One of the most prominent characteristics of gastrointestinal stromal tumors (GISTs) is their unpredictable and variable behavior. GISTs are not classified as "benign" or "malignant" but are rather stratified by their associated clinical risk of malignancy as determined by tumor size, location, and number of mitoses identified during surgical histology. The difficulty in assessing the malignant potential and prognoses of GISTs as well as the increasing incidence of "incidental GISTs" presents challenges to gastroenterologists. Recently, endoscopic enucleation has been actively performed as both a diagnostic and therapeutic intervention for GISTs. Endoscopic enucleation has several advantages, including keeping the stomach intact after the removal of GISTs, a relatively short hospital stay, a conscious sedation procedure, relatively low cost, and fewer human resources required compared with surgery. However, a low complete resection rate and the risk of perforation could reduce the overall advantages of this procedure. Endoscopic full-thickness resection appears to achieve a very high R0 resection rate. However, this technique absolutely requires a very skilled operator. Moreover, there is a risk of peritoneal seeding due to large active perforation. Laparoscopy endoscopy collaborations have been applied for more stable and pathologically acceptable management. These collaborative procedures have produced excellent outcomes. Many procedures have been developed and attempted because they were technically possible. However, we should first consider the theoretical basis for each technique. Until the efficacy and safety of sole endoscopic access are proved, the laparoscopy endoscopy collaborative procedure appears to be an appropriate method for minimally destructive GIST surgery.

BackgroundIntestinal metaplasia (IM) is regarded as a premalignant lesion. However, endoscopic diagnosis of IM has been considered difficult. Using endoscopy, we found a unique pattern of erythema, “Mottled Patchy Erythema (MPE),” which includes severe IM. Helicobacter pylori (Hp) infection itself can cause erythema, which reflects histologic changes in the gastric mucosa. Therefore we enrolled Hp eradication patients to validate the relation between MPE and pathologic findings.MethodsWe enrolled patients with chronic gastritis who underwent successful Hp eradication at least 6 months before the study. We defined MPE as multiple flat or depressed erythematous lesions. When encountering MPE on endoscopy, we performed biopsy on both the MPE site and non-MPE site. The non-MPE site was defined as an adjacent mucosa located within 3 cm of the MPE site. All biopsy specimens were evaluated immunohistochemically for IM subtype using MUC2, MUC5AC, MUC6, CD10, and CDX2 stains. The degree of IM was defined according to the Updated Sydney System. The diagnostic accuracy of the MPE findings for pathologic IM was calculated. The relation between MPE and IM subtype was also assessed.ResultsA total of 102 patients were selected for the study. Of these, 55 (54%) patients had MPE. Biopsy specimens were taken from the MPE sites and non-MPE sites from these 55 patients. The IM percentages and median scores of IM were both significantly higher at the MPE sites (P < 0.001) than at the non-MPE sites. The sensitivity and specificity for MPE in the detection of histologic IM were 72.7% and 84.1%, respectively. No significant associations were observed in the expression of MUC2, MUC5AC, MUC6, CD10, and CDX2 between the MPE sites and non-MPE sites. There were no significant differences in the ratios (complete/incomplete) of IM subtypes between the two groups.ConclusionsMPE is a useful endoscopic finding to detect histologic IM without the use of chromoendoscopy and magnifying endoscopy. However, the IM subtype is difficult to identify. In the era of Hp eradication, MPE has the potential to become a predictive finding for the risk of gastric cancer.

ESMR-L is a significantly superior modality to EMR for the complete removal of small rectal carcinoid tumors that are 10 mm or less in diameter.

Background/AimsIrritable bowel syndrome (IBS) is prevalent in general population. This study investigates the prevalence of IBS in medical college students in Korea as well as the influence of dietary habits and nutritional intake on IBS.MethodsThis study is a cross-sectional study of 319 students (239 males and 80 females, age 22.3 ± 2.5 years) from the 6 grade levels of the Medical College in Korea. All students filled out a self-reported questionnaire for ROME III criteria. They also completed a questionnaire to validate dietary habits and food frequency in Korean.ResultsThe overall prevalence of IBS was 29.2% without correlation to age, body mass index and grade level in Medical School. However, the prevalence was significantly higher in females than males (33/80 vs 60/239, P = 0.007). There were no significant differences between the IBS-group and the non-IBS group in aspect of nutrition. Not only the diet habits, but also the daily nutritional intake, and even the breakdown into the 12 micronutrients, yielded no significant differences between the 2 groups.ConclusionsTwenty-nine percent of the medical college students have IBS with a greater prevalence in females. The dietary habits and nutritional intake of the students might not be associated with IBS.

Background/AimsThe most common cause of chronic periodontitis is poor oral hygiene. Gastroesophageal reflux disease (GERD) enhances the proximal migration of gastric contents and may cause poor oral hygiene. We hypothesized that GERD may increase thse risk of chronic periodontitis and investigated this potential relationship.MethodsA retrospective cross-sectional study was conducted in outpatients between January 1, 2010, and April 30, 2012. GERD was defined as being present based on at least two of the following criteria: etiologic agent(s), identifiable signs and symptoms, and consistent anatomic alterations. A total of 280 patients with chronic periodontitis and 280 controls were analyzed. Information regarding patient demographics and other potential confounding factors for chronic periodontitis were collected through individual medical records.ResultsGERD was revealed to be independently associated with an increased incidence of chronic periodontitis (odds ratio [OR], 2.883; 95% confidence interval [CI], 1.775 to 4.682). The other three variables of dental caries (OR, 1.531; 95% CI, 1.042 to 2.249), tobacco use (OR, 2.335; 95% CI, 1.461 to 3.730), and history of medication (calcium channel blocker, cyclosporine, or phenytoin) (OR, 2.114; 95% CI, 1.160 to 3.854) were also determined to be independent risk factors.ConclusionsThe present study supported our hypothesis that GERD can be a risk factor for chronic periodontitis.