Results: A total of 1,406 tumors were resected from 1,401 patients. During a mean follow-up period of 55.4 months, there were 8 cases (0.5%) of recurrence. Overall, a complete resection was achieved in 77.6% of the patients, with modified endoscopic mucosal resection (mEMR) and endoscopic submucosal dissection (ESD) showing the highest rate at 86.0% and 84.9%, respectively, followed by conventional EMR (cEMR; 68.7%) and snare polypectomy (59.0%). In the subgroup analysis, statistically significant differences were observed in complete resection rates based on tumor size. ESD and mEMR demonstrated significantly higher complete resection rates compared with cEMR. Univariate and multivariate analyses showed that tumor location of the lower rectum and advanced techniques (mEMR and ESD) were significant prognostic factors for complete resection rates.Conclusion: When encountering rectal subepithelial lesions on endoscopic examination, endoscopists should consider the possibility of NETs and carefully decide on the endoscopic treatment method. Therefore, it is advisable to perform mEMR or ESD to achieve complete resection, especially for rectal NETs measuring ≤10 mm.

Kim HH, et al. Ann Surg Treat Res. 2024 Jul;107(1):1-7. https://doi.org/10.4174/astr.2024.107.1.1

Purpose: Most predictive factors for lymph node metastasis in rectal neuroendocrine tumors (NETs) have been based on local and endoscopic resection. We aimed to evaluate the risk factors for lymph node metastasis in patients who underwent radical resection for rectal NETs and stratify the risk of lymph node metastasis.Methods: Sixty-four patients who underwent radical resection for rectal NETs between January 2001 and January 2018 were included. We investigated the risk factors of lymph node metastasis using clinicopathologic data. We also performed a risk stratification for lymph node metastases using the number of previously known risk factors. For oncologic outcomes, the 5-year overall survival and recurrence-free survival were evaluated in both groups.Results: Among the patients who underwent radical surgery, 32 (50.0%) had lymph node metastasis and 32 (50.0%) had non–lymph node metastasis. In the multivariable analysis, only the male sex was identified as a risk factor for lymph node metastasis (odds ratio, 3.695; 95% confidence interval, 1.128–12.105; P=0.031). When there were 2 or more known risk factors, the lymph node metastasis rate was significantly higher than when there were one or no risk factors (odds ratio, 3.667; 95% confidence interval, 1.023–13.143; P=0.046). There was also no statistical difference between the 2 groups in 5-year overall survival (P=0.431) and 5-year recurrence-free survival (P=0.144).Conclusion: We found that the rate of lymph node metastasis increased significantly when the number of known risk factors is 2 or more.

Background Transanal minimally invasive surgery (TAMIS) is technically demanding and requires extensive training. We developed the TAMIS simulator model by remodeling an existing laparoscopic training system to educate trainees and analyzed their learning curves. Methods Between March 2020 and June 2020, 12 trainees performed TAMIS simulator training sessions. The total operative time, including specimen removal and wound closure, was recorded. The wound closure and specimen quality, trainee self-confidence, and supervisor evaluation of technical performance were documented. A moving average was used to analyze the number of training sessions required to stabilize the procedure time, while a cumulative sum analysis was performed to identify that required to reach proficiency with each item. Results Each trainee completed 20 TAMIS simulator training sessions. The median total procedure time was 13 min (range, 4–60 min), which stabilized after 15 training sessions. The median times for specimen removal and wound closure were 3 min (range, 1–18 min) and 10 min (range, 2–50 min), respectively, which stabilized after 7 and 15 training sessions, respectively. The mean specimen and wound closure quality scores were 2.9 ± 0.9 (on a scale from 1 to 4) and 2.3 ± 1.1 (on a scale from 1 to 4), respectively, competencies in which were achieved after 16 and 20 training sessions, respectively. The mean trainee self-confidence and supervisor evaluation of technical performance scores were 2.4 ± 1.2 (on a scale from 1 to 5) and 2.7 ± 1.2 (on a scale from 1 to 5), respectively, competencies in which were achieved after 20 and 17 training sessions, respectively. Conclusion Trainees required 15 training sessions to stabilize the procedure time and 16–20 training sessions to demonstrate competencies with the TAMIS simulator model. We expect this simulator model may help surgeons more rapidly acquire the skills required for TAMIS. Graphical abstract