Rungsun Rerknimitr

King Chulalongkorn Memorial Hospital, Krung Thep, Bangkok, Thailand

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Publications (108)279.15 Total impact

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    ABSTRACT: An overdose of the acetaminophen causes liver injury. This study aims to examine the anti-oxidative, anti-inflammatory effects of Aloe vera in mice with acetaminophen induced hepatitis.
    BMC Complementary and Alternative Medicine 07/2014; 14(1):229. · 2.08 Impact Factor
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    ABSTRACT: The double balloon enteroscopy (DBE) procedure is long and requires moderate sedation. We aim to determine whether the administration of propofol infusion is safe by comparing it to intravenous midazolam/meperidine in patients undergoing DBE.
    05/2014; 97(5):483-9.
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    ABSTRACT: Currently, the strategy for real-time endoscopic diagnosis of duodenal, including ampullary, adenoma is still unclear. In the era of high-definition and magnification endoscopy, using this modality for the detection and diagnosis of these neoplasms is very challenging for endoscopists. Over the past 10 years, many instruments have been developed to improve the detection rate of duodenal and ampullary polyps and to distinguish between adenoma and non-adenoma. The present review will focus on these novel methods and their usefulness in the diagnosis of ampullary and non-ampullary adenoma.
    Digestive Endoscopy 04/2014; 26(S2). · 1.61 Impact Factor
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    ABSTRACT: To evaluate feasibility of the novel forward-viewing radial-array echoendoscope for staging of colon cancer beyond rectum as the first series. A retrospective study with prospectively entered database. From March 2012 to February 2013, a total of 21 patients (11 men) (mean age 64.2 years) with colon cancer beyond the rectum were recruited. The novel forward-viewing radial-array echoendoscope was used for ultrasonographic staging of colon cancer beyond rectum. Ultrasonographic T and N staging were recorded when surgical pathology was used as a gold standard. The mean time to reach the lesion and the mean time to complete the procedure were 3.5 and 7.1 min, respectively. The echoendoscope passed through the lesions in 13 patients (61.9%) and reached the cecum in 10 of 13 patients (76.9%). No adverse events were found. The lesions were located in the cecum (n = 2), ascending colon (n = 1), transverse colon (n = 2), descending colon (n = 2), and sigmoid colon (n = 14). The accuracy rate for T1 (n = 3), T2 (n = 4), T3 (n = 13) and T4 (n = 1) were 100%, 60.0%, 84.6% and 100%, respectively. The overall accuracy rates for the T and N staging of colon cancer were 81.0% and 52.4%, respectively. The accuracy rates among traversable lesions (n = 13) and obstructive lesions (n = 8) were 61.5% and 100%, respectively. Endoscopic ultrasound and computed tomography had overall accuracy rates of 81.0% and 68.4%, respectively. The echoendoscope is a feasible staging tool for colon cancer beyond rectum. However, accuracy of the echoendoscope needs to be verified by larger systematic studies.
    World Journal of Gastroenterology 03/2014; 20(10):2681-7. · 2.55 Impact Factor
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    ABSTRACT: A 55-year-old healthy Thai man presented with incidental finding of a well-circumscribed, 5.8×5.4 cm mass in the right side of the pelvic cavity with heterogeneous density by a CT scan performed for trauma. No other distant lesion was detected. The pathology from pelvic mass showed poorly differentiated neuroendocrine carcinoma (NEC). A submucosal mass of 10 cm from the anal verge was found at colonoscopy, and a biopsy showed the same histopathology as in the pelvic mass. Final diagnosis was poorly differentiated primary rectal NEC with metastasis to the right iliac node (by CT scan). Carboplatin and etoposide were given for six cycles and tumour size was decreased.
    Case Reports 01/2014; 2014.
  • Gastrointestinal Endoscopy. 01/2014; 79(5):AB113.
  • Gastrointestinal Endoscopy. 01/2014; 79(5):AB113.
