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Original Article
Endoscopic Factors that Can Predict Histological Ulcerations in Early Gastric Cancers
Jaesin Lee, Byung-Wook Kim, Cheal Wung Huh, Joon Sung Kim, Lee-So Maeng
Clin Endosc 2020;53(3):328-333.   Published online January 7, 2020
DOI: https://doi.org/10.5946/ce.2019.133
AbstractAbstract PDFPubReaderePub
Background
/Aims: Predicting histological ulceration in early gastric cancer (EGC) during endoscopic examination is crucial for endoscopists deciding on the treatment modality. The aim of this study was to investigate the endoscopic factors that can predict histological ulcerations in EGCs.
Methods
We retrospectively analyzed patients who underwent endoscopic submucosal dissection (ESD) for EGC. Clinical features and endoscopic characteristics of EGC such as location, histological differentiation, longest diameter, tumor morphology, mucosal break, converging fold, color change, and surface irregularity were reviewed. Histological ulceration was defined based on ESD specimens.
Results
A total of 633 EGC lesions from 613 patients were included and histological ulcerations were found in 90 lesions (14.2%). Presence of converging folds, tumor morphology, and color changes on endoscopic examination were related to histological ulceration in the univariate analysis and converging folds along with color changes were statistically significant factors in the multivariate analysis. Kaplan–Meier analysis showed that patients with histological ulcerations in EGCs tended to have higher marginal recurrence rates.
Conclusions
Mucosal breaks are not equivalent to histological ulcerations. Rather, the existence of converging folds and color changes during endoscopic examination suggest histological ulcerations. Endoscopists should consider these factors when they decide the treatment modality for EGCs.

Citations

Citations to this article as recorded by  
  • Clinical Impact of Proton Pump Inhibitor and Potassium-Competitive Acid Blocker for Predicting the Curability of Endoscopic Resection in Ulcerative Early Gastric Cancer
    Konomu Uno, Takaya Shimura, Shingo Inaguma, Keita Kuroyanagi, Ruriko Nishigaki, Takuya Kanno, Makiko Sasaki, Shigeki Fukusada, Naomi Sugimura, Yusuke Mizuno, Takayuki Nukui, Yuki Kojima, Mamoru Tanaka, Keiji Ozeki, Eiji Kubota, Satoru Takahashi, Hiromi Ka
    Digestion.2024; 105(3): 192.     CrossRef
  • Identification of maximal tumor size associated with negligible lymph node metastasis for endoscopic submucosal dissection of undifferentiated-type early gastric cancer
    Sung Eun Oh, Soomin Ahn, Kyoung-Mee Kim, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Ji Yeong An
    Gastric Cancer.2024; 27(4): 850.     CrossRef
  • Endoscopic diagnosis of early gastric cancer
    Dong Chan Joo, Gwang Ha Kim
    Journal of the Korean Medical Association.2022; 65(5): 267.     CrossRef
  • Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
    Eun Jeong Gong, Chang Seok Bang
    Journal of the Korean Medical Association.2022; 65(5): 284.     CrossRef
  • Construction and analysis of an ulcer risk prediction model after endoscopic submucosal dissection for early gastric cancer
    San-Dong Gong, Huan Li, Yi-Bin Xie, Xiao-Hui Wang
    World Journal of Gastrointestinal Oncology.2022; 14(9): 1823.     CrossRef
  • Long‑term outcome of the endoscopic submucosal dissection of early gastric cancer: A comparison between patients with and without liver cirrhosis
    Seung Kim, Moon Joo, Ah-Young Yoo, Seong Kim, Won Kim, Beom Lee, Jong Park, Hoon Chun, Sang Lee
    Oncology Letters.2022;[Epub]     CrossRef
  • Discrepancy between endoscopic and pathological ulcerative findings in clinical intramucosal early gastric cancer
    Yohei Yabuuchi, Kohei Takizawa, Naomi Kakushima, Noboru Kawata, Masao Yoshida, Yoichi Yamamoto, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Hirotoshi Ishiwatari, Kinichi Hotta, Hiroyuki Matsubayashi, Etsuro Bando, Masanori Terashima, Takashi Sugino, Hiro
    Gastric Cancer.2021; 24(3): 691.     CrossRef
  • What is the Most Precise Endoscopic Finding for Predicting the Clinicopathological Behaviors in Ulcerative Early Gastric Cancer?
