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Original Articles
Colorectal neoplasia
Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery
Yun Sik Choi, Wan Soo Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
Intest Res 2020;18(1):96-106.   Published online January 30, 2020
DOI: https://doi.org/10.5217/ir.2019.00092
AbstractAbstract PDFPubReaderePub
Background/Aims
We aimed to investigate the proportion of and risk factors for residual cancer and/or lymph node metastasis after surgery was performed because of high-risk pathological features in endoscopic resection specimen of suspected superficial submucosal colorectal cancer (SSMC).
Methods
We reviewed medical records of 497 patients (58.8 ± 9.8 years, 331 males) undergoing endoscopic resection of suspected SSMC. High-risk pathological features included: deep submucosal cancer invasion ≥ 1,000 μm; positive lymphovascular and/or perineural invasion; poorly differentiated adenocarcinoma; and positive resection margin. We investigated the occurrence of additional surgery and residual cancer and/or lymph node involvement in the surgical specimen.
Results
En bloc resection was performed in 447 patients (89.9%). High-risk pathological features were detected in 372 patients (74.8%). Additional surgery was performed in 336 of 372 patients with high-risk pathological features. Of these, 47 surgical specimens (14.0%) showed residual cancer and/or lymph node metastasis. Piecemeal resection was more common in those with residual cancer and/or lymph node involvement than those without (9/47 [19.1%] vs. 24/289 [8.3%], P= 0.032). Positive resection margin was also significantly associated with positive residual cancer and/or lymph node involvement. As the number of high-risk pathological features increased, the risk of regional lymph node metastasis increased proportionally (P= 0.002).
Conclusions
High-risk pathological features were frequently detected after endoscopic resection of suspected SSMC while residual cancer and/or lymph node metastasis were not commonly present in the additional surgical specimen. Further optimized strategy for proper endoscopic management of suspected SSMC is necessary.

