Jae Keun Kim

Ajou University, Sŏul, Seoul, South Korea

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Publications (25)50.43 Total impact

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    ABSTRACT: We aimed to investigate the use of novel serum biomarkers for predicting the recurrence and survival of patients with hepatitis B virus (HBV)-related early hepatocellular carcinoma (HCC) after hepatic resection or radiofrequency ablation (RFA). One hundred and five patients with HBV-related HCC, who fulfilled the Milan criteria without vascular invasion and underwent hepatic resection or RFA, were followed-up for a median duration of 52months. Pretreatment serum concentrations of 16 cytokines including interleukin-6 (IL-6) were measured by using a Luminex 200 system. The measured serum cytokines and several clinical factors were analyzed retrospectively. Univariate analysis showed that patients with lower pretreatment serum levels of IL-10, IL-6, monocyte chemoattractant protein-1, and tumor necrosis factor-α had significantly shorter disease-free survival (DFS) than those with higher levels. Multivariate analysis revealed that a low serum IL-6 level (⩽33.00pg/mL; hazard ratio [HR]=5.39; 95% confidence interval [CI]=1.27-22.93; P=0.022), low platelet count (<100×10(9)/L; HR=2.23; 95% CI=1.28-3.89; P=0.005), and low serum albumin level (⩽3.5g/L; HR=2.26; 95% CI=1.28-3.97; P=0.005) had a negative prognostic impact on DFS. In the analysis for overall survival, a low serum platelet level (<100×10(9)/L; HR=2.80; 95% CI=1.31-5.99; P=0.008) and multiple tumor (⩾2; HR=4.05; 95% CI=1.56-10.48; P=0.004) showed a negative prognostic impact on the overall survival. A low serum IL-6 level is, in addition to low platelet count and low serum albumin level, an independent prognostic factor for DFS in patients with HBV-related early HCC who underwent hepatic resection or RFA with curative intention. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Cytokine 03/2015; 73(2):245-252. DOI:10.1016/j.cyto.2015.02.027 · 2.87 Impact Factor
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    ABSTRACT: Extrahepatic bile duct (EHD) cancer varies in uptake of FDG. The aim of the present study was to determine the role of glucose transporter (GLUT) 1 and hexokinase (HK) 2 in the glucose metabolism of EHD cancer cells using immunohistochemistry and F-FDG PET/CT. Twenty-six patients with EHD cancer who underwent baseline PET/CT and surgery were studied. Biopsies were immunohistochemically analyzed using antibodies against GLUT1 and HK2, and the expression was scored from 0 to 4 according to the percentage of stained cells. SUV and tumor-to-liver ratio (T/Lratio) were obtained from F-FDG PET/CT data. SUV and T/Lratio and GLUT1 and HK2 expression were compared with histological grades and tumor locations (proximal and distal EHD) to correlate glucose metabolism with the expression of GLUT1 and HK2. SUV, T/Lratio, and GLUT1 and HK2 expression did not differ as a function of histological grade and tumor location. GLUT1 and HK2 were expressed in 20 (76.9%) and 22 (84.6%) of 26 tumor biopsies, respectively. The GLUT1 score, SUV, and T/Lratio increased, and the GLUT1 score, but not the HK2 score, correlated significantly with SUV (ρ = 0.648) and T/Lratio (ρ = 0.703). There was no direct correlation between the expression of GLUT1 and that of HK2 (ρ = 0.2046, P = 0.3161). Although GLUT1 and HK2 regulate intracellular accumulation of FDG in many cancers, only GLUT1 expression was correlated with FDG uptake by EHD cancers.
