Three-year colonoscopy surveillance after polypectomy in Korea: a Korean Association for the Study of Intestinal Diseases (KASID) multicenter prospective study

Bora Keum,Nicoli Elena,Hye-Sung Won,Seham M. Khan,Sang Hoe Koo,Han Dong-Gun,Lee Jun-Woo,BYUN Hae Cheol,You-sun Ko,Yu Ya-Nan,Ji Sang-Gyu,Kang Joon Mo,Young-Cheong Kim,Sang-Woo Park,Hyun-Suk Shim,Joo My 대한장연구학회 2018 Intestinal Research Vol.16 No.1

Background/Aims: Colonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy. Methods: A total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics. Results: Among 1,323 patients enrolled, 387 patients (29.3%) were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%). Advanced adenoma recurrence was observed in 17 patients (4.4%) at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P =0.09). Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3%) at follow-up. Male sex, older age (≥50 years), and multiple adenomas (≥3) at baseline were independent risk factors for adenoma recurrence. Conclusions: A colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate. (Intest Res 2018;16:126-133)

Role of Innate Immunity in Colorectal Cancer

Bora Keum Korean Society of Gastrointestinal Cancer 2018 Journal of digestive cancer reports Vol.6 No.1

Chemotherapy and surgical resection are the mainstay of cancer treatment. Particularly for chemotherapy, although it is effective method to care, sometimes cure various cancers, there are many different status of cancer not being controlled by chemotherapy such as recurrence and resistance to chemotherapy. In order to overcome those difficulties during cancer therapy, immunotherapy targeting immune cells and immune associated factors to enhance cancer immunity has been highlighted. Innate immunity plays important roles on initial stage of cancer immunity that are detecting, killing cancer cells and initiating adaptive immunity for cancer. So many basic and clinical studies to manage innate immunity for cancer therapy have been going on, and most of them were to stimulate innate immune cells including dendritic cell, macrophage, monocyte, and natural killer cell in various ways. They showed promising results but still there are many things to be resolved before clinical application. Herein, I review the role of innate immune cells and therapeutic trials for colorectal cancer.

Western Blot을 이용한 대장암과 대장선종의 Calreticulin 단백 발현 연구

금보라 ( Bora Keum ),진윤태 ( Yoon Tae Jeen ),박상훈 ( Sanghoon Park ),서연석 ( Yeon Seok Seo ),김용식 ( Yong Sik Kim ),전훈재 ( Hoon Jai Chun ),이홍식 ( Hong Sik Lee ),엄순호 ( Soon Ho Um ),이상우 ( Sang Woo Lee ),최재현 ( Jai Hy 대한장연구학회 2006 Intestinal Research Vol.4 No.1

목적: 대장암 발생에 여러 유전자 변이가 관여하여 이에 대한 표지자의 검색을 위해 유전자의 최종 발현산물인 단백질을 연구하여 유전자의 기능을 규명하고 암의 조기 진단 및 치료의 표지자를 찾는 연구가 진행되고 있다. Calreticulin은 대장암에서 정상 대장 점막에 비해 특이하게 발현하는 것으로 밝혀졌다. 본 연구에서는 calreticulin을 이용하여 정상조직과 대장선종 및 대장암에서의 발현을 비교 분석하고자 하였다. 대상 및 방법: 2004년 12월부터 2005년 3월까지 대장암 및 동시성 대장선종 각 예에서 선종, 대장암과 정상점막의 조직을 채취하였다. 채취한 조직에서 단백질을 분리하여 western blot을 시행하였고 항 calreticulin 항체를 사용하여 표지한 후 화학 발광 염색방법에 의해 확인하였다. 각 예에서 정상 대장 점막의 발현정도를 ‘1’로 하여 선종과 대장암의 발현을 비교하였다. 결과: Calreticulin의 발현 정도는 정상 대장 점막에 비해 대장선종이 평균 1.69±0.37, 대장암이 평균 2.78±1.12였다. 각 군 간의 차이를 비교하였을 때 정상점막과 대장암, 정상점막과 선종 간에는 유의한 차이를 보였다. 대장선종보다 대장암에서 calreticulin이 많이 발현되었으나 통계적으로 유의하지는 않았다. 결론: 대장암뿐만 아니라 전구 병변인 선종에서도 calreticulin이 정상조직에 비해 높게 발현되어 대장암 및 대장 선종을 예측하는 선별 검사 표지자 연구에서 calreticulin의 역할을 기대할 수 있을 것으로 생각한다. 향후 많은 환자를 대상으로 대장암 발생과 calreticulin의 연관성 및 검사 실용 가능성에 대한 연구가 필요할 것으로 생각된다. Background/Aims: Colon cancer has a multistep process of molecular changes on the way of carcinogenesis. The detection of gene mutations associated with those molecular changes is expected to be able to predict or diagnose colon cancer. Calreticulin is one of the protein which has being investigated as a biomarker of colorectal cancer. The Aims of this study was to demonstrate the expression of calreticulin in normal colon mucosa, colonic tubular adenoma and colorectal cancer of each patient, and analyze the differences among them. Methods: 8 patients who have colorectal adenocarcinoma and more than 10 mm sized tubular adenoma synchronously were enrolled. Colorectal adenocarcinoma, tubular adenoma and normal colon tissue were taken from each patient. After proteins isolation and separation, western blot assay were performed to demonstrate calreticulin. The results were analyzed by Wilcoxon Signed Rank Test. Results: Calreticulin was more expressed in colorectal adenocarcinoma and tubular adenoma significantly compared with normal mucosa. Also, calreticulin was more expressed in adenocarcinoma than in adenoma but there were no significant diffences. Conclusions: These results suggest that calreticulin may be available for an early diagnostic biomarker for colorectal cancer or advanced colon adenoma. (Intestinal Research 2006;4:7-11)