Citations

Citations to this article as recorded by  
  • Artificial Intelligence Models May Aid in Predicting Lymph Node Metastasis in Patients with T1 Colorectal Cancer
    Ji Eun Baek, Hahn Yi, Seung Wook Hong, Subin Song, Ji Young Lee, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Namkug Kim, Jeong-Sik Byeon
    Gut and Liver.2025; 19(1): 69.     CrossRef
  • Artificial Intelligence in Lymph Node Metastasis Prediction for T1 Colorectal Cancer: Promise and Challenges
    Jung Ho Bae
    Gut and Liver.2025; 19(1): 3.     CrossRef
  • Survey of the Actual Practices Used for Endoscopic Removal of Colon Polyps in Korea: A Comparison with the Current Guidelines
    Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong-Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoon Yang, Eun R
    Gut and Liver.2025; 19(1): 77.     CrossRef
  • Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer – a nationwide cross-sectional cohort study
    L.R. Moolenaar, E.G.M. van Geffen, S.J.A. Hazen, T.C. Sluckin, G.L. Beets, J.W.A. Leijtens, A.K. Talsma, J.H.W. de Wilt, P.J. Tanis, M. Kusters, R. Hompes, J.B. Tuynman, Arend G.J. Aalbers, Susanna M. van Aalten, Femke J. Amelung, Marjolein Ankersmit, Imo
    European Journal of Surgical Oncology.2025; : 109623.     CrossRef
  • Survival machine learning model of T1 colorectal postoperative recurrence after endoscopic resection and surgical operation: a retrospective cohort study
    Zhihong Li, Yiliyaer Aihemaiti, Qianqian Yang, Yiliminuer Ahemai, Zimei Li, Qianqian Du, Yan Wang, Hanxiang Zhang, Yingbin Cai
    BMC Cancer.2025;[Epub]     CrossRef
  • Curative criteria for endoscopic treatment of colorectal cancer
    Lucille Quénéhervé, Mathieu Pioche, Jérémie Jacques
    Best Practice & Research Clinical Gastroenterology.2024; 68: 101883.     CrossRef
  • Early Rectal Cancer and Local Excision: A Narrative Review
    Cecilia Binda, Matteo Secco, Luigi Tuccillo, Chiara Coluccio, Elisa Liverani, Carlo Felix Maria Jung, Carlo Fabbri, Giulia Gibiino
    Journal of Clinical Medicine.2024; 13(8): 2292.     CrossRef
  • Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens
    Joo Hye Song, Eun Ran Kim, Yiyu Hong, Insuk Sohn, Soomin Ahn, Seok-Hyung Kim, Kee-Taek Jang
    Cancers.2024; 16(10): 1900.     CrossRef
  • How secure can we expect the surveillance policies to be after the implementation in T1 polyps with carcinoma?
    Cristina Mateos Sanchez, Elvira Quintanilla Lazaro, Luis Ramon Rabago
    World Journal of Gastrointestinal Endoscopy.2024; 16(9): 502.     CrossRef
  • Comparative prediction of lymph node metastasis in pT1 colorectal cancer among Western and Japanese guidelines
    Fumiaki Tanino, Ken Yamashita, Shin Morimoto, Yudai Takehara, Noriko Yamamoto, Yuki Kamigaichi, Tomoyuki Nishimura, Hidenori Tanaka, Hidehiko Takigawa, Yuji Urabe, Toshio Kuwai, Fumio Shimamoto, Shiro Oka
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • The risk factors of lymph node metastasis in early colorectal cancer: a predictive nomogram and risk assessment
    Jiahui Xu, Fan Yin, Linlin Ren, Yushuang Xu, Congcong Min, Peng Zhang, Mengyu Cao, Xiaoyu Li, Zibin Tian, Tao Mao
    International Journal of Colorectal Disease.2024;[Epub]     CrossRef
  • Comment on " Positive fecal immunochemical test results are associated with non-colorectal cancer mortality"
    Yong Eun Park
    The Korean Journal of Internal Medicine.2023; 38(2): 264.     CrossRef
  • Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma
    Hyun Jin Bae, Hoyeon Ju, Han Hee Lee, Jinsu Kim, Bo-In Lee, Sung Hak Lee, Daeyoun David Won, Yoon Suk Lee, In Kyu Lee, Young-Seok Cho
    Surgical Endoscopy.2023; 37(2): 1231.     CrossRef
  • Comparative Cost Analysis Between Endoscopic Resection and Surgery for Submucosal Colorectal Cancer
    Soo Min Noh, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, In Ja Park, Seok-Byung Lim, Jeong-Sik Byeon
    Diseases of the Colon & Rectum.2023; 66(5): 723.     CrossRef
  • Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos)
    Jieun Lee, Yoo Jin Lee, Jong Won Seo, Eun Soo Kim, Sung Kook Kim, Min Kyu Jung, Jun Heo, Hyun Seok Lee, Joon Seop Lee, Byung Ik Jang, Kyeong Ok Kim, Kwang Bum Cho, Eun Young Kim, Dae Jin Kim, Yun Jin Chung
    Surgical Endoscopy.2023; 37(8): 5865.     CrossRef
  • Usage trends of colorectal endoscopic submucosal dissection according to hospital types based on nationwide claims data
    Ji Eun Na, Bohyoung Kim, Sung Hoon Jung, Arum Choi, Sukil Kim, Tae-Oh Kim
    Medicine.2023; 102(43): e35514.     CrossRef
  • Risk and Time Pattern of Recurrences After Local Endoscopic Resection of T1 Colorectal Cancer: A Meta-analysis
    Hao Dang, Nik Dekkers, Saskia le Cessie, Jeanin E. van Hooft, Monique E. van Leerdam, Philip P. Oldenburg, Louis Flothuis, Jan W. Schoones, Alexandra M.J. Langers, James C.H. Hardwick, Jolein van der Kraan, Jurjen J. Boonstra
    Clinical Gastroenterology and Hepatology.2022; 20(2): e298.     CrossRef
  • Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?
    Han Hee Lee
    Clinical Endoscopy.2022; 55(2): 315.     CrossRef
  • Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis
    Liselotte W. Zwager, Barbara A.J. Bastiaansen, Nahid S.M. Montazeri, Roel Hompes, Valeria Barresi, Katsuro Ichimasa, Hiroshi Kawachi, Isidro Machado, Tadahiko Masaki, Weiqi Sheng, Shinji Tanaka, Kazutomo Togashi, Chihiro Yasue, Paul Fockens, Leon M.G. Moo
    Gastroenterology.2022; 163(1): 174.     CrossRef
  • Utility of artificial intelligence with deep learning of hematoxylin and eosin-stained whole slide images to predict lymph node metastasis in T1 colorectal cancer using endoscopically resected specimens; prediction of lymph node metastasis in T1 colorecta
    Joo Hye Song, Yiyu Hong, Eun Ran Kim, Seok-Hyung Kim, Insuk Sohn
    Journal of Gastroenterology.2022; 57(9): 654.     CrossRef
  • Endoscopic diagnosis and treatment of early colorectal cancer
    Seung Wook Hong, Jeong-Sik Byeon
    Intestinal Research.2022; 20(3): 281.     CrossRef
  • Long-term prognosis of curative endoscopic submucosal dissection for early colorectal cancer according to submucosal invasion: a multicenter cohort study
    Jongbeom Shin, Eun Ran Kim, Hyun Joo Jang, Dong Hoon Baek, Dong-Hoon Yang, Bo-In Lee, Kwang Bum Cho, Jin Woong Cho, Sung-Ae Jung, Su Jin Hong, Bong Min Ko, Jung-Won Jeon, Weon Jin Ko, Sun Moon Kim, Young Dae Kim, Kim Chan Gyoo, Gwang Ho Baik, In Kyung Yoo
    BMC Gastroenterology.2022;[Epub]     CrossRef
  • Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
    Ji Young Chang
    Clinical Endoscopy.2022; 55(5): 699.     CrossRef
  • 7,253 View
  • 187 Download
  • 23 Web of Science
  • 23 Crossref
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Clinical outcome of endoscopic management in delayed postpolypectomy bleeding
Jeong-Mi Lee, Wan Soo Kim, Min Seob Kwak, Sung-Wook Hwang, Dong-Hoon Yang, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
Intest Res 2017;15(2):221-227.   Published online April 27, 2017
DOI: https://doi.org/10.5217/ir.2017.15.2.221
AbstractAbstract PDFPubReaderePub
<b>Background/Aims</b><br/>

