Background: With the introduction of Xpert MTB/RIF assay (Xpert), its incorporation into tuberculosis (TB) diagnostic algorithm has become an important issue. The aim of this study was to evaluate the performance of the Xpert assay in comparison with a commercial polymerase chain reaction (PCR) assay.Methods: Medical records of patients having results of both Xpert and AdvanSure TB/NTM real-time PCR (AdvanSure) assays using the same bronchial washing specimens were retrospectively reviewed.Results: Of the 1,297 patients included in this study, 205 (15.8%) were diagnosed with pulmonary TB. Using mycobacterial culture as the reference method, sensitivity of the Xpert assay using smear-positive specimens was 97.5%, which was comparable to that of the AdvanSure assay (96.3%, p=0.193). However, the sensitivity of the Xpert assay using smear-negative specimens was 70.6%, which was significantly higher than that of the AdvanSure assay (52.9%, p=0.018). Usng phenotypic drug susceptibility testing as the reference method, sensitivity and specificity for detecting rifampicin resistance were 100% and 99.1%, respectively. Moreover, a median turnaround time of the Xpert assay was 1 day, which was significantly shorter than 3 days of the AdvanSure assay (p<0.001).Conclusion: In comparison with the AdvanSure assay, the Xpert assay had a higher sensitivity using smear-negative specimens, a shorter turnaround time, and could reliably predict rifampin resistance. Therefore, the Xpert assay might be preferentially recommended over TB-PCR in Korean TB diagnostic algorithm.

Objectives: Although phytobezoars are the most common type of gastric bezoar, a standardized treatment method has not been adopted.Methods: In this study, we evaluated patient clinical features and treatment outcomes following the use of different treatment methods, with a focus on the efficacy of carbonated beverage consumption. A review of medical charts and endoscopic reports revealed 15 cases of gastric phytobezoars from September 2008 to May 2016. Patient medical records were retrospectively reviewed to assess patient clinical characteristics and treatment results.Results: The mean patient age was 71.3±11.1 years. The most common symptoms were epigastric pain (46.7%) and bloating (40.0%). A history of intra-abdominal surgery was found in 26.7% of the patients. The mean bezoar size was 47.3±14.5 mm. The final successful treatment methods were consumption of a carbonated beverage alone (n=7, 46.7%), endoscopic removal (n=5, 33.3%), and surgery (n=3, 20.0%). During the treatment course, few patients (3/15, 20.0%) experienced small bowel obstructions after the consumption of the carbonated beverage and endoscopic fragmentation; these obstructions required surgical interventions. There was no significant difference in the baseline characteristics between patients successfully or unsuccessfully treated with the carbonated beverage.Conclusions: Most patients presenting with gastric phytobezoars can be successfully treated by consuming carbonated beverages in conjunction with endoscopic therapy. However, small bowel obstructions may occur due to the migration of a fragmented bezoar, necessitating surgical intervention.

Despite advancements in diagnostic techniques, the accurate identification and management of localized terminal ileitis or ulcers (LTIU) remains challenging, with a wide range of associated diseases presenting with similar clinical and endoscopic features. This retrospective observational study aimed to determine the etiology and discrimination of various diseases in patients with symptomatic LTIU. Data on demographics, clinical manifestations, and endoscopic findings were collected and analyzed statistically using descriptive and inferential methods, including frequency analysis and chi-square tests. Among the 224 patients who underwent LTIU on ileocolonoscopy, 110 (49.1%) had symptoms, of which 71 (64.5%) had specific etiologies on initial testing and after 6 months of follow-up. Definitive diagnoses were ascertained, with Crohn disease (CD) and Behçet disease (BD) being the most common diseases in this cohort, accounting for 27.3% (30 patients) and 18.2% (20 patients) of cases, respectively. Other diagnoses included infectious enteritis in 10 (9.1%) patients, drug-induced enteropathy in 5 (4.5%), intestinal tuberculosis in 5 (4.5%), and lymphoma in 1 (0.9%). Additionally, 39 patients (35.5%) had nonspecific ulcers. After 1 year of treatment, symptomatic and endoscopic resolution was noted in 7 out of 30 patients (23.3%) with CD and 10 out of 20 (50.0%) with BD. Of the 39 patients initially diagnosed with nonspecific ulcers with persistent symptoms, 2 were eventually diagnosed with CD. The high proportion of diagnosed diseases among symptomatic patients with LTIU underscores the importance of early and accurate diagnosis in guiding appropriate treatment strategies. These findings highlight the need for further research to refine diagnostic approaches and optimize patient outcomes in this challenging clinical scenario.