대장 근위부 진행성 선종 예측을 위한 원위부 용종의 임상적 의의: 전향적 다기관 대장 용종 연구

금보라 ( Bora Keum ),진윤태 ( Yoon Tae Jeen ),최재현 ( Jai Hyun Choi ),정성애 ( Sung Ae Jung ),김현수 ( Hyun Soo Kim ),김영호 ( Young Ho Kim ),김원호 ( Won Ho Kim ),김태일 ( Tae Il Kim ),김효종 ( Hyo Jong Kim ),양석균 ( Suk Kyun Y 대한장연구학회 2005 Intestinal Research Vol.3 No.2

목적: 대장암 선별 검사로 사용되는 S상결장경이 근위부 대장에 있는 진행성 병변의 상당부분을 간과할 수 있다는 것이 밝혀지면서 선별 검사로서 대장내시경의 사용과 대장 원위부 용종의 임상적 의미에 대한 연구들이 있었다. 본 연구는 국내에서 대장 근위부 진행성 선종을 예측하는 데 원위부 용종의 임상적 의미와 위험 인자를 알아보고자 하였다. 대상 및 방법: 전향적 다기관 대장 용종 연구에서 50세 이상 무증상 환자에서 대장 내시경을 시행하며 용종 절제를 시행받은 826명을 대상으로 용종의 크기, 모양, 조직형, 위치 등의 성상을 기록하였다. 비장 굴곡을 경계로 근위부와 원위부를 나누었고 용종의 성상에 따라 분류한 후 원위부 소견에 따른 근위부 소견, 근위부 진행성 선종에 대한 원위부 용종의 민감도, 양성 예측률과 위험 인자를 분석하였다. 결과: 근위부에 진행성 선종 환자는 98명이었고 이들에서 원위부 대장 용종이 없었던 경우가 45명(45.9%)이었다. 원위부 용종의 크기에 따라 5 mm 미만이었을 때 근위부 진행성 선종이 있었던 경우가 1.9%, 5-10 mm인 경우 26.4%, 10 mm 이상인 경우 71.7%였다(p<0.01). 크기와 함께 조직형을 고려하여 분석하였을 때에도 역시 원위부 용종이 진행성 선종일수록 근위부에도 진행성 선종이 증가하였다(p<0.01). 용종 크기로 근위부 진행성 선종에 대한 민감도를 구하였을 때 10 mm 이상, 5 mm 이상일 때 각각 38.7%, 53.2%였고 조직형을 합한 진행성 선종에서는 38.8%였으며 양성 예측률은 10 mm 이상, 5-9 mm일 때 각각 13.3%, 4.1%였고 진행성 선종은 14.4%였다. 근위부 진행성 선종을 예측하는 위험인자로 남자(OD 3.9, 95%CI 1.61-9.48), 원위부 용종 10 mm 이상(OD 7.8, 95%CI 1.04-58.95), 원위부 진행성 선종(OD5.4 95%CI 1.61-17.9)이 통계적으로 유의한 위험 인자였다. 결론: 원위부 용종 소견이 대장 내시경을 통한 선별 검사 시에도 근위부 병변 예측에 도움이 될 것으로 생각하나 원위부 병변없는 근위부 진행성 선종 환자를 반드시 고려해서 주의 깊게 검사해야 할 것으로 생각한다. Backgroud/Aims: Proximal lesion without distal finding is weak point in colon cancer screening. Clinical significance of distal finding for advanced proximal neoplasia (APN) is uncertain. Aims of this study were to assess distal finding for prediction of APN. Methods: Asymptomatic 826 adults (age≥50) were collected in KASID prospective study, who underwent colonoscopy and polypectomy. Polyps located distal to splenic flexure were defined as distal polyps. Age, gender, size, appearance, histology of distal polyps were analyzed as risk factor of APN (adenoma≥10 mm or villous histology or high grade dysplasia or invasive cancer). Sensitivity and positive predictive value of distal polyp on APN were assessed. Results: APN were found in 98 patients and 45 (45.9%) patients of them were not associated with any distal findings. Risk factors of APN were male, size of distal polyp and advanced distal polyp. Sensitivity of distal polyp size≥10 mm on APN was 38.8% and advanced distal polyp also 38.8%. Positive predictive value of distal polyp size≥10 mm and advanced distal polyp were 13.3%, 14.4% respectively. Conclusions: Although distal colon findings were helpful to predict APN in asymptomatic 50 years of age or order patients screening, more careful examination is required considering APN without distal polyps. (Intestinal Research 2005;3:121-126)