The clinical course after endoscopic management of delayed postpolypectomy bleeding (DPPB) has not been clearly determined. This study aimed to assess clinical outcomes after endoscopic hemostasis of DPPB and evaluate risk factors for rebleeding after initial hemostasis.

Methods

We reviewed medical records of 198 patients who developed DPPB and underwent endoscopic hemostasis between January 2010 and February 2015. The performance of endoscopic hemostasis was assessed. Rebleeding negative and positive patients were compared.

Results

DPPB developed 1.4±1.6 days after colonoscopic polypectomy. All patients achieved initial hemostasis. Clipping was the most commonly used technique. Of 198 DPPB patients, 15 (7.6%) had rebleeding 3.3±2.5 days after initial hemostasis. The number of clips required for hemostasis was higher in the rebleeding positive group (3.2±1.6 vs. 4.2±1.9, P=0.047). Combinations of clipping with other modalities such as injection methods were more common in the rebleeding positive group (67/291, 23.0% vs. 12/17, 70.6%; P<0.001). Multivariate analysis showed a large number of clips and combination therapy were independent risk factors for rebleeding. All the rebleeding cases were successfully managed by repeat endoscopic hemostasis.

Conclusions

Endoscopic hemostasis is effective for the management of DPPB because of its high initial hemostasis rate and low rebleeding rate. Endoscopists should carefully observe patients in whom a large number of clips and/or combination therapy have been used to manage DPPB because these may be related to the severity of DPPB and a higher risk of rebleeding.

