Intestinal Research

Review

IBD

Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis: Soo-Young Na, Chang Hwan Choi, Eun Mi Song, Ki Bae Bang, Sang Hyoung Park, Eun Soo Kim, Jae Jun Park, Bora Keum, Chang Kyun Lee, Bo-In Lee, Seung-Bum Ryoo, Seong-Joon Koh, Miyoung Choi, Joo Sung Kim, on behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases; Intest Res 2023;21(1):61-87. Published online May 31, 2022; DOI: https://doi.org/10.5217/ir.2022.00007

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Ulcerative colitis (UC), a relapsing-remitting chronic inflammatory bowel disease (IBD), has a variable natural course but potentially severe disease course. Since the development of anti-tumor necrosis factor (TNF) agents has changed the natural disease course of moderate-to-severe UC, therapeutic options for patients who failed conventional treatments are expanding rapidly. IBD clinical trials have demonstrated the potential efficacy and safety of novel biologics such as anti-integrin α4β7 and anti-interleukin-12/23 monoclonal antibodies and small molecules such as a Janus kinase inhibitor. Anti-TNF biosimilars also have been approved and are widely used in IBD patients. Wise drug choices should be made considering evidence-based efficacy and safety. However, the best position of these drugs remains several questions, with limited data from direct comparative trials. In addition, there are still concerns to be elucidated on the effect of therapeutic drug monitoring and combination therapy with immunomodulators. The appropriate treatment regimens in acute severe UC and the risk of perioperative use of biologics are unclear. As novel biologics and small molecules have been approved in Korea, we present the Korean guidelines for medical management of adult outpatients with moderate-to-severe UC and adult hospitalized patients with acute severe UC, focusing on biologics and small molecules.

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Original Article

Endoscopy

Three-year colonoscopy surveillance after polypectomy in Korea: a Korean Association for the Study of Intestinal Diseases (KASID) multicenter prospective study: Won Seok Choi, Dong Soo Han, Chang Soo Eun, Dong Il Park, Jeong-Sik Byeon, Dong-Hoon Yang, Sung-Ae Jung, Sang Kil Lee, Sung Pil Hong, Cheol Hee Park, Suck-Ho Lee, Jeong-Seon Ji, Sung Jae Shin, Bora Keum, Hyun Soo Kim, Jung Hye Choi, Sin-Ho Jung; Intest Res 2018;16(1):126-133. Published online January 18, 2018; DOI: https://doi.org/10.5217/ir.2018.16.1.126

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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.

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Erratum

Erratum: Treatment of inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2^nd Asian Organization for Crohn's and Colitis (AOCC) meeting in Seoul: Hiroshi Nakase, Bora Keum, Byong Duk Ye, Soo Jung Park, Hoon Sup Koo, Chang Soo Eun; Intest Res 2016;14(4):381-381. Published online October 17, 2016; DOI: https://doi.org/10.5217/ir.2016.14.4.381

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Quality of Care in Inflammatory Bowel Disease: the Role of Steroid Assessment Tool (SAT) - a Review
Loredana GORAN, Monica STATE, Ana NEGREANU, Lucian NEGREANU
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Original Articles

Treatment of inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2^nd 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; Intest Res 2016;14(3):231-239. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.231

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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.

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Gastric lesions in patients with Crohn's disease in Korea: a multicenter study: Hoonsub So, Byong Duk Ye, Young Soo Park, Jihun Kim, Joo Sung Kim, Won Moon, Kang-Moon Lee, You Sun Kim, Bora Keum, Seong-Eun Kim, Kyeong Ok Kim, Eun Soo Kim, Chang Kyun Lee, Sung Pil Hong, Jong Pil Im, Ja Seol Koo, Chang Hwan Choi, Jeong Eun Shin, Bo In Lee, Kyu Chan Huh, Young-Ho Kim, Hyun-Soo Kim, Young Sook Park, Dong Soo Han; Intest Res 2016;14(1):60-68. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.60

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Background/Aims

Gastric pathology and Helicobacter pylori (H. pylori) infection among Asian patients with Crohn's disease (CD) are still unclear. We evaluated gastric histologic features and frequency of H. pylori infection in Korean patients with CD.

