Tertiary Medical Center In Korea Research Articles

Validation of diagnostic codes of major clinical outcomes in a National Health Insurance database

Background and objectivesThe Korean National Health Insurance Service (NHIS) database has been widely used for cardiovascular research. We validated the primary diagnostic codes of major clinical outcomes, including acute myocardial infarction (AMI), gastrointestinal bleeding (GIB), stroke, and intracranial hemorrhage (ICH) used for Korea NHIS claims.Subjects and methodsFrom 2016 to 2017, 800 patients with primary diagnostic codes of AMI, GIB, stroke, or ICH at discharge were randomly selected from a single tertiary medical center in Korea (200 patients per each diagnosis). The positive predictive value (PPV), sensitivity, and specificity of the primary diagnostic codes were calculated using hospital medical record review as the gold standard. Further improvement in the diagnostic validity of the codes was assessed by combining clinical information such as duration of hospitalization, blood transfusion, brain imaging studies, or prescription records of antithrombotic agents.ResultsAmong 200 patients with AMI as the primary discharge diagnosis, 184 patients were clinically confirmed (PPV of 92.0%). For GIB, 184 (92.0%) patients with the primary discharge diagnosis were verified to have true GIB events, showing PPV of 92%. For stroke, 181 (90.5%) patients were clinically confirmed with true stroke events. For ICH, 143 (71.5%) patients were verified to be true ICH events. In stroke and ICH, the PPV and specificity improved after combining with the hospitalization duration, imaging studies, and prescription of antithrombotic agents.ConclusionsFor major clinical outcomes in the NHIS database, the primary diagnostic codes showed favorable reliability. For stroke and ICH, considerations of relevant clinical information could improve the accuracy of diagnosis.

Genotype-based Treatment With Thiopurine Reduces Incidence of Myelosuppression in Patients With Inflammatory Bowel Diseases

Thiopurine-related myelosuppression (most frequently leukopenia) interferes with thiopurine therapy for patients with inflammatory bowel diseases (IBD). We investigated whether pretreatment analyses genetic variants associated with thiopurine-induced leukopenia could be used to effectively identify patients who required dose adjustments. We performed a multicenter, prospective study of patients with IBD at 5 tertiary medical centers in Korea, from January 2016 through September 2018. Seventy-two patients were randomly assigned to a group that underwent genotype analysis for the NUDT15 variant (rs116855232) and FTO variant (rs79206939) and 3 common TPMT variants (rs1800460, rs1800462, rs1142345) associated with myelosuppression and 92 patients were assigned to a group that did not undergo genotype analysis (non-genotyping group). Patients heterozygous for any variant received 50 mg azathioprine equivalents, whereas those who were homozygous for any variant received alternative drugs. Patients who did not carry any of the genetic variants and patients in the non-genotyping group received 50 mg azathioprine equivalents followed by dose escalation up to 2-2.5 mg/kg. Myelosuppression was defined as white blood cell counts below 3000/μL, levels of hemoglobin 10 g/dL, or platelet counts below 100 K/μL. Twelve patients (16.7%) in the genotype analysis group and 33 patients (35.9%) in the non-genotyping group developed myelosuppression (P=.005). A multivariate analysis revealed that body mass indices above 21 kg/m2 (hazard ratio [HR], 0.43; 95% CI, 0.22-0.81; P= .009), pretreatment genotype analysis (HR, 0.37; 95% CI, 0.18-0.77; P= .008), and the maximum dose of thiopurines (HR, 0.34; 95% CI, 0.19-0.59; P < .001) independently decreased risk of myelosuppression. Pretreatment genotype analysis reduced numbers of outpatient clinic visit and numbers of patients with drug discontinuation or dose reductions. In a randomized controlled study of patients undergoing thiopurine therapy for IBD, we found that selection of therapy based on genetic variants associated with thiopurine-induced leukopenia significantly reduced the proportion of patients with myelosuppression during treatment. ClinicalTrials.gov no: NCT03719118.

Non-albumin proteinuria as a parameter of tubulointerstitial inflammation in lupus nephritis.