  • Endoscopy 11/2013; 45(S 02):E363-E364. · 5.74 Impact Factor
  • Endoscopy 10/2013; 45 Suppl 2:E352-3. · 5.74 Impact Factor
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    ABSTRACT: Abstract Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.
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    ABSTRACT: Management of endoscopic complications is a pertinent aspect of patient care that has received great attention in the past decade due to advancements and increases in complexity of therapeutic endoscopy. Working groups from various institutions such as American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy have devised detailed guidelines and management algorithms. Three main factors that contribute to endoscopic complications are patient, operator, and type of procedure. No one rule suits all;hence endoscopic complication management must be customized to individual patients. Comprehensive knowledge of patient, machine/device, and its interrelationship must be in place to manage endoscopic complications.
    Digestive Endoscopy 05/2013; 25(S2). · 1.61 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. METHODS: We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 y, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. RESULTS: We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 undetermined [IBD-U]). The crude annual overall incidence values, per 100,000 individuals, were 1.37 for IBD in Asia (95% confidence interval [CI], 1.25-1.51) (0.76 for UC, 0.54 for CD, and 0.07 for IBD-U) and 23.67 in Australia (95% CI, 18.46-29.85) (7.33 for UC, 14.00 for CD, and 2.33 for IBD-U). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. The median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15]. Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P =.001), whereas a family history of IBD was less common in Asia (3% vs 17%; P <.001). CONCLUSIONS: We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe, or more severe, in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health-care resources, and offers a unique opportunity to study etiologic factors in developing nations.
    Gastroenterology 04/2013; epub. · 12.82 Impact Factor
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    ABSTRACT: In Asia, the incidence of pancreatic cancer in some countries has been increasing. Owing to most cases being diagnosed late, prognosis for pancreatic cancer remains dismal. It is clear the future for pancreatic cancer is early detection. While the possible presence of pancreatic masses is often first raised by non-invasive abdominal imaging such as computerized tomography (CT) and magnetic resonance imaging (MRI), smaller lesions and locoregional lymph node metastases are often not detectable by these means. Endoscopic ultrasonography (EUS) offers a higher sensitivity (93-100%) for the detection of small potentially curable pancreatic masses than other existing imaging modalities. It is also recommended to evaluate portal vein confluence, portal vein, celiac axis and SMA origin, and exclude respectability. Due to the closer proximity of EUS to the target structure, and lower rate of needle tract seeding, EUS-guided fine needle aspiration (FNA) of pancreatic mass is considered the most suitable tissue acquisition technique. Lastly, EUS also enables the performance of endoscopic interventions. Its performance can be further enhanced with newer techniques, including contrast enhanced ultrasound and elastrography. It is anticipated that in the near future, molecular technologies may make it possible to detect microscopic amounts of cancer in tissue or blood, predict relapse and survival after therapy, as well as determine optimal therapy.
    Journal of Gastroenterology and Hepatology 03/2013; · 3.33 Impact Factor
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    ABSTRACT: BACKGROUND AND AIM: Probe-based confocal laser endomicroscope (pCLE) has been applied for the early detection and confirmation of many GI neoplasms however its use in gastric intestinal metaplasia (GIM) detection has not yet been validated. The objective of this study was to assess the diagnostic yield of magnifying Flexible Spectral Imaging Color Enhancement (ME-FICE) plus pCLE for GIM detection. METHODS: Sixty patients with previous histology confirmed as GIM underwent a surveillance EGD. Standard and 100x ME-FICE were used as a screening mode to depict GIM by light blue crest, large long crest, and villous pattern criteria. Then pCLE was followed to confirm the presence of GIM. In each patient, two biopsies were obtained from one positive area and the other two were taken from the negative area. All specimens were interpreted by a clinically-blinded pathologist. The reading results by ME-FICE and by ME-FICE plus pCLE were assessed for sensitivity, specificity, PPV, NPV, false positive rate, false negative rate, and accuracy. RESULTS: Of the 59 areas suspicious for GIM in 45 patients, 44 areas were confirmed as GIM by histology. The overall criteria from ME-FICE plus pCLE provided the highest sensitivity, specificity, PPV, NPV, and accuracy at 96%, 90%, 86%, 97%, and 92%, respectively. There were 2 false negatives (4%) and 7 false positives (10%). No early gastric cancer was detected in any. CONCLUSION: Combining ME-FICE with pCLE provides high sensitivity and NPV for GIM detection. The prompt histology reading by this technique may avoid unnecessary biopsy. (Clinical trial registration number: NCT01489397).