Methods

Among 492 patients with CD receiving upper gastrointestinal (GI) endoscopic evaluation in 19 Korean hospitals, we evaluated the endoscopic findings and gastric histopathologic features of 47 patients for our study. Histopathologic classification was performed using gastric biopsy tissues, and H. pylori infection was determined using the rapid urease test and histology.

Results

There were 36 men (76.6%), and the median age of patients at the time of upper GI endoscopy was 23.8 years (range, 14.2–60.5). For CD phenotype, ileocolonic disease was observed in 38 patients (80.9%), and non-stricturing, non-penetrating disease in 31 patients (66.0%). Twenty-eight patients (59.6%) complained of upper GI symptoms. Erosive gastritis was the most common gross gastric feature (66.0%). Histopathologically, H. pylori-negative chronic active gastritis (38.3%) was the most frequent finding. H. pylori testing was positive in 11 patients (23.4%), and gastric noncaseating granulomata were detected in 4 patients (8.5%). Gastric noncaseating granuloma showed a statistically significant association with perianal abscess/fistula (P=0.0496).

Conclusions

H. pylori-negative chronic active gastritis appears to be frequent among Korean patients with CD. The frequency of H. pylori infection was comparable with previous studies. An association with perianal complications suggests a prognostic value for gastric noncaseating granuloma in patients with CD.

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Endoscopic findings in the upper gastrointestinal tract in patients with Crohn’s disease are common, highly specific, and associated with chronic gastritis
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Scientific Reports.2023;[Epub] CrossRef
Detection Rates of Non-Cavitary Epithelioid Cell Granuloma by Gastrointestinal Biopsy in Patients with Treatment-Naïve Crohn’s Disease
Katsuya Endo, Yoko Kawakami, Yuki Yoshino, Shiho Kondo, Daisuke Fukushi, Atsuko Takasu, Takayuki Kogure, Morihisa Hirota, Kazuhiro Murakami, Kennichi Satoh
Inflammatory Intestinal Diseases.2023; 8(3): 105. CrossRef
Beyond Helicobacter: dealing with other variants of gastritis—an algorithmic approach
Hala El‐Zimaity, Robert H Riddell
Histopathology.2021; 78(1): 48. CrossRef
Endoscopic and Histopathological Findings of the Esophagus, Stomach, and Duodenum in Patients with Crohn’s Disease from a Reference Center in Bahia, Brazil
Andrea Maia Pimentel, Luiz Antônio Rodrigues de Freitas, Rita de Cássia Reis Cruz, Isaac Neri de Novais Silva, Laíla Damasceno Andrade, Paola Nascimento Marques, Júlia Cordeiro Braga, Flora Maria Lorenzo Fortes, Katia Rejane Marques Brito, Jaciane Araújo
Clinics and Practice.2021; 11(2): 374. CrossRef
The gastric microbiota in patients with Crohn’s disease; a preliminary study
Jerzy Ostrowski, Maria Kulecka, Iwona Zawada, Natalia Żeber-Lubecka, Agnieszka Paziewska, Katarzyna Graca-Pakulska, Krzysztof Dąbkowski, Karolina Skubisz, Patrycja Cybula, Filip Ambrożkiewicz, Elżbieta Urasińska, Michał Mikula, Teresa Starzyńska
Scientific Reports.2021;[Epub] CrossRef
Associations between the Presence of Granulomata and Disease Phenotype and Outcomes in Children Diagnosed with Crohn’s Disease
Laura Appleton, Euan Watt, Fiona Jagger, Richard Hansen, Richard B. Gearry, Andrew S. Day
Gastrointestinal Disorders.2020; 2(2): 164. CrossRef
Ovarian Crohn’s Disease: A Case Report and Review of the Literature
Hamza Mohammed, Rana Bokhary, Mohammed Nassif, Mahmoud Mosli, Haruhiko Sugimura
Case Reports in Gastrointestinal Medicine.2020; 2020: 1. CrossRef
Crohn’s disease of esophagus, stomach and duodenum
Andréa Maia Pimentel, Raquel Rocha, Genoile Oliveira Santana
World Journal of Gastrointestinal Pharmacology and Therapeutics.2019; 10(2): 35. CrossRef
Prognostic significance of granulomas in children with Crohn’s disease
Benjamin Rothschild, Firas Rinawi, Yonatan Herman, Osnat Nir, Raanan Shamir, Amit Assa
Scandinavian Journal of Gastroenterology.2017; 52(6-7): 716. CrossRef
Endoscopic Bamboo Joint-like Appearance of the Stomach in Crohn's Disease
Kwang Il Seo, Won Moon
The Korean Journal of Gastroenterology.2017; 69(2): 151. CrossRef
Characteristics of Upper Gastrointestinal Tract Involvement in Korean Pediatric Crohn's Disease: A Multicenter Study
Ji Hyoung Park, Hye Na Nam, Ji-Hyuk Lee, Jeana Hong, Dae Yong Yi, Eell Ryoo, In Sang Jeon, Hann Tchah
Pediatric Gastroenterology, Hepatology & Nutrition.2017; 20(4): 227. CrossRef
Increased duodenal expression of miR-146a and -155 in pediatric Crohn’s disease
Dániel Szűcs, Nóra Judit Béres, Réka Rokonay, Kriszta Boros, Katalin Borka, Zoltán Kiss, András Arató, Attila J Szabó, Ádám Vannay, Erna Sziksz, Csaba Bereczki, Gábor Veres
World Journal of Gastroenterology.2016; 22(26): 6027. CrossRef