Background: To date, there have been no reports assessing the incidence, risk factors, and clinical outcomes of GB disease in patients receiving ECMO for cardiorespiratory failure. Methods: The medical records of adults (aged > 18 years) who underwent ECMO between May 2010 and October 2019 were retrospectively reviewed. We investigated the prevalence and related factors of GB disease during ECMO therapy, compared clinical outcomes between patients with and without GB disease, and performed propensity-matched analysis. Results: In total, 446 patients were included, and symptomatic GB disease was found in 62 patients (13.9%, 76.2/1000 ECMO days). Complicated GB disease occurred in 42 patients (9.4%, 89.4/1000 ECMO days) and presented as acute cholecystitis, acute cholangitis, and biliary pancreatitis in 33 (7.4%), 7 (1.6%), and 5 (1.1%) patients, respectively. In multivariate Cox regression analysis, longer ECMO support (>2 weeks) (hazard ratio (HR), 2.95; 95% confidence interval (CI), 1.69–5.15) and elevated plasma hemoglobin (Hb, >50 mg/dL) (HR. 2.12; 95% CI, 1.18–3.78) were significantly associated with the development of GB disease. In the propensity-matched cohort, the intensive care unit (ICU) and hospital survival rates were significantly lower for patients with GB disease than for those without GB disease (ICU survival rate, 64.5% vs. 84.7%; hospital survival rate, 59.7% vs. 81.5%). Conclusion: The incidence of GB disease was higher in patients who received ECMO than in the general ICU patients. Furthermore, elevated plasma Hb and prolonged ECMO therapy were significant factors for the development of GB disease during ECMO therapy.

Background: Esophageal squamous cell carcinoma (ESCC) typically occurs in older individuals. The etiology and clinical characteristics of ESCC in relatively younger patients under 60 years of age remain unclear. Understanding whether age affects tumor behavior or prognosis is important for improving patient management. This study aimed to analyze the characteristics of ESCC diagnosed before the age of 60. Methods: We retrospectively reviewed the medical records of ESCC patients diagnosed between December 2008 and May 2025. A total of 516 patients were divided into two groups based on whether they were aged 60 or above. Medical history, clinical features, and outcomes were compared between the two groups. Results: There were 100 patients under 60 years and 416 patients aged 60 and above. The median ages were 55 (range 41–59) and 72 (range 60–95), respectively. Younger patients had a significantly stronger association with heavy drinking (72.0% vs. 39.2%, p < 0.001) and smoking (76.0% vs. 55.0%, p < 0.001). There was a trend toward more advanced disease (Stage IV: 26.0% vs. 18.5%, p = 0.094) and metastatic presentation (18.0% vs. 13.9%, p = 0.305) in the under-60 group. Despite being younger with better performance status and fewer comorbidities, their overall survival did not differ from that of older patients (HR 0.92; 95% CI, 0.67–1.26; p = 0.593). Conclusions: Patients diagnosed with ESCC under the age of 60 showed a stronger association with heavy alcohol consumption and smoking and more frequent presentation with advanced-stage disease compared with older patients. Younger age did not confer a better prognosis, highlighting the importance of early detection and timely intervention regardless of patient age.

Esophageal submucosal tumors are increasingly identified through routine upper endoscopy, often performed as part of health screenings. Although many of these lesions are benign, some have malignant potential, necessitating accurate diagnosis and appropriate resection. Underwater endoscopic mucosal resection (UEMR) has gained attention as a novel technique that enables mucosal resection without submucosal injection, offering advantages in terms of safety and efficacy. However, data regarding its use for esophageal submucosal tumors are limited. This retrospective single-center study included 31 patients who underwent UEMRs for esophageal submucosal tumors between 2020 and 2024. The inclusion criteria were lesions <15 mm in diameter, confined to the submucosal layer, as confirmed by endoscopic ultrasound. Clinical variables, including age, sex, lesion characteristics, procedural details, and histopathological findings, were reviewed. Outcomes included en bloc and pathological complete (R0) resection rates, complications, and recurrence during follow-up. Among the 31 patients (mean age: 57.0 ± 12.5 years; 61% male), the most common lesion location was the lower esophagus (45.2%). Most lesions measured 5 to 10 mm (51.6%). Histopathologic diagnoses included leiomyomas (38.7%), granular cell tumors (32.3%), inflammatory fibroid polyps, and other benign entities. All lesions were resected en bloc using UEMR, with a 100% R0 resection rate. No major complications, including bleeding or perforation, occurred. During a follow-up period of up to 37 months, no recurrence was observed, including in cases of granular cell tumors or adenoid cystic carcinomas. UEMR is a safe and effective technique for managing esophageal submucosal tumors, demonstrating high en bloc and R0 resection rates with no major complications. These findings support UEMR as a favorable option for the resection of small esophageal submucosal tumors, providing a rationale for further prospective studies comparing UEMR with conventional endoscopic mucosal resection, band ligation-assisted endoscopic mucosal resection, and endoscopic submucosal dissection.