    Clinical Nuclear Medicine 01/2015; 40(3). DOI:10.1097/RLU.0000000000000640 · 2.86 Impact Factor
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    ABSTRACT: Background Routine drainage of the abdominal cavity after surgery has been a robust dogma for many decades. Nevertheless, the policy of routine abdominal drainage is increasingly questioned. Many surgeons believe that routine drainage after surgery may prevent postoperative intra-abdominal infection. The goal of this study was to assess the role of drains in laparoscopic cholecystectomy (LC) for acute cholecystitis. Materials and methods From May 2008 to July 2012, 160 patients that underwent LC due to acute cholecystitis at Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea, were enrolled in this study. After surgery, patients were randomly allocated to undergo drain placement in the subhepatic space (Group A) or no drainage (Group B). Results There was no significant difference in the intra-abdominal abscess rate, which was 0.0 % with Group A and 1.3 % with Group B (P = 0.319). The median subhepatic fluid collection was 4.1 mL (1.1–60 mL) in Group A and 4.5 mL (1.1–80.0 mL) in Group B (P = 0.298). However, the median hospital stay was 2 days (1–4 days) in Group B and 3 days (2–7 days) in group A (P = 0.001). The subgroup of empyema patients did not have any significant differences in intra-abdominal fluid collection or intra-abdominal abscess rate. Conclusions This study suggests that postoperative routine drainage of the abdominal cavity for acute cholecystitis does not prevent intra-abdominal infections.
    Surgical Endoscopy 07/2014; 29(2). DOI:10.1007/s00464-014-3685-5 · 3.31 Impact Factor
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    ABSTRACT: Liver resection with colorectal liver metastasis widely accepted and has been considered safe and effective therapeutic option. However, the role of liver resection in breast cancer with liver metastasis is still controversial. Therefore, we reviewed the outcome of liver resection in breast cancer patients with liver metastases in a single hospital experiences. Between January 1991 and December 2006, 2176 patients underwent breast cancer surgery in Gangnam Severance Hospital. Among these patients, 110 cases of liver metastases were observed during follow-up and 13 of these patients received liver resection with potential feasibility to achieve an R0 resection. The median time interval between initial breast cancer and detection of liver metastasis was 62.5 months (range, 13-121 months). The 1-year and 3-year overall survival rates of the 13 patients with liver resection were 83.1% and 49.2%, respectively. The 1-year and 3-year overall survival rates of patients without extrahepatic metastasis were 83.3% and 66.7% and those of patients with extrahepatic metastasis were 80.0% and 0.0%, respectively (p=0.001). Liver resection for metastatic breast cancer results in improved patient survival, particularly in patients with solitary liver metastasis and good general condition.
    Yonsei medical journal 05/2014; 55(3):558-62. DOI:10.3349/ymj.2014.55.3.558 · 1.26 Impact Factor
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    ABSTRACT: While clinical practice guidelines are effective tools for improving the quality of patient care and provide specific recommendations for daily practice, the usage of them have been often suboptimal. Therefore, evaluation of physician attitude to guidelines is an important initial step in improving guideline adherence levels. The aim of this study was to survey the attitude on general guidelines and adherence with the Korea Practical Guidelines for gallbladder (GB) polyp two year after their publication and distribution among Korean private clinicians.
    01/2014; 18(2):52. DOI:10.14701/kjhbps.2014.18.2.52
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    ABSTRACT: Few reports have validated the clinical postoperative pancreatic fistula (PF) after distal pancreatectomy. The study intended to validate the predictability for clinical PF of drain amylase and lipase and to find out more appropriate postoperative day (POD) for diagnostic criterion of PF.
    01/2014; 18(3):90. DOI:10.14701/kjhbps.2014.18.3.90
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    ABSTRACT: Self-expandable metal stents are an alternative to preoperative and palliative colostomy for patients with malignant colorectal obstruction. However, self-expandable metal stent placement is considered unsuitable or contraindicated for patients with malignant lower rectal obstruction within 5 cm of the anal verge because the exposed stent portion can irritate the distal rectum and cause anal pain and a foreign body sensation. To describe our experience with 6 patients with malignant lower rectal obstruction who underwent stent insertion with a proximal releasing delivery system (PRDS). Prospective clinical series outcome study. A tertiary-care referral university hospital. This study involved all patients at our center who had a malignant lower rectal obstruction within 5 cm of the anal verge caused by rectal cancer and bladder cancer. Uncovered stent with the PRDS with endoscopic and fluoroscopic guidance. Technical and clinical success rate, adverse event rate, and stent migration rate. All stents were placed at the expected location. Technical and clinical success rates were 100%. Two patients reported anal pain, which was controlled with analgesics. One case of tumor ingrowth occurred after 5 months and was treated with reinsertion of a stent with the PRDS. After stent insertion, the patients received chemotherapy, chemoradiotherapy, or conservative care. Small number of patients and no comparison group. Further prospective, randomized, controlled trials are needed. Uncovered stent insertion with the PRDS is a feasible, safe, and effective treatment for the patient with malignant lower rectal obstruction within 5 cm from the anal verge.
