Journal of Yeungnam Medical Science

Jong Ryul Eun

14 Articles

Ulcerative Colitis Mimicking Acute Hemorrhagic Colitis.: Hee Jung Moon, Byung Ik Jang, Sung Bum Kim, Ho Chan Lee, Jae Hyun Park, Jong Ryul Eun, Tae Nyeun Kim; Yeungnam Univ J Med. 2008;25(2):182-186. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.182

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Abstract PDF: Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract that affects the large bowel. Its etiology remains controversial. However, an infectious or immunologic origin is considered the primary cause. The onset of UC is typically slow and insidious, but some patients may present acutely with symptoms mimicking infectious colitis. We report a case of ulcerative colitis mimicking acute hemorrhagic colitis at initial presentation. A 60-year-old man was referred to Yeungnam University Hospital for bloody diarrhea and abdominal pain. Sigmoidoscopy revealed mildly edematous mucosa in the rectum and hyperemic mucosa with petechiae in the sigmoid colon. The patient was treated with antibiotics for several days, and his symptoms improved. However, after one month, his bloody diarrhea relapsed. Follow-up sigmoidoscopy revealed mucosal friability in the rectum and sigmoid colon. He was diagnosed with ulcerative colitis, and his symptoms were improved with mesalazine and a steroid enema.

A Case of Hepatocellular Carcinoma with intradural growth Presenting as Obstructive Jaundice.: Sung Bum Kim, Tae Nyeun Kim, Sung Jun Kim, Ho Chan Lee, Jae Hyun Park, Jong Ryul Eun, Byung Ik Jang, Heon Ju Lee, Sung Su Yun, Young Kyung Bae; Yeungnam Univ J Med. 2008;25(2):165-170. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.165

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Abstract PDF: The incidence of hepatocellular carcinoma presenting as obstructive jaundice is 0.7~9%. The mechanisms of obstructive jaundice include bile duct invasion by tumor, tumor thrombi, blood clots, direct bile duct compression by tumor, and intraductal tumor growth. We report a rare case of hepatocellular carcinoma with intraductal growth. A 46-year-old woman was admitted due to colicky right upper abdominal pain and jaundice for 4 days. Computed tomography showed dilatation of the left intrahepatic duct, and endoscopic retrograde cholangiography showed a filling defect in the left main intrahepatic duct. We performed a left lobectomy with a Roux-en-Y hepaticojejunostomy. The tumor was diagnosed as a hepatocellular carcinoma with intraductal growth.

The Short Term Efficacy of Entecavir Therapy in Chronic Hepatitis B.: Hyun Kim, Hee Bok Chae, Won Joong Jeon, Seon Mee Park, Sei Jin Youn, Jong Ryul Eun, Heon Ju Lee; Yeungnam Univ J Med. 2008;25(1):31-40. Published online June 30, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.1.31

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Abstract PDF: BACKGROUND
/AIMS: Entecavir is a synthetic nucleoside analogue, cyclopentyl guanine nucleoside, which has a potent antiviral effect and the least viral breakthrough in hepatitis B virus (HBV) replication. Entecavir has been available in Korea since 2007 but there are few reports on its effects. The aim of this study was to evaluate the virological response (VR) and biochemical response (BR) to entecavir in HBV patients at 3, 6 and 9 months after treatment with entecavir. MATERIALS AND METHODS: Thirty-three chronic hepatitis B patients who took entecavir for at least 9 months were enrolled. We investigated VR and BR by retrospectively reviewing medical records. Patients who satisfied the following criteria were chosen: 1) initial alanine aminotransferase (ALT) levels = 1.5upper limit of normal (ULN) and 2) initial HBV DNA levels = 5 log10 copies/ml. We measured ALT levels every 3 months until month 9. HBV DNA was measured every 2 or 3 months by polymerase chain reaction (PCR) method. RESULTS: Most patients taking entecavir showed good BR (ALT < 40 IU/L). The BR rates were 61%, 73% and 67% at months 3, 6 and 9, respectively. VR (HBV DNA < 5 log(10) copies/ml or 2 log lower than initial HBV DNA) rates were 82%, 91% and 91% at months 3, 6 and 9, respectively. Undetectable HBV DNA (HBV DNA < 4 log(10) copies/ml) rates were 49%, 73% and 85% at months 3, 6 and 9, respectively. Two patients presented with virological breakthrough without adverse effects until month 9. CONCLUSIONS: Entecavir showed good BR and VR from month 3 and these effects continued through the 9-month observation period. This suggests that entecavir is also a good choice for the first line treatment of chronic hepatitis B (CHB). Further studies are needed to determine the long-term efficacy and drug resistance of entecavir in Korean CHB patients.

