Kosin Medical Journal

Review article

Bowel preparation for colonoscopy in special populations: a practical and risk-stratified approach: Myung-Hun Lee, Won Moon, Kyoungwon Jung, Jae Hyun Kim, Sung Eun Kim, Moo In Park, Seun Ja Park; Kosin Med J. 2026;41(1):9-18. Published online March 27, 2026; DOI: https://doi.org/10.7180/kmj.26.156

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Abstract PDF PubReader ePub: Bowel preparation is a key determinant of colonoscopy quality; however, inadequate cleansing remains common among patients with overlapping clinical and logistical barriers. In routine practice, preparation failure may prolong procedures, reduce diagnostic confidence, and necessitate early repeat colonoscopy. We review major society guidelines and selected studies addressing bowel preparation in inflammatory bowel disease (IBD), chronic kidney disease (CKD), older adults, chronic constipation, and hospitalized patients. Across these settings, the most consistently supported measures include split-dose administration, completion of the final dose close to the time of colonoscopy in accordance with local fasting and sedation policies, and structured patient instructions reinforced through follow-up communication. A standardized assessment of preparation quality is recommended to support quality improvement and appropriate follow-up. Risk stratification can help identify patients who may benefit from intensified preparation pathways, including those with prior inadequate preparation, severe constipation, frailty, or inpatient status. Safety considerations are particularly important in CKD, in which oral sodium phosphate should be avoided and magnesium-containing agents used cautiously; polyethylene glycol-based solutions are generally preferred. In IBD, regimen selection should also consider endoscopic interpretability because sodium phosphate preparations have been associated with preparation-related mucosal abnormalities that may confound the assessment of subtle inflammatory findings. Among hospitalized patients, system-level barriers often predominate, and protocolized pathways may improve workflow and patient comfort while maintaining cleansing effectiveness. We propose a practical, risk-stratified approach to regimen selection, timing, rescue strategies, and safety monitoring that can be implemented in high-volume clinical practice.

Case report

Gastric cancer with lymphoid stroma mimicking a subepithelial lesion after a 10-year disease-free interval: a case report: Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang; Kosin Med J. 2025;40(3):233-238. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.123

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Abstract PDF PubReader ePub: A 74-year-old male patient presented to our hospital for treatment of gastric cancer in 2021. He had previously visited our institution in 2011 for assessment of a gastric subepithelial lesion (SEL), which was discovered incidentally during a health screening esophagogastroduodenoscopy (EGD). Endoscopic ultrasonography and abdominal computed tomography were conducted for evaluation of the gastric SEL, revealing an approximately 1 cm lesion arising from the muscularis propria. The lesion was initially thought to represent a mesenchymal tumor such as leiomyoma or gastrointestinal stromal tumor. Owing to its small size and absence of symptoms, no immediate intervention was undertaken, and the patient underwent regular surveillance only. Follow-up was maintained until 2018 and no notable changes in the gastric SEL were detected. The patient then voluntarily discontinued further follow-up. In 2021, a routine health screening EGD identified changes in the gastric SEL, and histopathological analysis confirmed adenocarcinoma. The patient subsequently underwent radical total gastrectomy utilizing the Roux-en-Y technique, with the final pathological diagnosis being stage I (pT2N0M0) gastric cancer with lymphoid stroma (GCLS). As of April 2025, there has been no evidence of cancer recurrence. This case illustrates a lesion initially diagnosed as SEL that later was identified as GCLS after a 10-year interval. Therefore, during EGD, clinicians should consider the potential for SEL-like gastric cancer if an SEL is observed. This report highlights the importance of close monitoring and a thorough diagnostic evaluation.

Review article

Endoscopic diagnosis of Helicobacter pylori infection: Eun Jeong Gong, Kyoungwon Jung; Kosin Med J. 2025;40(1):4-14. Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.130

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Accurate prediction of Helicobacter pylori infection status based on endoscopic findings is essential for optimizing management. This review emphasizes the importance of accurate endoscopic diagnosis of H. pylori infection. The endoscopic findings categorized in the Kyoto classification provide valuable indicators of infection status. Specifically, findings such as atrophic gastritis, intestinal metaplasia, nodular gastritis, enlarged folds, sticky mucus, xanthoma, and map-like redness are associated with H. pylori infection. Regular arrangement of collecting venules and linear red streaks are reliable indicators of non-infection. Selective testing based on endoscopic findings can optimize diagnosis and treatment of H. pylori infection and, minimizing unnecessary procedures. However, some findings overlap and do not clearly distinguish between current and past infections, indicating a need for further research.