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Review

Variable Clinical Classifications and Diagnostic Coding Systems of Colorectal Neuroendocrine Tumor: Byung Chang Kim, Cheol Hee Park, Tae Il Kim, Suck-Ho Lee, Jin-Oh Kim, Hyun Soo Kim, Dong-Hoon Yang, Bora Keum, Sung Pil Hong, Seong-Eun Kim, Hyun Gun Kim, Jeong Eun Shin, Jae Myung Cha, Young Eun Joo, Dong Il Park, Hwang Choi, Kyu Chan Huh, Seung-Jae Myung, Dong Kyung Chang, Seun Ja Park; Intest Res 2013;11(1):14-22. Published online January 31, 2013; DOI: https://doi.org/10.5217/ir.2013.11.1.14

Abstract PDF

The incidence of colorectal carcinoid tumor is recently increasing as screening colonoscopy increased. Traditional carcinoid tumor had been known as low grade, malignant neuroendocrine cell orign tumor. In 2000, World Health Organization (WHO) suggested that carcinoid was called well-differentiated neuroendocrine tumor (NET). It recently updated in 2010 by WHO; according to the differentiation and malignant potential, NET classified with NET Grade 1, Grade 2, and neuroendocrine carcinoma. They suggested that NET had malignant potential in accordance with histopathologic characteristics. Therefore, WHO recommended the behavior code of NET as malignant. However, European Neuroendocrine Tumor Society (ENETS) proposed the behavior of NET to four grades based on the histopathologic features; benign, benign or low grade malignant, low grade malignant, and high grade malignant. Also, American Joint Committee on Cancer (AJCC) suggested that topography codes of NET were defined as malignant. Korean Standard Classification of Diseases (KCD) described the different codings of carcinoid (NET). The discrepancies of behavior code or coding system exist among WHO, ENETS, AJCC and KCD. Also, there were differences in the perception for topographic coding system between clinicians and pathologists. NETs of colorectum were reported with the variable clinical characteristics (especially, metastasis) and long term prognosis from many studies. Especially, risk of metastasis and long term prognosis of small sized NET (<1 cm) had some discrepancies and should be investigated prospectively. Therefore, the consensus about topographic codes of NET should be needed with multidisplinary approach among gastroenterologists, pathologists and surgeons. (Intest Res 2013;11:14-22)