Black Pigmentation of Terminal Ileum after Long Term Ingestion of Charcoal: Jun Young Lee, Sung Bum Kim, Sang Hoon Lee, Hee Jung Moon, Jae Won Choi, Jong Ryul Eun, Byung Ik Jang, Tae Nyeun Kim, Joon Hyuk Choi; Yeungnam Univ J Med. 2007;24(2 Suppl):S623-626. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S623

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Abstract PDF: Isolated pigmentation of the terminal ileum is rare incidental finding when performing a colonoscopic examination. The common substances that cause gastrointestinal pigmentations are lipofuscin, iron sulphide(FeS), hemosiderin, and other exogenous materials such as silicates and titanium. In most cases, pigmentation of the terminal ileum has no subjective symptoms, so it is found in autopsy or incidental colonoscopic examination. The cause of pigmentation has not been clearly identified. We experienced a case of pigmentation of terminal ileum associated with long term charcoal ingestion. This finding supports that the source of ileal pigmentation is ingested material.

A Case of Esophageal Bullous Pemphigoid Manifestated by Upper Gastrointestinal Bleeding: Kyeong Ok Kim, Byung Ik Jang, Jong Ryul Eun, Tae Nyun Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S671-675. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S671

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Bullous pemphiogid (BP) is a chronic vesicular disorder and an autoimmune disease which has an autoantibodies to hemidesmosime in the keratinocyte. The authors report a case of gastrointestinal bleeding caused by BP involved with esophagus. A seventy year old man visited our clinic due to melena for a week. He had a quadriplegia due to fracture of cervical spine and was on therapy with corticosteroid and immunomodulatory drug for the diagnosis of BP. On endoscopic examination, multiple bullae filled with blood at lower esophagus was revealed and there was no other bleeding focus in stomach and duodenum. Medical treatment for BP with supportive care was done. The patient died due to sepsis caused by pneumonia. BP is common in elderly or poor conditioned patients. We need to consider the invasion of esophagus in case of gastrointestinal bleeding in patients with BP.

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Esophageal Involvement of Bullous Pemphigoid
Junseak Lee, Sanggon Moon, Chul-Hyun Lim
The Korean Journal of Gastroenterology.2021; 78(4): 249. CrossRef

A Case of Gastric Bezoar Causing Ileal Obstruction During Treatment with Coca-Cola: Jun Young Lee, Sung Bum Kim, Sang Hoon Lee, Hee Jung Moon, Jong Ryul Eun, Tae Nyeun Kim, Byung Ik Jang; Yeungnam Univ J Med. 2007;24(2 Suppl):S683-688. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S683

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Gastric bezoars are usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Recently, the efficacy of nasogastric lavage or endoscopic injection therapy with Coca-Cola has been reported. But the complication like intestinal obstruction has poorly been reported. We report a case of gastric bezoar causing ileal obstruction during treatment with oral administration and endoscopic injection of Coca-Cola. A 53-year-old man was referred because of epigastric pain for a day. He had a history of subtotal gastrectomy with gastroduodenostomy since 8 years ago. On upper gastrointestinal endoscopy, about 6cm sized, dark-greenish hard bezoar was impacted at gastric antrum and about 3-5cm sized three bezoars were found at body. We injected Coca-Cola into the bezoar through the endoscopy and the patient was instructed to drink four liters of Coca-Cola per day. On the 12^th day of admission, the patient complained severe abdominal pain. On plain abdominal X-ray and CT scan, small bowel obstruction at proximal ileum with bezoar was suspected and exploration was performed. About 4cm sized two bezoars were impacted at proximal ileum, and small bowel resection with primary closure after removal of bezoar was performed. The patient was discharged on the 10th postoperative day without any complication.