Tubulointerstitial inflammation (TI) has prognostic significance in the renal outcomes of lupus nephritis. Here, we aimed to determine whether non-albumin proteinuria is associated with TI severity and with the renal response in lupus nephritis. We included patients with biopsy-confirmed lupus nephritis at a tertiary medical center in Korea from January 2011 to April 2017. Patients in whom the urine protein/creatinine ratio (uPCR) and the urine albumin/creatinine ratio (uACR) were measured simultaneously were included. Laboratory data and renal pathology were reviewed. Non-albumin proteinuria was calculated by subtracting uACR from uPCR. The renal response was assessed by the amount of proteinuria present at 6months after treatment with immunosuppressants. Logistic regression analyses were performed to identify factors associated with TI severity and renal response. Out of 45 patients, 36 (80%) had no-to-mild TI, whereas 9 (20%) had moderate-to-severe TI. Proliferative (class III ± V/IV ± V) and nonproliferative (class II/V) glomerulonephritis (GN) were present in 38 (84.4%) and 7 (15.6%) patients, respectively. In the logistic regression analyses, non-albumin proteinuria (uPCR - uACR) was associated with moderate-to-severe TI (odds ratio [OR] 3.166, 95% confidence interval [95% CI] 1.145-8.757, p = 0.026) and was inversely associated with complete renal response (adjusted OR 0.180, 95% CI 0.045-0.718, p= 0.015). In lupus nephritis, non-albumin proteinuria was associated with TI severity and with poor renal response after immunosuppressive treatment. Thus, the determination of non-albumin proteinuria can provide clinically valuable information on lupus nephritis.

Analysis of Dermatologic Consultations in a Neonatal Intensive Care Unit Over a 7-Year Period: Retrospective Review of 60 Cases.

The need for dermatology consultations for neonatal intensive care unit (NICU) patients is increasing, but no study has systemically examined the skin diseases of patients in NICUs. The aim of this study was to analyze dermatology consultations in the NICU of a tertiary medical center in Korea and determine the effect of the dermatology consultation on the clinical course and management of the patients after the consultation. The medical records of patients undergoing dermatologic consultation during their stay in a NICU between March 2009 and February 2016 were reviewed retrospectively. Sixty patients were enrolled in this study; the male-to-female ratio was 1:1.1, and mean age at the time of consultation was 3.7weeks. Mean gestational age was 33.7weeks, and 35 of the subjects (58.3%) were preterm neonates. Mean birth weight was 2.14kg (range 550-4,200g). The most-common disease category was birthmarks and neoplasms (20.0%), followed by eczematous dermatoses (18.3%), skin appendageal disease (16.7%), and infectious disease (13.3%). This study identified the dermatologic problems of neonates in a NICU and can raise dermatologists' awareness of the types of patients they may encounter in a NICU.

A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015).

Sinonasal fungus ball (FB) is a type of noninvasive fungal rhinosinusitis affecting immunocompetent hosts. FB, previously considered rare, has been reported with increasing frequency. We reviewed our experience of 538 cases over the past 20 years. We retrospectively examined clinical records including clinical presentations, radiological findings, management, and outcomes of FB patients who have undergone surgery for treatment. The number of FB patients who underwent endoscopic sinus surgery (ESS) was calculated annually. Causal relationships between structural variations and FB were also investigated. The number of FB patients who underwent sinus surgery has increased. The mean age was 58.3 years, and the gender ratio was approximately 2 (female): 1 (male). While the most common presenting symptoms of maxillary sinus FB patients were nasal symptoms, such as postnasal drip and nasal obstruction, sphenoid sinus FB patients presented with headache mostly. On computed tomography (CT) scans, the most common finding was intralesional hyperdensity (77.3%). There was no significant correlation between the presence of FB and structural variations (nasal septal deviation, concha bullosa, Haller cell). Median follow-up period of the patients was 11 months. Recurrence or residual disease occurred in only 6 (1.1%) cases. The number of FB patients who underwent surgery has increased steadily over the past 20 years. FB should be considered in patients with unilateral nasal symptoms and unexplained headaches. A preoperative CT scan is an essential tool in making diagnosis easier and faster. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate.

The prevalence and clinical characteristics of anemia in Korean patients with inflammatory bowel disease.