    Gastrointestinal endoscopy 12/2013; 78(6):930-3. DOI:10.1016/j.gie.2013.08.018 · 4.90 Impact Factor
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    ABSTRACT: The measurement of fecal elastas-1 in stools is a sensitive and relatively inexpensive noninvasive test. The aim of this study was to study fecal elastase levels in patients who develop pancreatic leakage after pancreaticoduodenectomy (PD) to determine if fecal elastase level can be used to predict patients at high risk for pancreatic leakage after PD. Pancreatic function was considered normal when fecal elastase-1 concentration exceeded 200 μg/g feces and moderately or severely insufficient when fecal elastas-1 concentration was less than 200 μg/g feces. Of 123 patients who underwent PD, 67 (54.5%) showed fecal elastase-1 levels less than 200 μg/g, indicating moderate or severe pancreatic insufficiency. Pancreas texture, pathology origin, and level of γ-glutamyl transferase (r-GT) were significantly correlated with fecal elastas-1 level. On univariate analysis, the incidence of pancreatic leakage was significantly greater in the group with normal fecal elastase-1 level (≥200 μg/g), pathologic origin (bile duct/ampulla/duodenum), and soft pancreas texture. In multivariate analysis, normal fecal elastase-1 level (≥200 μg/g) and soft pancreatic texture were identified as independent factors for pancreatic leakage. Fecal elastase-1 is the most simple and objective method for predicting pancreatic leakage after PD.
    Journal of Clinical Laboratory Analysis 09/2013; 27(5):379-83. DOI:10.1002/jcla.21614 · 1.14 Impact Factor
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    Jae Keun Kim, Joonseong Park, Dong Sup Yoon
    Pancreatology 07/2013; 13(4):S64. DOI:10.1016/j.pan.2013.07.242 · 2.50 Impact Factor
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    ABSTRACT: BACKGROUND: Bile duct cancer has very poor prognosis. Important prognostic factors include the TNM stage, cell differentiation, and histologic type; however, we often observe patients whose prognosis is not consistent with the TNM stage. Additional prognostic indicators are mandatory to complement those used presently. We evaluated the hypermethylation status of genes for the power to predict overall survival following curative resection of mid/distal bile duct cancer. METHODS: Pyrosequencing hypermethylation status at the loci of interest was analyzed in 65 mid/distal bile duct carcinoma specimens obtained at Severance Hospital of Yonsei University College of Medicine from January 2000 to December 2006. RESULTS: Significant methylation frequencies (MtI >5 %) were obtained for 5 genes (which P16 [17 %], DAPK [54 %], E-cadherin [60 %], RASSF-1 [46.2 %], and hMLH1 [43.1 %]). MtI status of P16, DAPK, and RASSF-1 were correlated with perineural invasion, tumor depth, and age, respectively. In the multivariate analysis of overall survival, the presence of lymph node metastasis and P16 methylation status were identified as independent prognostic factors for overall survival. Patients with unmethylated of P16 had the 3- and 5-year survival rates of 60.8 and 54.9 %, respectively. In patients with hypermethylated P16, the 3- and 5-year survival rates were 27.3 and 0.0 %, respectively. CONCLUSIONS: P16 hypermethylation and lymph node metastasis may predict overall survival in curative resected mid/distal bile duct cancer. Classification of mid/distal bile duct cancer by both genetic and epigenetic profiles may improve the accuracy in predicting outcome and the effectiveness of tailored therapy in these diseases.
