Clinical Outcomes of Metachronous Gastric Cancer after Endoscopic Resection for Early Gastric Cancer

( Jue Lie Kim ),( Sang Gyun Kim ),( Jung Kim ),( Jae Yong Park ),( Hyo-joon Yang ),( Hyun Ju Kim ),( Hyunsoo Chung ) 대한간학회 2020 Gut and Liver Vol.14 No.2

Background/Aims: Patients treated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are at risk of developing metachronous gastric cancer (MGC). The aim of this study was to evaluate the clinical outcomes of MGC after ESD for EGC between the re-ESD and surgery groups. Methods: In total, data from 1,510 patients who underwent ESD for EGC from January 2005 to May 2014 were retrospectively reviewed, and data from 112 patients with MGC were analyzed according to the type of treatment, namely, re-ESD and surgery. The clinicopathological factors affecting the subsequent treatment and outcomes of MGC were evaluated. Results: The median duration to the development of MGC was 47 months. In multivariate analysis, lower body mass index (BMI) (p=0.037) and multiplicity (p=0.014) of index cases were significantly associated with subsequent surgery for MGC. In cases of MGC, a diffuse or mixed-type Lauren classification (p=0.009), the depth of tumor mucosal invasion (p=0.001), and an upper stomach location (p=0.049) were associated with surgery. Overall survival was significantly shorter in the surgery group than in the re-ESD group after treatment for MGC (log-rank test, p=0.01). Conclusions: Lower BMI and multiplicity of index cancers were significantly associated with the surgical resection of MGC. Close follow-up is needed to minimize additional treatment for cases at high risk of advanced MGC after ESD for EGC. (Gut Liver 2020;14:190-198)

Clinical efficacy of endoscopic ultrasonography for decision of treatment strategy of gastric cancer

Kim, Jung,Kim, Sang Gyun,Chung, Hyunsoo,Lim, Joo Hyun,Choi, Ji Min,Park, Jae Yong,Yang, Hyo-Joon,Han, Seung Jun,Oh, Sooyeon,Kim, Min Seong,Kim, Hyun Ju,Hong, Hyoungju,Lee, Hee Jong,Kim, Jue Lie,Lee, E Springer-Verlag 2018 Surgical endoscopy Vol.32 No.9

Helicobacter pylori Eradication Can Reverse Rho GTPase Expression in Gastric Carcinogenesis

Kim Jue Lie,Kim Sang Gyun,Natsagdorj Enerelt,Chung Hyunsoo,Cho Soo-Jeong 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.5

Background/Aims: Altered DNA methylation is a key mechanism of epigenetic modification in gastric cancer (GC). This study aimed to evaluate the changes in epigenetic and genetic expression of multiple Rho GTPases in Helicobacter pylori-related gastric carcinogenesis by comparing H. pylori-positive GCs and negative controls. Methods: The messenger RNA expression and methylation of Rho GTPases (RhoA, Rac1, DOCK180, ELMO1, and CDC42) were evaluated in H. pylori-negative (control) human gastric tissues and H. pylori-positive GCs by using real-time reverse transcription-polymerase chain reaction and the quantitative MethyLight assay, respectively. Changes in expression and methylation levels of the genes were also compared between H. pylori-eradicated and -persistent GCs at 1-year follow-up. Results: In GCs, the methylation and expression levels of DOCK180 and ELMO1 were higher than in controls, while RhoA and Rac1 had lower levels than controls. CDC42 had the same expression pattern as DOCK180 and ELMO1 without DNA methylation. Although methylation levels of DOCK180 and ELMO1 had no difference between H. pylori-eradicated and -persistent GCs at the index endoscopic resection, those of H. pylori-persistent GCs increased and H. pylorieradicated GCs decreased for 1 year. The expression levels of DOCK180, ELMO1, and CDC42 in H. pylori-persistent GCs were higher than those in H. pylori-eradicated GCs over 1 year, unlike those of RhoA and Rac1. The methylation levels at index and the degrees of change over time of RhoA and Rac1 had no difference between H. pylori-persistent and -eradicated GCs. Conclusions: Epigenetic alterations of DOCK180 and ELMO1 are involved in H. pylori-related gastric carcinogenesis. This epigenetic field could be improved by H. pylori eradication.