    Youngdae Kim
    Clinical Endoscopy.2020; 53(3): 249.     CrossRef
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A Case of Lower Gastrointestinal Bleeding with Ileal Ulceration in Scrub Typhus
Su Jung Baik, M.D., Ki-Nam Shim, M.D., Min Jung Kang, M.D., Hyun Joo Song, M.D., Kum Hei Ryu, M.D., Hye Jung Yeom, M.D., Tae Hun Kim, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D. and Kyu Won Chung, M.D.
Korean J Gastrointest Endosc 2007;34(1):56-59.   Published online January 30, 2007
AbstractAbstract PDF
Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi-induced vasculitis, is common in Korea, Asia and Pacific Islands. Endoscopic mucosal lesions or mucosal damages have rarely been reported in Scrub typhus. However, four cases of upper gastrointestinal bleeding, controlled by hemoclipping, in Tsutsugamushi-infected patients have been reported in Korea; although, no case of lower gastrointestinal bleeding in Scrub typhus has been reported. We experienced massive hematochezia in a 77-year-old female patient with Scrub typhus. Special studies, including upper gastroduodenoscopy, colonoscopy, abdominal CT scan, and SMA angiography were performed, but the focus of the bleeding could not be found. An RBC scan showed suspicious small bowel bleeding, but a capsule endoscopy could not reveal the focus of the bleeding focus; however, a colonoscopy showed active bleeding at the terminal ileum, with multiple ileal ulcerations. After conservative therapy, the patient's condition was stable and the hematochezia disappeared.
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충수돌기 절제술후 발생한 지연성 위장관 출혈 1 예 (A Case of Appendiceal Stump Ulceration and Bleeding One Year after Appendectomy )
Korean J Gastrointest Endosc 1999;19(1):121-124.   Published online November 30, 1998
AbstractAbstract PDF
Postappendectomy bleeding is a rare and occasionally catastrophic phenomenon. Bleed-ing in the gastrointestinal tract may occur early or late. The cause of late bleeding included ulceration, vascular malformation or granuloma. We experienced a case of delayed appen-diceal stump ulceration and bleeding who underwent an appendectomy 1 year ago. The patient was admitted due to melena. A colonoscopy showed a well-circumscribed deep ulcer containing of silk suture material at the base of appendiceal stump. Biopsy revealed only granulation tissue with nonspecific inflammation. The silk was removed by biopsy forcep and sulfasalazine was tried. A repeat colonoscopy showed the complete ulcer heal-ing 3 months later. We report this case with a review of literatures. (Korean J Gastrointest Endosc 19: 121 ∼124, 1999)
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상부위장관을 침범한 H-S Purpura 1예 ( A Case of Henoch - Schoenlein Purpura Involving upper GI Tract )
Korean J Gastrointest Endosc 1992;12(2):231-235.   Published online November 30, 1991
AbstractAbstract PDF
Henoch-Schonlein purpura(anaphylactoid purpura) is a necrotizing vasculitis of small vessels in which systemic manifestation include palpable purpura on the lower extremities and buttocks due to leukocytoclastic vasculitis of dermal vessels; arthralgia of large joints, usually the knees and ankles; gastronitestinal involvement with colic and bleeding; and renal ievolvement, usually with a focal necrotizing glomerulonephritis. Gastrointestinal involvement occurs in about two thirds of all pediatric cases and in about,one third of adult cases, Any bowel segment may be involved, but the jejunum and ileum are most frequently affected. With a brief review of the literature, we report a case of H-S purpura involving stomach and duodenum.
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