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A Case of Huge Gastric Bezoar Removed by Endoscopic Combination Therapy with Coca-Cola Injection
Min Suk Jung, Jang Won Lee, Seung Hyun Lee, Dong Hyun Kim, Sang Hwan Byun, Yeong Muk Kim
Yeungnam University Journal of Medicine.2013; 30(1): 62. CrossRef

Clinical Characteristics of Adult Patients with Acute Hepatitis A.: Jong Ryul Eun, Heon Ju Lee, Tae Nyeun Kim, Byung Ik Jang, Hee Jung Moon; Yeungnam Univ J Med. 2007;24(2):170-178. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.170

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BACKGROUND
The incidence of acute hepatitis A in adults has recently been increasing. This study was conducted to investigate the epidemiology and clinical characteristics of acute hepatitis A in Daegu province over the past 10 years. MATERIALS AND METHODS: We reviewed the medical records of 55 patients (male/female: 34/21), who were diagnosed with acute hepatitis A by confirmation of the IgM anti-HAV between January 1998 and June 2007. RESULTS: The mean age was 29.7+/-10.3 years (range; 17-65 years). The incidence was most common between March and June (56.1%), in the third and fourth decades of life (78.2%) and 90.9% (50/55) of the patients were diagnosed from 2003 to present. The common symptoms included anorexia, nausea or vomiting (69.1%), fever and chills (49.1%), myalgia (47.3%), weight loss (47.3%), fatigue (40.0%), abdominal pain (36.4%), diarrhea (9.1%) and pruritus (5.5%). The mean duration of hospital stay was 8.6+/-3.4 days (range; 3-20 days). The route of transmission was identified in only 11 patients (20.0%); 7 patients (12.7%) traveled (abroad or domestic), 2 patients (3.6%) ingested raw food and 2 patients (3.6%) had friends with acute hepatitis A. Fifty four patients recovered without complication; one patient developed fulminant hepatitis and recovered after a liver transplantation. CONCLUSION: The incidence of acute hepatitis A in adults is increasing. Because of the cost of treatment and potential for serious disease, persons, under 40 are recommened to have hepatitis A vaccination and confirmation of IgG anti-HAV.

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Pattern of Hepatitis A Incidence According to Area Characteristics Using National Health Insurance Data
Joo Youn Seo, Jae Hee Seo, Myoung Hee Kim, Moran Ki, Hee Suk Park, Bo Youl Choi
Journal of Preventive Medicine & Public Health.2012; 45(3): 164. CrossRef

Gastric Phytobezoar Treated by Oral Intake and Endoscopic Injection of Coca-Cola.: Hee Jung Moon, Sang Hoon Lee, Jun Young Lee, Dong Hee Kim, Ji Eun Lee, Chang Hun Yang, Jong Ryul Eun, Tae Nyeun Kim, Heon Ju Lee, Byung Ik Jang; Yeungnam Univ J Med. 2006;23(2):247-251. Published online December 31, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.2.247

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Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract; they usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. Recently, the efficacy of nasogastric lavage or endoscopic infusion of Coca-Cola for the dissolution of phytobezoar have been reported. We report a case of phytobezoar successfully treated by oral administration and endoscopic injection of Coca-Cola. A 62-year-old woman was referred to Yeungnam University Hospital for epigastric pain. Upper gastrointestinal endoscopy revealed one very large, dark-greenish, solid bezoar in the stomach with gastric ulcer and duodenal bulb deformity. We performed endoscopic injection of Coca-Cola into the bezoar. The patient was instructed to drink four liters of Coca-Cola per day. At endoscopy two days later, the phytobezoar was easily broken into pieces. At endoscopy on the 11th day of admission, the phytobezoar was decreased in size and removed by endoscopic fragmentation with a polypectomy snare. At follow up endoscopy after 13 days, the bezoar was completely dissolved.

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Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment
S. D. Ladas, D. Kamberoglou, G. Karamanolis, J. Vlachogiannakos, I. Zouboulis-Vafiadis
Alimentary Pharmacology & Therapeutics.2013; 37(2): 169. CrossRef

Colon Cancer in Behcet's Disease.: Ji Eun Lee, Jang Won Sohn, Kyu Hyung Lee, Youn Sun Park, Kook Hyun Kim, Jae Won Choi, Jong Ryul Eun, Byung Ik Jang, Tae Nyeun Kim; Yeungnam Univ J Med. 2006;23(1):124-130. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.124

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Behcet's disease has rarely been reported in association with malignant diseases. In most cases the autoimmune nature of the disease itself or immunosuppressive drug use has been blamed for malignant transformation. Solid tumors in addition to lymphoid and hematological malignancies are also seen during the course of Behcet's disease. We present here a case of colon cancer in a 40-year-old man with Behcet's disease. A near total colectomy was performed and postoperative chemotherapy and radiotherapy was administered to treat visceral peritoneal invasion. Recurrent evidence was not found. We present the clinical details of this rare case of colon cancer with Behcet's disease.