    Annals of Surgical Oncology 03/2013; DOI:10.1245/s10434-013-2908-7 · 3.94 Impact Factor
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    ABSTRACT: BACKGROUND: Chyle leakage is a rare complication of pancreaticoduodenectomy (PD), and its association with pancreatic fistula has not been established. The aim of this study was to (1) evaluate the incidence, management, and risk factors of chyle leakage after PD; (2) determine if there is a relation between chyle leakage and diagnosis of pancreatic fistula; and (3) predict chyle leakage with drainage volume early. METHODS: A total of 222 patients underwent PD or pylorus-preserving PD. We used the clinical database registry system of the Gangnam Severance Hospital, Yonsei University Health System to establish a retrospective cohort with clinicopathologic data. RESULTS: Altogether, 24 patients (10.8 %) developed chyle leakage. Chyle leakage was identified at a median 5 days after surgery and a mean 2 days after enteral intake. The mean drain triglyceride level was 315 mg/dl. Early enteral intake was independently associated with chyle leakage. Chyle leakage was inversely correlated with a diagnosis of pancreatic fistula with marginal significance (odds ratio 0.27; 95 % confidence interval 0.66-1.09). The receiver operating characteristic curve of the volume on postoperative day 4 demonstrated an area under the curve of 0.740 (p = 0.0001). Drainage >335 ml indicated possible chyle leakage. CONCLUSIONS: Chyle leakage after PD is associated with early enteral intake. It was inversely correlated with a diagnosis of pancreatic fistula because of the dilution effect of drainage volume on the concentration of drained amylase. Because early diagnosis helps with appropriate management, prediction/suspicion of chyle leakage based on drainage volume may be useful.
    World Journal of Surgery 02/2013; 37(4). DOI:10.1007/s00268-013-1919-7 · 2.35 Impact Factor
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    ABSTRACT: With recent advances in pancreatic surgery, pancreaticoduodenectomy (PD) has become increasingly safe. However, pancreatic leakage is still one of the leading postoperative complications. An accurate prediction model for pancreatic leakage after PD can be helpful for pancreas surgeons. The aim of this study was to provide a new model that was simple and useful with high accuracy for predicting pancreatic leakage after PD.
    01/2013; 17(4):166. DOI:10.14701/kjhbps.2013.17.4.166
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    ABSTRACT: Obesity is associated with perioperative complications and has been considered a risk factor for surgical outcomes of patients undergoing abdominal surgery. The aim of this study is to evaluate the impact of the amount of visceral fat on postoperative morbidity of patients who underwent pancreaticoduodenectomy (PD). We reviewed 181 patients who underwent surgery for periampullary lesions at the Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System between January 2003 and June 2010. The visceral fat area (VFA) and subcutaneous fat area were calculated by computed tomography software. The mean body mass index (BMI) was 23.4 kg/m(2) (±3.1 kg/m(2)), and the mean VFA was 94.4 cm(2) (±49.5 cm(2)). The mean intraoperative blood loss, and the incidence of clinically relevant pancreatic fistula (grade B/C) and clinically relevant delayed gastric emptying (grade B/C) were significantly higher in the high-VFA group (≥100 cm(2)). In univariate analysis, the incidence of clinically relevant pancreatic fistula (grade B/C) was significantly higher in the high-BMI group (≥25 kg/m(2)), the high-VFA group(≥100 cm(2)), the large intraoperative blood loss and transfusion group, and in patients with pathology of nonpancreatic origin (ampulla, bile duct, or duodenum). In multivariate analysis, the high-VFA group (≥100 cm(2)) and patients with pathology of nonpancreatic origin were identified as independent factors for clinically relevant pancreatic fistula. VFA is a better indicator for the development of pancreatic fistula after PD than BMI. High VFA (≥100 cm(2)) is a risk factor for developing a pancreatic fistula after PD.