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Efficacy of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors
Hoonsub So, Su Hyun Yoo, Seungbong Han, Gwang-un Kim, Myeongsook Seo, Sung Wook Hwang, Dong-Hoon Yang, Jeong-Sik Byeon
Clinical Endoscopy.2017; 50(6): 585. CrossRef
Diagnostic Coding for Intramucosal Carcinoma and Neuroendocrine Tumor in the Colorectum: Proposal for Avoiding Confusing Coding in Korea
Dong Soo Han, Jin Hee Sohn, Jeong-Sik Byeon, Hwang Choi, Joon Mee Kim
Clinical Endoscopy.2015; 48(3): 216. CrossRef
Highlights from the 50th Seminar of the Korean Society of Gastrointestinal Endoscopy
Eun Young Kim, Il Ju Choi, Kwang An Kwon, Ji Kon Ryu, Seok Ho Dong, Ki Baik Hahm
Clinical Endoscopy.2014; 47(4): 285. CrossRef

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Case Reports

A Case of Cronkhite-Canada Syndrome Presenting with Hematochezia: Hyun Ji Lee, Sang Jung Park, Hyuk Soon Choi, Bora Keum, Yeon Seok Seo, Yong Sik Kim, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu; Intest Res 2011;9(3):238-242. Published online December 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.3.238

Abstract PDF

Cronkhite-Canada syndrome (CCS) is a rare, non-familial hamartomatous polyposis syndrome characterized by multiple polyps in the entire gastrointestinal tract, nail dystrophy, skin pigmentation, and systemic alopecia. The clinical symptoms of this syndrome include diarrhea, abdominal pain, and alopecia often accompanied by taste disturbances, hypoalbuminemia, recurrent infections, nutritional absorption disturbances, heart failure, and gastrointestinal bleeding. We report a patient with CCS who was admitted complaining of hematochezia, melena, and a 1 month history of diarrhea, nail changes, taste disturbances, and alopecia. Upper endoscopy, colonoscopy, and capsule endoscopy were performed and showed numerous polyps in the stomach, small intestine, and large intestine. Histological sections of these polyps showed edematous stroma and cystically dilated foveolar epithelium, which was consistent with CCS. We diagnosed CCS based on the clinical symptoms and the histological findings of the polyps found via endoscopy. We report on this case and review this syndrome. (Intest Res 2011;9:238-242)

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Cronkhite-Canada Syndrome Associated with Serrated Adenoma and Malignant Polyp: A Case Report and a Literature Review of 13 Cronkhite-Canada Syndrome Cases in Korea
So Hee Yun, Jin Woong Cho, Ji Woong Kim, Joong Keun Kim, Moon Sik Park, Na Eun Lee, Jae Un Lee, Young Jae Lee
Clinical Endoscopy.2013; 46(3): 301. CrossRef
A Case of Cronkhite-Canada Syndrome Showing Spontaneous Remission
Dong-Uk Kang, Dong-Hoon Yang, Yunsik Choi, Ji-Beom Kim, Ho-Su Lee, Hyo Jeong Lee, Sang Hyoung Park, Kee Wook Jung, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim
Intestinal Research.2013; 11(4): 317. CrossRef

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A Case of Pyoderma Gangrenosum of the Face Associated with Ulcerative Colitis: Eun Sil Kim, Min Ho Seo, Hyuk Soon Choi, Bora Keum, Yeon Seok Seo, Yong Sik Kim, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu; Intest Res 2011;9(3):225-229. Published online December 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.3.225

Abstract PDF: Ulcerative colitis is associated with various extra-intestinal manifestations, including rheumatic, dermatologic, ophthalmologic, biliary, and hematologic manifestations. Cutaneous findings are common extra-intestinal manifestations of ulcerative colitis, occurring in 10-20% of patients. Cutaneous manifestations include erythema nodosum, pyoderma gangrenosum, aphthous stomatitis, and acute febrile neutrophilic dermatosis. Treatments for these cutaneous manifestations include corticosteroids, cyclosporine, tacrolimus, mycophenolate mofetil, azathioprine, and infliximab. A 48-year-old male presented with an acute exacerbation of ulcerative colitis associated with multiple skin lesions on his face, thumbs, thighs, and feet. The final impression was neutrophilic folliculitis, which is an early form of pyoderma gangrenosum. The patient's skin lesions and colitis both improved with corticosteroids. There are rare published case reports of ulcerative colitis exacerbations associated with pyoderma gangrenosum that initiated as neutrophilic folliculitis of the face. This case report includes a review of the literature. (Intest Res 2011;9:225-229)