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Cancer colique au cours de la maladie de Behçet
S. Bouomrani, H. Baïli, K. Souid, I. Kilani, M. Beji
Journal Africain d'Hépato-Gastroentérologie.2016; 10(1): 1. CrossRef
Morbidity of Solid Cancer in Behçet's Disease: Analysis of 11 Cases in a Series of 506 Patients
So Young Na, Jaeyoung Shin, Eun-So Lee
Yonsei Medical Journal.2013; 54(4): 895. CrossRef

The Usefulness of Capsule Endoscopy in Diagnosis of Small Bowel Diseases.: Jong Ryul Eun, Byung Ik Jang; Yeungnam Univ J Med. 2006;23(1):45-51. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.45

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Abstract PDF: BACKGROUND
This study was conducted to evaluate the usefulness of capsule endoscopy (CE) for the diagnosis of small bowel diseases. MATERILAS AND METHODS: We reviewed the medical records of 66 patients (mean age: 52.1 years, male/female: 39/27), who underwent CE at Yeungnam University Hospital from August 2003 to March 2006. RESULTS: Suspicious gastrointestinal (GI) bleeding presenting as anemia or history of gross bleeding was the most common reason to perform CE (71.2%). Other indications included GI symptoms (21.2%) such as abdominal pain/discomfort, nausea, diarrhea, and others (7.6%). In studies performed for GI bleeding (n=47), ulcer/erosion was the most common finding (n=22, 46.8%) followed by tumor (n=5, 10.6%), angiodysplasia (n=3, 6.4%), polyp (n=3, 6.4%), active bleeding (n=1, 2.1 %), ulcer with stenosis (n=1, 2.1%), and normal findings (n=12, 25.5%). Of these, a bleeding focus was detected in 32 cases (68.1%) undergoing CE studies. Among 14 patients with GI symptoms, only two patients had typical findings related with symptoms. Surgical resection was performed in five cases with tumor. Of these, four were diagnosed as gastrointestinal stromal tumor and the other one was a lymphangioma. There were no complications associated with the CE procedure. CONCLUSION: Capsule endoscopy is a safe, noninvasive diagnostic tool for small bowel diseases and may be useful for the diagnosis of small bowel hemorrhage including obscure bleeding. However, further studies are needed to confirm its utility for abdominal symptoms other than hemorrhage because of the low diagnostic yield.

Clinical Features of Cholestatic Hepatitis.: Sun Taek Choi, Jong Ryul Eun, Song Woo Lim, Bong Jun Kim, Heoon Ju Lee, Mi Jin Gu, Joon Hyuk Choi; Yeungnam Univ J Med. 2001;18(1):51-58. Published online June 30, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.1.51

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Abstract PDF: BACKGROUND
Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstable obstruction of the major bile ducts. The prognosis of usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged causes of Chronic liver disease is needed. MATERIALS AND METHODS: From January 1991 through January 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were included. The possible causative drug, clinical features, laboatory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. RESULTS: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 50 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol > or =250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. CONCLUSION: In chlestatic hepatitis, durations of abnormal LET are variable regardless of causative drugs. If chlestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.

The Role of Radiotherapy in Treatment of Hepatocellular Carcinoma.: Jong Ryul Eun, Kyo Won Choi, Heon Ju Lee, Mung Se Kim; Yeungnam Univ J Med. 2000;17(2):137-145. Published online December 31, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.2.137

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Abstract PDF: BACKGROUND
Hepatocellular carcinomal(HCC) has been considered to be relatively radioresistant. The role of radiotherapy(RT) in the treatment of HCC is controversial. But RT has a role in the treatment of hepatocellular carcinoma as a single or combination modalities. The effect of radiotherapy on HCC was evaluated. Patients and METHODS: From January 1984 through January 2000, a total of 18 patients with unresectable HCC underwent radiotherapy alone or in conjunction with transarterial embolization(TAE). We reviewed the medical ecords of patients treated with RT and measured the tumor size using measured the tumor size using planimetry method. The Kaplan-Meier method was used to calculate the survival rate. RESULTS: The RT patients were 15 men and 3 women. The mean age was 51 years. four(22.2%) of them were accompanied with ascites. Eleven(61.1%) of them were accompanied with liver cirrhosis and their functions were 6, 3, 2 in each Child-Pugh A, B, C, respectively. A partial response(PR) was observed in 2 patients(11.1%), minimal response(MR) in 4 patients (22.2%) and no change(NC), in 11 patients(61.1%), whereas progressive disease(PD) was seen in 1 patients(6%), respectively. CONCLUSIONS: Although the radiotherapy in HCC did not improve the survival rate. it decreased the tmor size. Radiotherapy strengthens the therapeutic efficacy when combined with TAE, but more studies are needed.