    Journal of Investigative Surgery 06/2012; 25(3):169-73. DOI:10.3109/08941939.2011.616255 · 1.19 Impact Factor
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    ABSTRACT: Angiogenesis is essential for tumor growth and metastasis. Currently, the Chalkley assay with CD34 immunostaining is the proposed standard method for angiogenesis quantification in solid tumor sections. The purpose of this study was to evaluate the expression of CD34 and its prognostic significance using the Chalkley method in node negative carcinoma of the ampulla of Vater. Between January 1997 and December 2006, 56 node negative patients who had curative resection for carcinoma of the ampulla of Vater were retrospectively reviewed. The Chalkley count was expressed as the mean value of the three counts for each tumor and further divided into two groups according to the mean value of the Chalkley count: low < 4 or high ≥ 4. The mean Chalkley count value was 4.0 (± 3.1). In the low Chalkley group, the 1- and 3-yr recurrence rates were 18.3%, 47.6% respectively; in the high Chalkley group, the 1- and 3-yr recurrence rates were 26.5% and 60.6% respectively. Only high Chalkley count had statistical significance as a factor in recurrence of node negative ampulla of Vater carcinoma. Assessment of angiogenesis may have an important role in the prognostic evaluation of node negative cancer of the ampulla of Vater.
    Journal of Korean medical science 05/2012; 27(5):495-9. DOI:10.3346/jkms.2012.27.5.495 · 1.25 Impact Factor
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    ABSTRACT: The benefits of early enteral feeding (EEN) have been demonstrated in gastrointestinal surgery. But, the impact of EEN has not been elucidated yet. We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy (PD) according to the postoperative nutritional method and compared the clinical outcomes of two methods. A prospective randomized trial was undertaken following PD. Patients were randomly divided into two groups; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition (TPN) management. Thirty-eight patients were included in our analyses. The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group. Prealbumin and transferrin were significantly reduced on post-operative day (POD) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group. EEN group rapidly recovered weight after POD 21 whereas it was gradually decreased in TPN group until POD 90. EEN after PD is associated with preservation of weight compared with TPN and impact on recovery of digestive function after PD.
    Journal of Korean medical science 03/2012; 27(3):261-7. DOI:10.3346/jkms.2012.27.3.261 · 1.25 Impact Factor
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    ABSTRACT: S-plasty for pilonidal disease reduces the tension on the midline by distributing it diagonally and flattening the natal cleft. The aim of this study was to evaluate the outcomes of S-plasty on simple midline primary closure and the clinical features of pilonidal patients in a low incidence country. S-plasty was applied on 17 patients from July 2008 to October 2010. Data of these patients were collected with computerized prospective database forms during a perioperative period and via telephone interview for follow-up. Surgical site infection (SSI) was defined according to the Center for Disease Control guidelines. The severity of surgical site infection was graded. All patients were treated with primary S-plasty. Two patients (11.7%) developed low grade SSI. The average healing time after S-plasty was 18.1 days. No recurrences were observed. The mean follow-up period was 13.5 months (range, 6 to 33 months). We have shown that primary S-plasty for pilonidal disease is simple, and its surgical outcomes are compatible to the results of other surgical treatments. We present primary S-plasty as a feasible treatment option in a low incidence country.
    02/2012; 82(2):63-9. DOI:10.4174/jkss.2012.82.2.63
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    ABSTRACT: Accurate indications and the extent of surgery for branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas are still debatable. In particular, small tumor is located at the head portion of pancreas presents a dilemma. The purpose of this study is to compare the efficacy of enucleation (EN) with that of pancreaticoduodenectomy (PD) in patients with small (2 cm<size<3 cm) branch duct IPMN located at the head of pancreas or uncinate process. Among 155 patients who underwent pancreatic surgery due to pancreatic cystic tumors between January 2000 and December 2007 at Yonsei University Health System in Seoul, Korea, 14 patients with small (2 cm<size<3 cm) branch duct IPMN located at the head of pancreas or uncinate process were included in this study. Ten patients underwent PD, and four patients underwent EN. We compared short term surgical outcomes between the two groups. Correlation of the variables was analyzed using Mann-Whitney test and Fisher's exact test (SPSS Window 12.0). p-values less than 0.05 were considered significant. The average age was 62.21 years (±6.71 years) and consisted of 8 men and 6 women. The mean operation time and blood loss were significantly lower in EN group. There were no significant differences in other surgical morbidities. The result suggests that enucleation for small branch duct IPMN located at the head of pancreas or uncinate process is feasible and as safe as PD, despite a high rate of minor complications.