Background/AimsQuality of life is closely related to anemia in patients with inflammatory bowel disease (IBD). Several studies have reported on anemia in patients with IBD in Western countries. This study investigated the prevalence and clinical characteristics of anemia in Korean patients with IBD.MethodsWe reviewed the medical records of 92 patients with ulcerative colitis (UC) and 76 patients with Crohn's disease (CD) who were followed regularly at a single tertiary medical center in Korea between January 2003 and December 2012. Hemoglobin (Hb) thresholds used to define anemia were <13.0 g/dL in men and <12.0 g/dL in women according to the World Health Organization criteria. We chose the lowest Hb level in each year as a representative value because Hb levels changed at each examination and anemia was associated with disease deterioration. The relationship between clinical variables and lowest Hb level was assessed.ResultsThe prevalence of anemia was 36.3% in patients with UC and 41.6% in patients with CD. Anemia in patients with CD was associated with hospital admission, 5-aminosalicylate (5-ASA) and infliximab treatment in men. Anemia in patients with UC was associated with hospital admission, oral steroid use, thiopurine and infliximab treatment in men.ConclusionsThe prevalence of anemia in Korean patients with IBD was comparable to that of patients in Western countries. Anemia was associated with male patients with CD who were admitted to the hospital and received medications including 5-ASA and infliximab, and men with UC who were admitted to the hospital and received medications including oral steroids, thiopurine and infliximab.

Clinical and histological aspect of erythema dyschromicum perstans in Korea: A review of 68 cases.

Erythema dyschromicum perstans (EDP) is a hypermelanotic disorder of the idiopathic variety characterized by blue-gray macules in healthy individuals. It has been described mainly in patients from tropical areas of Central and South America. Our aim was to evaluate EDP in Korea through the analysis of retrospective case series with EDP and to describe the clinical and histopathological features. It was a retrospective study (2002-2012) of EDP confirmed by review of clinical photographs and biopsy specimens. The files of 68 patients with EDP from six tertiary medical centers in Korea were included in this study. Of the 68 patients, 29 were male and 39 female. The age of patients ranged 3-76years (mean, 33.9). Clinically, the majority of patients had lesions on the trunk (n=47, 69.1%); the neck was affected in 27 cases, the upper extremities in 26, the face in 22 and the lower extremities in 16. Peripheral erythematous borders were observed in 12 patients (17.6%) and 11 patients had itching sensation at the lesion. Histopathologically, dermal melanophages and pigment incontinence were the most common findings. A follow up of more than 1year was obtained in 51 patients. Of these, only one patient experienced complete clearance without recurrence. Our study illustrates the clinical and histopathological findings of EDP in Koreans. Our multicenter data may contribute to the understanding of EDP.

The effects of ethnic, social and cultural factors on axis I comorbidity of bipolar disorder: Results from the clinical setting in Korea

ObjectiveEthnic, social and cultural factors contribute to axis I comorbid conditions in bipolar disorder (BPD). Korea has strict laws against illicit drugs and a relatively permissive prevailing attitude toward alcohol. The present study aimed to explore the lifetime axis I comorbidity rate in patients with BPD in Korea. MethodsClinically stable patients with bipolar I (n=222) and bipolar II (n=194) disorders were recruited from four tertiary medical centers in Korea. The subjects׳ diagnoses and axis I comorbid conditions were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and the Korean version of the Diagnostic Interview for Genetic Studies (K-DIGS). The lifetime prevalence of anxiety disorders, substance use disorders and eating disorders was explored. The prevalence of these axis I comorbid conditions was compared with data from prior studies in other countries and to data concerning the general Korean population. ResultsA total of 45.1% of all subjects had at least one axis I comorbid condition. Anxiety disorders (30.2%) were the most common comorbidity, followed by alcohol use disorders (16.8%). Males with BPD showed a higher rate of alcohol dependence compared to the general male population and females with BPD showed a greater risk of having alcohol use disorder compared to the general female population. The rate of drug use disorder was extremely low (1.7%), and only one subject had an illicit-drug-related problem. LimitationCross-sectional studies. ConclusionComorbid conditions of Korean patients with BPD showed a distinct pattern, which is associated with the ethnic, social and cultural characteristics in Korea.

Management after endoscopic snare papillectomy for ampullary adenomas.

This study was designed to investigate clinicopathological features of patients who underwent endoscopic snare papillectomy (ESP) and to suggest how to manage patients after the procedure according to the pathological findings. Seventy-nine patients underwent ESP for ampullary tumors in 7 tertiary medical centers in Korea. We retrospectively reviewed the medical records of each patient and analyzed the data. Complete resection and complication rates of ESP were 76% and 21.7%, respectively; and pancreatitis rate was 11.5%. ESP-related mortality rate was 2.5% (n=2; 1 perforation and 1 pancreatitis). According to the pathological findings, endoscopic management was performed in 62/65 (95.4%) of low grade dysplasia (LGD) and 9/14 (64.3%) of high grade dysplasia (HGD)/cancer on pre-ESP; in 57/62 (92.0%) of LGD and 13/16 (81.3%) of HGD/cancer on ESP; and in 11/13(84.7%) of LGD and 0/6(0%) of HGD/cancer on follow-up biopsy. The rates of incomplete resection according to the pre-ESP pathological findings were 18.4% (12/65) in the LGD group and 50% (7/14) in the HGD/cancer group (p=0.033). HGD or cancer required surgical management. Moreover, pre-procedural HGD/cancer was associated with a high rate of incomplete resection after ESP. Therefore, if the pre-ESP pathological results revealed HGD/cancer, a careful endoscopic follow-up with imaging study or an early surgical intervention should be considered.