Citations

Citations to this article as recorded by  
  • Delphi consensus statement for the management of delayed post-polypectomy bleeding
    Enrique Rodríguez de Santiago, Sandra Pérez de la Iglesia, Diego de Frutos, José Carlos Marín-Gabriel, Carolina Mangas-SanJuan, Raúl Honrubia López, Hugo Uchima, Marta Aicart-Ramos, Miguel Ángel Rodríguez Gandía, Eduardo Valdivielso Cortázar, Felipe Ramos
    Therapeutic Advances in Gastroenterology.2025;[Epub]     CrossRef
  • Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
    Hisham Wehbe, Aditya Gutta, Mark A. Gromski
    Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 363.     CrossRef
  • The Use of Clips to Prevent Post-Polypectomy Bleeding: A Clinical Review
    Matthew A. O’Mara, Peter G. Emanuel, Aaron Tabibzadeh, Robert J. Duve, Jonathan S. Galati, Gregory Laynor, Samantha Gross, Seth A. Gross
    Journal of Clinical Gastroenterology.2024; 58(8): 739.     CrossRef
  • Is endoscopic hemostasis safe and effective for delayed post-polypectomy bleeding?
    Jae-Yong Cho, Yunho Jung, Han Hee Lee, Jung-Wook Kim, Kee Myung Lee, Hyun Lim, Geun-Hyuk Choi, Seong Woo Choi, Bo-In Lee
    International Journal of Gastrointestinal Intervention.2024; 13(4): 122.     CrossRef
  • Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps: two or more clips may be safe
    Xue-Feng Guo, Xiang-An Yu, Jian-Cong Hu, De-Zheng Lin, Jia-Xin Deng, Ming-Li Su, Juan Li, Wei Liu, Jia-Wei Zhang, Qing-Hua Zhong
    Gastroenterology Report.2022;[Epub]     CrossRef
  • Management and Outcomes of Bleeding Within 30 Days of Colonic Polypectomy in a Large, Real-Life, Multicenter Cohort Study
    Enrique Rodríguez de Santiago, Maria Hernández-Tejero, Liseth Rivero-Sánchez, Oswaldo Ortiz, Irene García de la Filia-Molina, Jose Ramon Foruny-Olcina, Hector Miguel Marcos Prieto, Maria García-Prada, Almudena González-Cotorruelo, Miguel Angel De Jorge Tu
    Clinical Gastroenterology and Hepatology.2021; 19(4): 732.     CrossRef
  • Clinical Features of Re-Colonoscopy after Bleeding after Intestinal Polypectomy
    慧敏 翟
    Advances in Clinical Medicine.2021; 11(11): 5151.     CrossRef
  • Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy
    A. Rajendran, S. Pannick, S. Thomas‐Gibson, S. Oke, C. Anele, N. Sevdalis, A. Haycock
    Colorectal Disease.2020; 22(9): 1085.     CrossRef
  • Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy
    Hosim Soh, Jaeyoung Chun, Seung Wook Hong, Seona Park, Yun Bin Lee, Hyun Jung Lee, Eun Ju Cho, Jeong-Hoon Lee, Su Jong Yu, Jong Pil Im, Yoon Jun Kim, Joo Sung Kim, Jung-Hwan Yoon
    Gut and Liver.2020; 14(6): 755.     CrossRef
  • Post-polypectomy Visible Vessel
    Matthew Woo, Robert Bechara
    Journal of the Canadian Association of Gastroenterology.2018; 1(2): 51.     CrossRef
  • Comprehensive review of outcomes of endoscopic treatment of gastrointestinal bleeding
    Tae-Geun Gweon, Jinsu Kim
    International Journal of Gastrointestinal Intervention.2018; 7(3): 123.     CrossRef
  • 6,026 View
  • 73 Download
  • 9 Web of Science
  • 11 Crossref
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Case Report
Chronic intractable diarrhea caused by gastrointestinal mastocytosis
Hyungil Seo, Sang Hyoung Park, Jeong-Sik Byeon, Chang Gok Woo, Seung-Mo Hong, Kiju Chang, Hoonsub So, Minseob Kwak, Wan Soo Kim, Jeong-Mi Lee, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang
Intest Res 2016;14(3):280-284.   Published online June 27, 2016
DOI: https://doi.org/10.5217/ir.2016.14.3.280
AbstractAbstract PDFPubReaderePub

As mast cells have been highlighted in the pathogenesis of diarrhea-predominant irritable bowel syndrome, a new term "mastocytic enterocolitis" was suggested by Jakate and colleagues to describe an increase in mucosal mast cells in patients with chronic intractable diarrhea and favorable response to treatment with antihistamines. Although it is not an established disease entity, two cases have been reported in the English medical literature. Here, for the first time in Asia, we report another case of chronic intractable diarrhea caused by gastrointestinal mastocytosis. The patient was a 70-year-old male with chronic intractable diarrhea for 3 months; the cause of the diarrhea remained obscure even after exhaustive evaluation. However, biopsy specimens from the jejunum were found to have increased mast cell infiltration, and the patient was successfully treated with antihistamines.

Citations

Citations to this article as recorded by  
  • Mastocytic Enterocolitis: An Overlooked Diagnosis for Unexplained Chronic Diarrhea in a Patient With Colon Polyps and a Family History of Colon Cancer
    Leeann Hu, Liliana Franco, Jignesh Parikh, Vania Zayat
    Cureus.2023;[Epub]     CrossRef
  • Systemic Mastocytosis: A Rare Cause of Diarrhea
    Leonard Hamera, Andrew M Santos, Sean-Patrick A Prince, Sreekanth Chandrupatla, Jeffrey Jordan
    Cureus.2020;[Epub]     CrossRef
  • Gastrointestinal Manifestations of Hypereosinophilic Syndromes and Mast Cell Disorders: a Comprehensive Review
    Vivian C. Nanagas, Anna Kovalszki
    Clinical Reviews in Allergy & Immunology.2019; 57(2): 194.     CrossRef
  • Mastocytosis
    Jingtao Chen, Patrick Brady, Jay Mamel
    The Nurse Practitioner.2019; 44(8): 17.     CrossRef
  • The roles of mast cells in allergic inflammation and mast cell-related disorders
    Hee-Kyoo Kim
    Allergy, Asthma & Respiratory Disease.2017; 5(5): 248.     CrossRef
  • 9,523 View
  • 93 Download
  • 7 Web of Science
  • 5 Crossref
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