    Yonsei medical journal 01/2012; 53(1):106-10. DOI:10.3349/ymj.2012.53.1.106 · 1.26 Impact Factor
  • Gastrointestinal endoscopy 05/2011; 73(5):1039-40. DOI:10.1016/j.gie.2010.11.038 · 4.90 Impact Factor
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    ABSTRACT: Several surgical complications are related to obesity. This study evaluated the impact of obesity on pancreatic fistula after pancreaticoduodenectomy. We retrospectively reviewed the medical records of 159 patients who underwent pancreaticoduodenectomy between October 2002 and December 2008. The patients were divided according to the body mass index as obese (body mass index equal to, or greater than, 25 kg/m(2)), or normal (body mass index less than 25 kg/m(2)). Univariate and multivariate analyses were applied. Two-tailed P values less than 0.05 were considered as significant. Forty-six patients (28.9%) were obese and 113 patients (71.1%) were normal-weight. Obese group had a significantly higher incidence of pancreatic fistula and a greater amount of intraoperative blood loss. Other surgical complications were not significantly different between the two groups. Multivariate analysis found obesity, small pancreatic duct size (less than, or equal to, 3 mm), intraoperative blood loss, and combined resection as significant factors affecting pancreatic fistula. Obese patients have an increased risk for pancreatic fistula after pancreaticoduodenectomy.
    JOP: Journal of the pancreas 01/2011; 12(6):586-92.
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    ABSTRACT: Covered metallic or plastic stent placement has become an important treatment for postoperative esophageal leakage; however, fluoroscopic guidance is also required. Here we present a novel stent insertion technique with a newly designed proximal-releasing, self-expanding metallic stent (PR-SEMS) and transnasal endoscope that can enable stent insertion without fluoroscopy as a new method to prevent stent migration. To describe our experience with 7 patients who underwent PR-SEMS insertion with the direct-vision technique and our use of the transnasal endoscope without fluoroscopy. Prospective outcome study. A tertiary-care referral university hospital. This study involved all patients at our center who experienced postoperative esophageal leakage after esophagectomy, primary closure, or total gastrectomy. PR-SEMS insertion with the direct vision technique and use of transnasal endoscopy without fluoroscopy. Success rate of stent insertion, healing rate of postoperative esophageal leaks, and stent migration rate. All stents were placed at the expected location without complications. One patient had massive hematemesis and underwent surgery. The bleeding focus was the splenic artery, which was damaged during gastrectomy. A significant marginal ulcer occurred in one patient, and the stent was immediately retrieved with an endoscope. After stent removal, 4 postoperative leakages were completely healed, and 2 lesions were not occluded. The 2 remaining minimal lesions became completely occluded with conservative management after stent removal. Stent migration did not occur. A small number of patients. Further prospective, randomized, controlled trials are needed. PR-SEMS insertion under transnasal endoscopic guidance is a feasible, safe, and effective treatment for postoperative esophageal leakage, and it can be performed as a bedside procedure. Our anchoring method is effective for the prevention of migration from nonobstructed lesions.
    Gastrointestinal endoscopy 07/2010; 72(1):180-5. DOI:10.1016/j.gie.2010.02.052 · 4.90 Impact Factor

Publication Stats

150 Citations
50.43 Total Impact Points

Institutions

  • 2010–2015
    • Ajou University
      • Department of Radiology
      Sŏul, Seoul, South Korea
  • 2008–2014
    • Yonsei University Hospital
      • Surgery
      Sŏul, Seoul, South Korea
  • 2008–2013
    • Yonsei University
      • Department of Surgery
      Sŏul, Seoul, South Korea
  • 2012
    • Seongnam Central Hospital
      Sŏngnam, Gyeonggi-do, South Korea