Determinants of intelligence in childhood-onset epilepsy: A single-center study

The purpose of this study was to quantify the intelligence of children with epilepsy and to determine the clinical factors associated with intellectual impairment.The medical records of patients diagnosed with childhood-onset epilepsy at a single tertiary medical center in Korea between 2006 and 2011 were retrospectively reviewed. The Korean Education Development Institute—Wechsler Intelligence Scale for Children or Korean Wechsler Intelligence Scale for adults was used to quantify the level of intelligence. Age at seizure onset, etiology, epilepsy duration, number of seizures in the last year, use of antiepileptic drugs, EEG/MRI findings, and epilepsy classification were recorded. The association between clinical factors and the intelligence was determined using logistic regression.Three hundred and twenty-two patients were included in the analysis. One hundred and seventy-six (54.7%) patients had low intelligence (intelligence quotient [IQ]<80) with 18 (5.6%) defined as borderline mental retardation (IQ 70–79), 47 (14.6%) as mild mental retardation (IQ 60–69), and 111 (34.5%) as moderate-to-severe mental retardation (IQ<60). Epilepsy duration, number of seizures in the last year, and epilepsy classification were significantly associated with low intelligence in multivariate logistic regression (p<0.05). However, when analyzed according to etiology, these factors were not associated with low intelligence in children with idiopathic epilepsy.The most important factors associated with low intelligence in childhood-onset epilepsy are the underlying etiology and, in cryptogenic and symptomatic epilepsy, seizure burden. The results of this study underscore the importance of seizure control to alleviate the harmful impact of epilepsy on cognition.

Is gynecological cancer a new indication for surveillance colonoscopy in Korea?

Previous studies regarding the risk for colorectal neoplasms in women with a prior diagnosis of gynecological cancer have revealed conflicting results. Therefore, we conducted a cross-sectional study to quantify the risk for colorectal neoplasms in patients with gynecological cancers. A total of 4613 women (including 27, 51 and 92 women with a prior diagnosis of endometrial, ovarian and cervical cancers, respectively) >20 years of age were recruited prospectively from 9 tertiary medical centers in Korea between January 2008 and February 2009. All participants underwent complete colonoscopies for vague abdominal signs or symptoms or for colorectal cancer screening. Several risk factors for colorectal neoplasms and a prior history of gynecological cancer were compared between women with and without colorectal neoplasms. The risk for colorectal neoplasms was only elevated among women with previous endometrial cancer, but with ovarian or cervical cancer, particularly when diagnosed at <50 years of age (adjusted OR=3.7; 95% CI=1.0-13.3, p=0.016). This study demonstrated a higher risk for colorectal neoplasms in women with previous endometrial cancer, particularly when diagnosed at <50 years of age. Greater emphasis on colorectal cancer screening in this population may be necessary.

Korean Guideline for Colonoscopic Polypectomy

There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.

Immunoglobulin G Subclass Deficiency is the Major Phenotype of Primary Immunodeficiency in a Korean Adult Cohort

Primary immunodeficiency disease (PID) is a rare disorder in adults. Most often, serious forms are detected during infancy or childhood. However, mild forms of PID may not be diagnosed until later in life, and some types of humoral immunodeficiency may occur in adulthood. The purpose of this study was to identify clinical features of PID in Korean adults. A retrospective study was performed on 55 adult patients who were diagnosed as PID between January 1998 and January 2009 at a single tertiary medical center in Korea. IgG subclass deficiency was the most common phenotype (67%, 37/55), followed by total IgG deficiency (20%, 11/55), IgM deficiency (7%, 4/55), common variable immunodeficiency (2%, 1/55), and X-linked agammaglobulinemia (2%, 1/55). IgG3 and IgG4 were the most affected subclasses. Upper and lower respiratory tract infections (76%) were the most frequently observed symptoms, followed by multiple site infection (11%), urinary tract infection, and colitis. Bronchial asthma, rhinitis, and several autoimmune diseases were common associated diseases. IgG and IgG subclass deficiency should be considered in adult patients presenting with recurrent upper and lower respiratory infections, particularly in those with respiratory allergies or autoimmune diseases.