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Review

Clinical Classification of Colorectal Epithelial Tumors and Proposal for Diagnostic Coding: Hyun Gun Kim, Jin-Oh Kim, Suck-Ho Lee, Chang Kyun Lee, Hyun Soo Kim, Hwang Choi, Dong-Hoon Yang, Bora Keum, Sung Pil Hong, Seong-Eun Kim, Byung Chang Kim, Jeong Eun Shin, Cheol Hee Park, Chang Soo Eun, Tae Il Kim, Dong Il Park, Kyu Chan Huh, Dong Kyung Chang, Seun Ja Park; Intest Res 2011;9(1):1-11. Published online April 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.1.1

Abstract PDF

The Korean Standard Classification of Diseases (KCD), which reflects the International Classification of Diseases (ICD), is a fundamental coding system for the diagnosis of colorectal epithelial tumors. The KCD coding of colorectal lesions is entirely up to the clinician and is based on pathologic reports. However, coding discrepancies have arisen among physicians using the KCD and pathologists using the ICD for Oncology-3 (ICD-O-3). The Korean Society of Pathologists recently proposed a standardized pathology-reporting format and guidelines for the coding of colorectal cancer to decrease these discrepancies among pathologists. However, ICD and ICD-O are simple classification codes based on pathologic reports, and are neither intended nor suitable for indexing of distinct clinical entities. For appropriate diagnostic coding using the KCD, a corrected coding principle based upon pathologic reports is required, and unified coding between KCD and ICD-O is necessary. A standardized pathologic report format and communication with understanding between physicians and pathologists should be established. Additionally, the private medical insurance system for colorectal cancer should be revised to reduce conflicts among patients, clinicians, and insurance companies over the medical coding system. (Intest Res 2011;9: 2-11)

Citations

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Diagnostic Coding for Intramucosal Carcinoma and Neuroendocrine Tumor in the Colorectum: Proposal for Avoiding Confusing Coding in Korea
Dong Soo Han, Jin Hee Sohn, Jeong-Sik Byeon, Hwang Choi, Joon Mee Kim
Clinical Endoscopy.2015; 48(3): 216. CrossRef
Diminutive and Small Colorectal Polyps: The Pathologist's Perspective
Yun Kyung Kang
Clinical Endoscopy.2014; 47(5): 404. CrossRef
Early Colorectal Epithelial Neoplasm in Korea: A Multicenter Survey of Pathologic Diagnosis
Yun Kyung Kang, So-Young Jin, Mee Soo Chang, Jung Yeon Kim, Gyeong Hoon Kang, Hye Seung Lee, Jin Hee Sohn, Ho Sung Park, Kye Won Kwon, Mi Jin Gu, Young Hee Maeng, Jong Eun Joo, Haeng Ji Kang, Hee Kyung Kim, Kee-Taek Jang, Mi Ja Lee, Hee Kyung Chang, Joon
Korean Journal of Pathology.2013; 47(3): 245. CrossRef
Update on the Proposal for Creating a Guideline for Cancer Registration of the Gastrointestinal Tumors (I-2)
Eun Sun Jung, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Won Ae Lee, Hee Eun Lee, Sunhoo Park, Jin Hee Sohn, So-Young Jin
Korean Journal of Pathology.2012; 46(5): 443. CrossRef

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Original Articles

Comparison of Bowel Preparation Depending on Completion Time of Polyethylene Glycol Ingestion and Start Time of Colonoscopy: Jang Hyuk Yoon, Dong Il Park, Jeong Eun Shin, Seong Eun Kim, Sung Ae Jung, Suck Ho Lee, Dong Kyung Chang, Chang Soo Eun, Dong Soo Han, Hyun Soo Kim, Seun Ja Park, Il Hyun Baek, Bora Keum, Yoon Tae Jeen; Intest Res 2010;8(1):24-29. Published online June 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.1.24