The effect of Transarterial Chemoembolization(TAE) on Lung metastasis of Hepatocellular Carcinoma.: Heon Ju Lee, Jong Ryul Eun, Young Doo Song, Chan Won Park; Yeungnam Univ J Med. 2000;17(1):66-74. Published online June 30, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.1.66

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Abstract PDF: BACKGROUND
During follow up period after transarterial embolization(TAE), cases of pulmonary metastasis were more prevalent in TAE-treated patients than in TAE-untreated patients. Therefore, a study was conducted to evaluate whether TAE increases the incidence of pulmonary metastasis of hepatocellular carcinoma and to clarify the risk factors for pulmonary metastasis. METHODS: From march 1991 to march 1995, 156 patients who had been diagnosed with hepatocellular carcinoma by serology, and radiographic and histologic method at Yeungnam university hospital were involved in this study. We excluded 12 patients with lung metastasis on initial diagnosis and the others. The remaining 144 patients had been followed up for at least 5 months, and divided into four groups according to lung metastasis and trans-arterial embolization treatment, and evaluated the age, sex, child-pugh score, liver cirrhosis, and the level of AFP. RESULTS: Pulmonary metastasis was found in 18.0% (26/144), of witch 92.3%(24/26) and 7.7%(2/26) of the patients with and without transarterial chemoembolization, respectively. Of thepatients, 23.5% (24/102) with TAE had lung metastais during follow-up periods and 4.7% (2/42) without TAE had lung metastasis. there was more likelihood for lung metastasis after TAE, but there was no difference between two groups in age, sex, child-pugh class, the presence of liver cirrhosis, and AFP. CONCLUSIONS: The incidence of pulmonary metastasis of hepatocellular carcinoma after TAE was higher. child-pugh class was the only related clinical precipitating factors for pulmonary metastasis in TAE in our study. Our results suggest that regular chest X-ray check-up may be more frequently needed by patients who had TAE treatment for hepatocellular carcinoma.

The Significance of Small Polyp of colon in Koreans.: Soon Uk Kwon, Eun Ju Lee, Jong Ryul Eun, Sun Taek Choi, Hak Jun Lee, Byeong Ik Jang, Tae Nyeun Kim, Moon Kwan Chung; Yeungnam Univ J Med. 2000;17(1):39-48. Published online June 30, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.1.39

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BACKGROUND
There are two theories in the development of colon cancer. One is the adenoma-carcinoma sequence theory and the other is the de novo cancer theory. Western countries believe in the adenoma-carcinoma sequence theory, however there are many recent reports from Japan about cancers developing from small adenomas. METHODS: The present study analyzed 408 polyps from 508 cases that were taken by colonoscopic polypectomy at the Departmant of Internal Medicine, Yeung-Nam University Hospital. RESULTS: The percentage of patients who have polyp was 41.3%(210cases out of 526cases) and the peak incidence was noted in patients in their 50's and 60's. There was no difference between the sexes, but we noted significant increase in the incidence of polyps in patients over age of thirty. We found 395 polyps below 1cm and 13 polyps above 1cm. Among 408 polyps, 5 cases cancerous polyps and 3 cases showed polyp size of less than 1cm each. The first case was a polyp of 0.4cm in size with elevated mucosa at the ascending colon. The second was 0.5cm in size with round elevation and hyperemic mucosa in the rectum. The third polyp was 0.6cm in size with tubular elevation at the hepatic flexure. CONCLUSIONS: colon polyp is common disease in Koreans. even small polyps can have cancer tissue, which should be removed if discovered during colonoscopy. We believe that not all colon cancer originates in the manner described by the adenoma-carcinoma sequence theory. However further studies with a larger sample population are needed to determine the exact role colon polyps plays in the development of colon cancer.

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Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice
Moon Joo Hwang, Kyeong Ok Kim, A Lim Kim, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim
Intestinal Research.2018; 16(3): 475. CrossRef

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