Comparison of radiation therapy alone and concurrent chemoradiation therapy in stage III cervical cancer: A multicenter retrospective study

To evaluate whether concurrent chemoradiation therapy (CRT) improves overall survival as compared to radiation therapy (RT) alone in stage III cervical cancers. A multicenter retrospective review. Nine tertiary medical centers in Korea. A total of 277 patients treated for stage III cervical cancer without para-aortic lymph node (PALN) metastasis based on clinical staging workup from 1996 to 2003. Medical and histopathological record review. Disease-specific overall survival. CRT and RT alone were performed in 172 and 105 patients, respectively. There was no significant difference in disease-specific overall survival between the CRT and RT alone arms based on clinical staging workup, even though the CRT arm was characterized by younger age, more favorable performance status and lower pretreatment blood urea nitrogen level as compared to the RT alone arm. In the CRT arm, three patients succumbed to treatment-related death. CRT does not improve the overall survival rate in stage III cervical cancer as compared to RT alone based on clinical staging workup for PALN status. Special care needs to be taken regarding optimal dose and duration of RT, use of brachytherapy, anemia control and accurate pretreatment staging workup to improve survival outcome in patients with stage III cervical cancer.

Quality of life of patients with irritable bowel syndrome in Korea

The impact of irritable bowel syndrome (IBS) on HRQOL has been widely studied in the West. However, there are few data from Asian countries. The aim of this study was to assess the health-related quality of life (HRQOL) of patients suffering from IBS in Korea. Consecutive patients from six secondary and six tertiary medical centers in Korea were enrolled and completed self-administered questionnaires on sociodemographics and IBS-associated symptoms. HRQOL was assessed using the generic Short Form 36 (SF-36) and the disease-specific IBS-QOL questionnaires. Of the 932 patients with abdominal pain and bowel symptoms, 664 IBS patients who fulfilled the Rome II criteria were analyzed. On all eight SF-36 scales, IBS patients had a significantly worse HRQOL than the general population (P < 0.01). The overall score for the IBS-QOL was 74.2. The health concern domain was most affected (mean score 64.2), and the sexual domain (mean score 86.7) was least affected in the IBS-QOL. Significant impairment of HRQOL was only observed in patients with severe symptoms both in the generic and specific HRQOL measurement, whereas patients with mild and moderate symptoms showed only mild impairment (P < 0.01). Female patients reported a significantly lower HRQOL than male patients (P < 0.05), but the difference was minimal. The IBS-QOL was significantly associated with female gender, total symptom score, self-reported symptom severity, and level of education in the multivariate analysis. IBS-related symptoms had a great effect on the HRQOL of Korean patients. These results and the considerable prevalence of IBS in Korea indicate that IBS has a substantial social impact in this country.

Diagnostic Yield of Advanced Colorectal Neoplasia at Colonoscopy, According to Indications: An Investigation from the Korean Association for the Study of Intestinal Diseases (KASID)

The factors that more accurately predict the detection of colorectal cancers and adenomas at colonoscopy are different. We conducted a prospective multicenter study to evaluate which indications were most closely associated with advanced colorectal neoplasm (CRN), including colorectal cancer, in a group of patients undergoing colonoscopy. The 17 468 patients were enrolled in this study between July 2003 and March 2004, from 11 tertiary medical centers in Korea. They were recruited according to 11 itemized colonoscopic indications. The term "advanced adenoma" refers here to tubular adenomas of diameter of 11 mm or more, or to tubulovillous, villous, or severely dysplastic adenomas, irrespective of their size. Cancer was defined as the invasion of malignant cells beyond the muscularis mucosa. Advanced CRN was defined as advanced adenoma or invasive cancer. Advanced CRN was found in 1227/17 307 patients (1176 advanced adenomas plus 51 carcinomas, 7.1 %). According to univariate and multivariate analysis, the factors associated with advanced CRN included age >60 years (odds ratio (OR) 2.1, 95 % confidence interval (CI) 1.8 - 2.4, P < 0.0001), male gender (OR 2.1, 95 %CI 1.7 - 2.7, P < 0.0001), referral for colonoscopy from primary care physician (OR 3.1, 95 %CI 2.5 - 3.7, P < 0.0001), and several other indications (OR 1.8, 95 %CI 1.5 - 2.3, P < 0.001). The yield of colonoscopy for advanced CRN was lower (2.2 %) than expected in patients with iron-deficiency anemia (OR 0.5, 95 %CI 0.2 - 0.9, P = 0.03). Age, gender, and referral for colonoscopy from primary care physician constituted important independent predictors of advanced CRN in patients undergoing colonoscopy.