The Korea National Suicide Survey (KNSS) : Rationale and Design

Kim, Bora,Jung, Keum Ji,Lee, Sang Uk,Sea, Jonghan,Kim, Eun Young,Kim, Se Hyun,Jee, Sun Ha,Park, Jong-Ik,Kim, Kyungil,Ahn, Yong Min The Korean Society of Biological Psychiatry 2015 생물정신의학 Vol.22 No.1

Suicide, the fourth leading cause of death in Korea, is a serious national problem. The Korea National Suicide Survey (KNSS) is the result of the first legislation to address this issue, "Article 11 of THE ACT FOR THE PREVENTION OF SUICIDE AND THE CREATION OF A CULTURE OF RESPECT FOR LIFE" (the "Act for the Prevention of Suicide"). To overcome the limitations of previous studies, the KNSS was designed by collaborators from a variety of fields : psychology, epidemiology, social welfare, and psychiatry. The KNSS was composed of four substudies that addressed the multifaceted process involved in suicide-related behavior over time, exploring general attitudes toward suicide and suicidal ideation, suicide planning, suicide attempts, and completed suicides. Study 1 examined the risk factors for suicide based on data regarding completed suicides ; Study 2 adopted the approach of a psychological autopsy ; Study 3 focused on suicide attempters ; and Study 4 explored attitudes toward suicide in the general population. The KNSS was designed to provide a comprehensive understanding of suicide from a longitudinal, multifaceted perspective to serve as a basis for policies aimed at suicide prevention.

Treatment of inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2nd Asian Organization of Crohn`s and Colitis (AOCC) meeting in Seoul

( Hiroshi Nakase ),( Bora Keum ),( Byoung Duk Ye ),( Soo Jung Park ),( Hoon Sup Koo ),( Chang Soo Eun ) 대한장연구학회 2016 Intestinal Research Vol.14 No.3

Background/Aims: Inflammatory bowel disease (IBD) management guidelines have been released from Western countries, but no adequate data on the application of these guidelines in Asian countries and no surveys on the treatment of IBD in real practice exist. Since there is a growing need for a customized consensus for IBD treatment in Asian countries, Asian Organization of Crohn’s and Colitis performed a multinational survey of medical doctors who treat IBD patients in Asian countries. Methods: A questionnaire was developed between August 2013 and November 2013. It was composed of 4 domains: personal information, IBD diagnosis, IBD treatment, and quality of IBD care. Upon completion of the questionnaire, a web-based survey was conducted between 17 March 2014 and 12 May 2014. Results: In total, 353 medical doctors treating IBD from ten Asian countries responded to the survey. This survey data suggested a difference in available medical treatments (budesonide, tacrolimus) among Asian countries. Therapeutic strategies regarding refractory IBD (acute severe ulcerative colitis [UC] refractory to intravenous steroids and refractory Crohn’s disease [CD]) and active UC were coincident, however, induction therapies for mild to moderate inflammatory small bowel CD are different among Asian countries. Conclusions: This survey demonstrated that current therapeutic approaches and clinical management of IBD vary among Asian countries. Based on these results and discussions, we hope that optimal management guidelines for Asian IBD patients will be developed.

Clinical Management of Gastric Neuroendocrine Tumors

In Kyung Yoo,Bora Keum Korean Society of Gastrointestinal Cancer 2015 Journal of digestive cancer reports Vol.3 No.1

Gastric neuroendocrine tumors (GNETs, also known as gastric carcinoids) are rare form of hormone-secreting neoplasms that present with varied clinical syndromes. There are four types of GNETs based on size, proliferation, localization, differentiation, and hormone production. Type I GNET is related to autoimmune atrophic gastritis and hypergastrinemia. Type II GNETs are related to multiple endocrine neoplasia (MEN)-1, Zollinger-Ellison syndrome and hypergastrinemia. Type 3 GNETs are not associated with any background pathology, and type 4 GNETs are poorly differentiated tumors. The most useful diagnostic and prognostic marker for gastrointestinal NETs is plasma chromogranin A (CgA) levels. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. For optimal management, the type, biology, and stage of the tumor must be considered. Here, we provide a comprehensive and up-to-date review of GNETs.