Citations

Citations to this article as recorded by

Molecular characterization of H. pylori: genetic diversity and vacA s1m1/cagA+ prevalence in Western Algeria
Asma Boudouaia Ouali, Salmi Takwa, Dali-Sahi Majda, Etchiali Amal, BaB Hamed Nabila, Bekkhoucha Bouchra, Chiali Nihel Sarah, Benmansour Benguela Meriem, Berrahoui Samira, Dib Joanna, Harek Yahia, Medjati-Dennouni Nouria
Molecular Genetics and Genomics.2026;[Epub] CrossRef

Original article

The effects of rebamipide, sucralfate, and rifaximin against inflammation and apoptosis in radiation-induced murine intestinal injury: Won Moon, Sangwook Lim, Yeonsoon Jung, Yuk Moon Heo, Seun Ja Park, Moo In Park, Sung Eun Kim, Jae Hyun Kim, Kyoungwon Jung; Kosin Med J. 2022;37(4):320-341. Published online December 26, 2022; DOI: https://doi.org/10.7180/kmj.22.140

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Background
Radiotherapy improves overall survival in patients with abdominopelvic malignancies. However, the toxic effects of radiation restrict the maximum dose that can be given, and there are no well-established preventive or therapeutic strategies. This study was conducted to evaluate whether rebamipide, sucralfate, and rifaximin have a suppressive effect on acute ionizing radiation (IR)-induced inflammation in the intestines of mice.
Methods
Thirty-six ICR mice were divided into a vehicle-treated group with sham irradiation; a vehicle-treated group with irradiation; rebamipide, sucralfate, or rifaximin-treated groups with irradiation; and a rebamipide-treated group with sham irradiation. The expression of proinflammatory, anti-inflammatory, proapoptotic, and antiapoptotic factors was investigated.
Results
The downregulated expression of nicotinamide phosphoribosyltransferase by IR was attenuated by all drugs (p<0.05). All drugs suppressed the IR-induced activation of NF-κB and phosphorylation of MAPKs (p<0.05) and attenuated the production of TNF-α, IL-1β, and IL-6 in response to IR (p<0.05). The administration of all drugs markedly attenuated IR-induced increases in iNOS, COX-2, and PGE2 (p<0.05), as well as [Ca2+] oscillations that were increased by IR. The expression of proapoptotic genes and antiapoptotic genes was suppressed and induced, respectively, by all drugs. IR treatment increased the release of cytochrome C, which was attenuated by all drugs (p<0.05). All drug treatments resulted in a significant decrease in the expression of caspase-3 and caspase-7 (p<0.05), which were both upregulated following IR treatment.
Conclusions
The administration of rebamipide, sucralfate, or rifaximin prior to radiation therapy may prevent or attenuate acute radiation-induced enterocolitis.

Citations

Citations to this article as recorded by

Investigation of the preventive action of rebamipide versus cadmium nephrotoxicity effect in rats
Amr A. Abd Ellah, Reem M. Hazem, Amany M. Gad, Yasser M. Moustafa
Irish Journal of Medical Science (1971 -).2025;[Epub] CrossRef

Editorial

Which endoscopic treatment is effective for the treatment of benign esophageal stricture: balloon or incision?: Kyoungwon Jung; Kosin Med J. 2022;37(4):261-263. Published online December 20, 2022; DOI: https://doi.org/10.7180/kmj.22.143

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Original article

Differences in Endoscopic Findings of Primary and Secondary Gastric Lymphoma: Kyoungwon Jung, Hae Soo Jeon, Moo In Park, Il Hyeong Choe, Hyun Seung Je, Jae Hyun Kim, Sung Eun Kim, Won Moon, Seun Ja Park; Kosin Med J. 2020;35(2):114-124. Published online December 31, 2020; DOI: https://doi.org/10.7180/kmj.2020.35.2.114

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Objectives

: Since endoscopic findings of primary gastric lymphoma are ambiguous and diverse, it is not easy to distinguish them from gastric adenocarcinoma or secondary gastric lymphoma. The aim of this study was to investigate the difference in clinical and endoscopic features between primary gastric lymphoma and gastric involvement of lymphoma.

Methods

: Forty-eight patients were enrolled in this retrospective study between June 2008 and February 2017. The patients were divided into primary gastric lymphoma group (primary group, n = 18) and gastric involvement group (secondary group, n = 30) based on whether or not they carried gastric lesions alone. Patients’ clinical characteristics, endoscopic findings and pathologic data were retrospectively reviewed based on electronic medical records.

Results

: The mean age of patients was 63.3 ± 13.1 years and 29 patients were female (60.4%). Diffuse large B-cell lymphoma pathology (81.3%), gastric body involvement (47.9%) and ulceroinfiltrative morphology on endoscopy (43.8%) were common features. Regardless of the two groups, the initial endoscopic diagnosis was considered as lymphoma only in 41.7%. Compared with the primary group, fundus (P = 0.035) and regional lymph node (P < 0.001) were significantly associated with the secondary group. However, there was no significant difference in endoscopic findings including location, size, number, and morphology of lesion.

Conclusions

: Endoscopic diagnosis of gastric lymphoma is a challenge. There is no difference in endoscopic findings between the primary and secondary groups even when confirmed separately. However, when the lesion is present in the fundus, we keep in mind the possibility of secondary gastric lymphoma.

Citations

Citations to this article as recorded by

Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study
Quang Trung Tran, Thinh Nguyen Duy, Bao Song Nguyen-Tran, Tung Nguyen-Thanh, Quy Tran Ngo, Nam Phuong Tran Thi, Vi Le, Thuan Dang-Cong
Diagnostics.2023; 13(17): 2767. CrossRef
A Differential Diagnosis of Unusual Gastric Ulcer
Soo-Yoon Sung, Hyun Ho Choi, Kyung Jin Seo
Diagnostics.2022; 12(8): 1929. CrossRef

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