Diagnostic Yield of Advanced Colorectal Neoplasm with Colonoscopy by Indications

Background and Aims: The factors that best predict the presence of colorectal cancers and adenomas at colonoscopy are different. We conducted a prospective multicenter study to evaluate which indications were most closely associated with advanced colorectal neoplasm including colorectal cancer in patients undergoing colonoscopy. Methods: 6752 patients were enrolled in this study between July 2003 and March 2004 from 11 tertiary medical centers in Korea. They were recruited according to itemized 11 colonoscopic indications (1. bowel habit change, 2. stool caliber change, 3. melena/hematochezia, 4. tenesmus, 5. abdominal pain, 6. iron deficiency anemia, 7. past history of colorectal neoplasm, 8. familial history of colorectal cancer, 9. diagnosis and follow-up of inflammatory bowel disease, 10. referred for colonoscopy from primary physician, 11. other indications). The term ‘advanced adenoma’ is used to refer to tubular adenomas that were 10 mm or more in diameter or to tubulovillous, villous or severely dysplastic adenomas irrespective of size. Cancer was defined as the invasion of malignant cells beyond the muscularis mucosa. Advanced colorectal neoplasm was defined as advanced adenoma or invasive cancer. Results: Advance colorectal neoplasm was found in 422/6752 patients (368 advanced adenomas plus 54 carcinomas, 6.25%). In the multivariate analysis, age > 60 (Odds ratio 1.034, 95% confidence interval 1.025-1.043, p < 0.0001), female gender (OR 0.501, 95% CI 0.387-0.647, p < 0.0001), diagnosis and follow-up of inflammatory bowel disease (OR 3.126, 95% CI 1.723-5.674, p < 0.001), referred for colonoscopy from primary physician (OR 1.776, 95% CI 1.135-2.777, p < 0.05), other indications (OR 2.110, 95% CI 1.085-4.103, p < 0.05) were associated with advanced colorectal neoplasm. Conclusions: Age, gender, diagnosis and follow-up of inflammatory bowel disease, referred for colonoscopy from primary physician and other indications are important independent predictors of advanced colorectal neoplasm in patients undergoing colonoscopy. Background and Aims: The factors that best predict the presence of colorectal cancers and adenomas at colonoscopy are different. We conducted a prospective multicenter study to evaluate which indications were most closely associated with advanced colorectal neoplasm including colorectal cancer in patients undergoing colonoscopy. Methods: 6752 patients were enrolled in this study between July 2003 and March 2004 from 11 tertiary medical centers in Korea. They were recruited according to itemized 11 colonoscopic indications (1. bowel habit change, 2. stool caliber change, 3. melena/hematochezia, 4. tenesmus, 5. abdominal pain, 6. iron deficiency anemia, 7. past history of colorectal neoplasm, 8. familial history of colorectal cancer, 9. diagnosis and follow-up of inflammatory bowel disease, 10. referred for colonoscopy from primary physician, 11. other indications). The term ‘advanced adenoma’ is used to refer to tubular adenomas that were 10 mm or more in diameter or to tubulovillous, villous or severely dysplastic adenomas irrespective of size. Cancer was defined as the invasion of malignant cells beyond the muscularis mucosa. Advanced colorectal neoplasm was defined as advanced adenoma or invasive cancer. Results: Advance colorectal neoplasm was found in 422/6752 patients (368 advanced adenomas plus 54 carcinomas, 6.25%). In the multivariate analysis, age > 60 (Odds ratio 1.034, 95% confidence interval 1.025-1.043, p < 0.0001), female gender (OR 0.501, 95% CI 0.387-0.647, p < 0.0001), diagnosis and follow-up of inflammatory bowel disease (OR 3.126, 95% CI 1.723-5.674, p < 0.001), referred for colonoscopy from primary physician (OR 1.776, 95% CI 1.135-2.777, p < 0.05), other indications (OR 2.110, 95% CI 1.085-4.103, p < 0.05) were associated with advanced colorectal neoplasm. Conclusions: Age, gender, diagnosis and follow-up of inflammatory bowel disease, referred for colonoscopy from primary physician and other indications are important independent predictors of advanced colorectal neoplasm in patients undergoing colonoscopy.