How Is the Autonomic Nerve Function Different Between Gastroesophageal Reflux Disease Alone and Gastroesophageal Reflux Disease With Diabetes Mellitus Neuropathy?: Author`s Reply

( Sehe Dong Lee ),( Bora Keum ),( Hoon Jai Chun ),( Young Tae Bak ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Journal of Neurogastroenterology and Motility (JNM Vol.17 No.4

Polyethylene glycol plus ascorbic acid for bowel preparation in chronic kidney disease

Lee, Jae Min,Keum, Bora,Yoo, In Kyung,Kim, Seung Han,Choi, Hyuk Soon,Kim, Eun Sun,Seo, Yeon Seok,Jeen, Yoon Tae,Chun, Hoon Jai,Lee, Hong Sik,Um, Soon Ho,Kim, Chang Duck,Kim, Myung Gyu,Jo, Sang Kyung Williams & Wilkins Co 2016 Medicine Vol.95 No.36

<P>The safety of polyethylene glycol plus ascorbic acid has not been fully investigated in patients with renal insufficiency. High-dose ascorbic acid could induce hyperoxaluria, thereby causing tubule-interstitial nephritis and renal failure. This study aims to evaluate the safety and efficacy of polyethylene glycol plus ascorbic acid in patients with chronic kidney disease.We retrospectively reviewed prospectively collected data on colonoscopy in patients with impaired renal function. Patients were divided into 2 groups: 2 L polyethylene glycol plus ascorbic acid (n = 61) and 4 L polyethylene glycol (n = 80). The safety of the 2 groups was compared by assessing the differences in laboratory findings before and after bowel cleansing.The laboratory findings were not significantly different before and after the administration of 2 L polyethylene glycol plus ascorbic acid or 4 L polyethylene glycol. In both groups, the estimated glomerular filtration rate was not influenced by the administration of the bowel-cleansing agent. Patients' reports on tolerance and acceptability were better in the 2 L polyethylene glycol plus ascorbic acid group than in the 4 L polyethylene glycol group.The 2 L polyethylene glycol plus ascorbic acid solution is a safe choice for bowel preparation before colonoscopy in patients with impaired renal function.</P>

The Korean Society of Gastroenterology & SIDDS 2027 : Slide Session ; S-UG-08 : Upper GI Tract ; The Therapeutic Effect of Irreversible Electroporation According to Tissue Properties of Upper Gastrointestinal Tract: Gene Expression Signature Analysis

( Hyuk Soon Choi ),( Bora Keum ),( Hong Bae Kim ),( Jae Min Lee ),( Seung Han Kim ),( Seung Joo Nam ),( Eun Sun Kim ),( Yeon Seok Seo ),( Yoon Tae Jeen ),( Hong Sik Lee ),( Hoon Jai Chun ),( Soon Ho U 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Irreversible electroporation (IRE) is a promising novel technique for the ablation of tumors. IRE has an advantage over other ablation technique in its mechanism to remove undesired cells by affecting the cell membrane without thermally destructing blood vessels, nerves and the surrounding tissues. This therapeutic modality has been considered to apply to Barrett`s dysplasia or epithelial neoplasm of upper gastrointestinal tract instead of previous radiofrequency ablation. Our purpose was to study effectiveness of IRE according to tissue properties in rat stomach. Methods: The Sprague-Dawley rats were used throughout this study. IRE ablation was applied in upper stomach (squamous cell epithelium) and lower stomach (columnar cell epithelium) with same energy parameters. The energy delivered for each ablation was 50/100 pulses of 1KV/cm ~ 3KV/cm. And we used DNA microarrays to measure the expression levels of large numbers of genes in rat stomach according to different electrical energy. And we measured several apoptotic gene expression using real time RT-PCR. Results: All animals survived for their designated times. H-E staining showed extensive cell death area at 10 hours after IRE ablation in upper (squamous cell epithelium) and lower (columnar cell epithelium) gastric tissue. We confi rmed apoptotic cell death by Tunnel assay. The number of signifi cantly up-regulated apoptotic genes was higher in 2KV, 100 pulse and 10hr than that of other electrical energy groups. The signifi cantly up-regulated genes related to apoptosis after IRE ablation in all IRE setting were s100a8/9, Ccl2, Timp1. Aif1, Lcn2, hspb1 genes. Conclusions: This study showed that IRE ablated stomach tissue through cellular apoptosis. This study suggests the potentiality of IRE application in the treatment of not only gastric neoplasm but also esophageal neoplasm including dysplasia of Barrett`s esophagus without metastasis.