Continuous Use of Thienopyridine May Be as Safe as Low-Dose Aspirin in Endoscopic Resection of Gastric Tumors

( Sooyeon Oh ),( Sang Gyun Kim ),( Jung Kim ),( Ji Min Choi ),( Joo Hyun Lim ),( Hyo-joon Yang ),( Jae Yong Park ),( Seung Jun Han ),( Jue Lie Kim ),( Hyunsoo Chung ),( Hyun Chae Jung ) 대한간학회 2018 Gut and Liver Vol.12 No.4

Background/Aims: Current guidelines recommend withholding antiplatelets for 5-7 days before high-risk endoscopic procedures. We investigated whether this reduces post-endoscopic submucosal dissection (ESD) bleeding. Methods: Gastric ESD cases with antiplatelets were retorospectively reviewed. Withholding antiplatelets for 5-7 days before ESD was defined as cessation and 0-4 days as continuation. The rate and risk of post-ESD bleeding according to the types and cessation of antiplatelets were assessed. Results: Among the 215 patients (117 adenoma and 98 early gastric cancer), 161 patients were on single (94 aspirin, 56 thienopyridine, and 11 other agents), 51 on dual, and 3 on triple antiplatelets. Post-ESD bleeding rates were 12.8% in aspirin users, 3.6% in thienopyridine, 27.5% in dual, 33.3% in triple therapy, and 9.7% in the cessation and 15.0% in the continuation group. Multiple antiplatelets (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.01 to 5.76) and specimen size ≥ 5.5 cm (OR, 2.84; 95% CI, 1.04 to 7.73) were the risk of bleeding, while continuation of thienopyridine (OR, 0.23; 95% CI, 0.05 to 1.09) and antiplatelets (OR, 1.83; 95% CI, 0.68 to 4.94) did not increase the risk of bleeding. Conclusions: Continuing thienopyridine and aspirin did not increase the risk of post-ESD. Multiple antiplatelet therapy and a large specimen size were independent risk factors of post-ESD bleeding. (Gut Liver 2018;12:393-401)

S-35 Seasonal Variation in Acute Gastrointestinal Bleeding in Korea

( Gukhwan Choi ),( Han Myung Lee ),( Jue Lie Kim ),( Sun A Park ),( Hosim Soh ),( Min Su You ),( Gunn Huh ),( Jaeyoung Chun ),( Kyoung Sup Hong ),( Jong Pil Lim ),( Joo Sung Kim ) 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1

Background/Aims: Acute gastrointestinal bleeding (GIB) may have a seasonal variation. The aim of this study was to determine the seasonal and monthly patterns in the presentation of acute GIB in Korea. Methods: From March 2014 to February 2015, the medical records of all patients who visited the emergency room for the management of acute GIB were retrospectively reviewed. We analyzed the association between the number of patients with acute GIB and each temperature parameter. Results: A total of 716 patients with acute GIB were enrolled in this study. The study population comprised 497 males (69.4%) and 219 females (30.6%), and the mean age was 62.3 years. There were 497 (69.4%) and 219 (30.6%) patients with acute upper and lower GIB, respectively. Variceal bleeding was detected in 171 (23.9%) patients. There were significant association of the number of acute GIB with seasons (p=0.021) and months (p=0.018), respectively. The highest incidence of acute GIB was observed in spring while the lowest incidence occurred in summer. The peak number of patients with acute GIB was noticed in April and the lower plateau was observed from June to September. There was no significant correlation between the presentation of acute GIB and average temperature. However, the presentation of acute GIB showed a higher preference of daily temperature difference (correlation efficient=0.112, p=0.05) Conclusions: There is seasonal and monthly variation in the presentation of acute GIB. Acute GIB might occur more commonly in the days with higher temperature difference.

Impact of the Interval between Previous Endoscopic Exam and Diagnosis on the Mortality and Treatment Modality of Undifferentiated-Type Gastric Cancer

Lee, Ayoung,Chung, Hyunsoo,Lee, Hyuk-Joon,Cho, Soo-Jeong,Kim, Jue Lie,Ahn, Hye Seong,Suh, Yun-Suhk,Kong, Seong-Ho,Choe, Hwi Nyeong,Yang, Han-Kwang,Kim, Sang Gyun The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.2

Purpose: The impact of the interval between previous endoscopy and diagnosis on the treatment modality or mortality of undifferentiated (UD)-type gastric cancer is unclear. This study aimed to investigate the effect of endoscopic screening interval on the stage, cancer-related mortality, and treatment methods of UD-type gastric cancer. Materials and Methods: We reviewed the medical records of newly diagnosed patients with UD gastric cancer in 2013, in whom the interval between previous endoscopy and diagnosis could be determined. The patients were classified into different groups according to the period from the previous endoscopy to diagnosis (<12 months, 12-23 months, 24-35 months, ≥36 months, and no history of endoscopy), and the outcomes were compared between the groups. In addition, patients who underwent endoscopic and surgical treatment were reclassified based on the final treatment results. Results: The number of enrolled patients was 440, with males representing 64.1% of the study population; 11.8% of the participants reported that they had undergone endoscopy for the first time in their cancer diagnosis. The percentage of stage I cancer at diagnosis significantly decreased as the interval from the previous endoscopy to diagnosis increased (65.4%, 63.2%, 64.2%, 45.9%, and 35.2% for intervals of <12 months, 12-23 months, 24-35 months, ≥36 months, and no previous endoscopy, respectively, P<0.01). Cancer-related mortality was significantly lower for a 3-year interval of endoscopy (P<0.001). Conclusions: A 3-year interval of endoscopic screening reduces gastric-cancer-related mortality, particularly in cases of UD histology.