Abstract PDF

Background/Aims
Polyethylene glycol (PEG) solution is the most widely used bowel preparation agent for colonoscopy because of its safety and efficacy in colon cleansing. It has been hypothesized that the timing of colon preparation may influence the quality of colon cleansing, and therefore affect the diagnostic yield of colonoscopy. The aim of this study was to determine the optimal interval of time between complete ingestion of PEG and performing colonoscopy. Methods: We prospectively enrolled 1,355 patients who had undergone a PEG-based bowel preparation on the day of colonoscopy in 11 tertiary hospitals in Korea between March 2008 and February 2009. All colonoscopies were performed in the afternoon. The start time of PEG ingestion, completion time of PEG ingestion, dose of PEG ingested, start time of colonoscopy, and the quality of bowel cleansing were recorded. Results: There was no difference of cleansing quality of bowel preparation between three groups of less than 7 hours of elapsed time (2≤ and <3 hours, 3≤ and <5 hours, 5≤ and <7 hours). However, group of more than 7 hours of elapsed time presented poor cleansing quality than others (P<0.01). Conclusions: If >7 hours elapses after ingestion of PEG, the quality of bowel preparation is poor. Therefore, depending on the time colonoscopy is scheduled, the start time of PEG ingestion may need to be adjusted. (Intest Res 2010;8:24-29)

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The optimal bowel preparation intervals before colonoscopy: A randomized study comparing polyethylene glycol and low-volume solutions
Vladimir Kojecky, Jan Matous, Radan Keil, Milan Dastych, Zdena Zadorova, Michal Varga, Radek Kroupa, Jiri Dolina, Miroslav Misurec, Ales Hep, Martin Griva
Digestive and Liver Disease.2018; 50(3): 271. CrossRef
Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study
Se Hwan Yeo, Jae Hoon Kwak, Yeo Un Kim, Tae Ho Kwon, Jeong Bae Park, Jun Hyung Park, Yong Kook Lee, Yun Jeong Lim, Chang Heon Yang
The Korean Journal of Gastroenterology.2016; 67(4): 189. CrossRef
Randomized Controlled Trial of Sodium Phosphate Tablets versus 2 L Polyethylene Glycol Solution for Bowel Cleansing prior to Colonoscopy
Yun Ho Lee, Seong Yeon Jeong, You Sun Kim, Hye Jin Jung, Min Jung Kwon, Cheol Hun Kwak, Song I Bae, Jeong Seop Moon, Ji Won Kim, Su Hwan Kim, Kook Lae Lee
The Korean Journal of Gastroenterology.2015; 65(1): 27. CrossRef
Importance of the Time Interval between Bowel Preparation and Colonoscopy in Determining the Quality of Bowel Preparation for Full-Dose Polyethylene Glycol Preparation
Tae Kyung Kim, Hyung Wook Kim, Su Jin Kim, Jong Kun Ha, Hyung Ha Jang, Young Mi Hong, Su Bum Park, Cheol Woong Choi, Dae Hwan Kang
Gut and Liver.2014; 8(6): 625. CrossRef
A Comparison of 2 L of Polyethylene Glycol and 45 mL of Sodium Phosphate versus 4 L of Polyethylene Glycol for Bowel Cleansing: A Prospective Randomized Trial
Suh Eun Bae, Kyung-Jo Kim, Jun Bum Eum, Dong Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim
Gut and Liver.2013; 7(4): 423. CrossRef
A Clear Liquid Diet Is Not Mandatory for Polyethylene Glycol-Based Bowel Preparation for Afternoon Colonoscopy in Healthy Outpatients
Yoon Suk Jung, Hyo Sun Seok, Dong Il Park, Chang Seok Song, Seong Eun Kim, Suck Ho Lee, Chang Soo Eun, Dong Soo Han, Yong Soo Kim, Chang Kyun Lee
Gut and Liver.2013; 7(6): 681. CrossRef
Comparison of Bowel Preparation Quality between Clear-liquid Diet and No Diet Restriction
Woo Shin Jeong, Dong Il Park, Hyo Sun Seok, Seong Eun Kim, Suck-Ho Lee, Chang Kyun Lee, Chang Soo Eun, Dong Soo Han
Intestinal Research.2012; 10(3): 272. CrossRef
Comparison among Conventional 4 L Polyethylene Glycol, Split Method of 4 L Polyethylene Glycol and Combination of 2 L Polyethylene Glycol and Sodium Phosphate Solution for Colonoscopy Preparation
So Young Jo, Nayoung Kim, Jung Won Lee, Ji Hwan Lim, Chiun Choi, Ilyoung Chon, Ho Kil, Bo Young Min, Young Sang Byoun, Ban Seok Lee, Sang Eon Jang, Hyun Kyung Park, Hyun Jin Jo, Cheol Min Shin, Sang Hyup Lee, Young Soo Park, Jin-Hyeok Hwang, Jin-Wook Kim,
The Korean Journal of Gastroenterology.2012; 59(6): 414. CrossRef

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Clinical Significance of Serum C-Reactive Protein in Patients with Colorectal Cancer: Sung Chul Park, Yoon Tae Jeen, Kwang Gyun Lee, Juhyung Kim, Jong Jin Hyun, Eun Sun Kim, Sanghoon Park, Bora Keum, Yeon Seok Seo, Yong Sik Kim, Hoon Jai Chun, Soon Ho Um, Jai Hyun Choi, Chang Duck Kim, Ho Sang Ryu; Intest Res 2009;7(2):93-99. Published online December 30, 2009

Abstract PDF: Background/Aims
C-reactive protein (CRP) is a general marker of inflammation and increased CRP level is reported in several cancers. It has been reported that CRP is an independent factor predicting survival in colorectal cancer patients, although this claim is still under debate. The aim of this study was to investigate the association between CRP and the characteristics of colorectal cancer patients. Methods: One hundred eighty-four patients diagnosed with colorectal cancer between January 2007 and January 2009 were included. The patients with active infectious diseases, other tumors, cardiovascular disease, or inflammatory bowel disease were excluded. The CRP levels of colorectal cancer patients were compared with the control group comprised of 175 healthy adults with a normal colonoscopy. Results: The median CRP in the colorectal cancer patients (3.36 mg/L) was higher than the control group (0.48 mg/L). There was a significant correlation between CRP and the stage of colorectal cancer (p＜0.001). CRP was increased significantly in Dukes' stage D. CRP had a significant correlations with the CEA and CA 19-9 levels, the ESR, and the white blood cell count, and an inverse correlation with albumin. The CRP level in colon cancer patients was higher than rectal cancer patients (p=0.032). There were no significant difference in the CRP according to metastatic sites, such as the liver and peritoneum. Conclusions: Serum CRP levels were higher in patients with colorectal cancer and high CRP level is a predictor of advanced disease. (Intest Res 2009;7:93-99)

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Calreticulin Expression in Colon Cancer and Adenoma with Western Blot Assay: Bora Keum, Yoon Tae Jeen, Sanghoon Park, Yeon Seok Seo, Yong Sik Kim, Hoon Jai Chun, Hong Sik Lee, Soon Ho Um, Sang Woo Lee, Jai Hyun Choi, Chang Duck Kim, Ho Sang Ryu; Intest Res 2006;4(1):7-11. Published online June 30, 2006

Abstract PDF: 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)

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Clinical Value of Distal Colon Polyps for Prediction of Advanced Proximal Neoplasia: The KASID Prospective Multicenter Study: Bora Keum, Yoon Tae Jeen, Jai Hyun Choi, Sung-Ae Jung, Hyun Soo Kim, Young-Ho Kim, Won Ho Kim, Tae Il Kim, Hyo Jong Kim, Suk Kyun Yang, Seung Jae Myung, Jeong Sik Byeon, Moon Sung Lee, Il Kwon Jung, Moon Kwan Chung, Hwang Choi, Dong Soo Han, Jae Suk Song; Intest Res 2005;3(2):121-126. Published online December 30, 2005

Abstract PDF: 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)

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