    Journal of Gastroenterology and Hepatology 02/2013; · 3.33 Impact Factor
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    ABSTRACT: Hilar cholangiocarcinoma (HCCA) is one of the most common types of hepatobiliary cancers reported in the world including Asia Pacific region. Early HCCA may be completely asymptomatic. When significant hilar obstruction develops, the patient presents with jaundice, pale stools, dark urine, pruritus, abdominal pain, and sometimes fever. Since no single test can establish the definite diagnosis then a combination of many investigations such as tumour markers, tissue acquisition, CT scan, MRI/MRCP, EUS/IDUS, and advanced cholangioscopy is required. Surgery is the only curative treatment. Unfortunately, the majority of HCCA has a poor prognosis due to their advanced stage on presentation. Although, there is no survival advantage, inoperable HCCA managed by palliative drainage may benefit from symptomatic improvement. Currently, there are three techniques of biliary drainage which include endoscopic, percutaneous, and surgical approaches. For non-surgical approaches, stent is the most preferred device and there are two types of stents i.e. plastic and metal. Type of stent and number of stent for HCCA biliary drainage are subjected to debate since the decision is made under many grounds i.e. volume of liver drainage, life expectancy, expertise of the facility, etc. Recently, radiofrequency ablation and photodynamic therapy are promising techniques that may extend drainage patency. Through a review in the literature and regional data, the Asia-Pacific Working Group for hepatobiliary cancers has developed statements to assist clinicians in diagnosing and managing of HCCA. After voting anonymously using modified Delphi method, all final statements were determined for the level of evidence quality and strength of recommendation.
    Journal of Gastroenterology and Hepatology 01/2013; · 3.33 Impact Factor
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    ABSTRACT: A 50-year-old woman with end-stage kidney disease was admitted for a living-donor kidney transplantation. On post-transplantation day 6, she developed antibody-mediated rejection and was treated with plasmapheresis, rituximab and intravenous immunoglobulin. 1 week later, she developed severe upper gastrointestinal bleeding from multiple duodenal ulcers along the bulb and the third part of the duodenum. She underwent 11 sessions of endoscopic and interventional therapies comprised with the combination of various techniques including bipolar coaptation, hemoclipping, band ligation and angiogram with coil embolisation of duodenal branch of gastroduodenal artery. Histopathology showed neither any organism nor any feature of graft-versus-host disease. However, empiric treatments with intravenous proton pump inhibitor and broad-spectrum antibiotics/antifungal were given but failed to heal the ulcer, and bleeding recurred from the new developed ulcers. Finally, a single dose of intravenous infliximab was administered to stop bleeding. The patient responded dramatically with rapid ulcers healing and there was no recurrent bleeding during a 3-month follow-up.
    Case Reports 01/2013; 2013.
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    ABSTRACT: An elderly Thai woman had presented with dyspepsia and reflux symptoms since 6 years. Oesophagogastroduodenoscopy showed a large gastric ulcer with a histopathological diagnosis of signet ring cell carcinoma. The test for Helicobacter pylori was positive and it was successfully eradicated. An abdominal CT scan showed the irregularly thick antral wall along with non-specific subcentimeter lymph nodes which was compatible with at least stage IA. Her serum carcinoembryonic antigen level was within normal range. She refused any surgical treatment and preferred to take her own medications. To date, 6 years after her first diagnosis, the second oesophagogastroduodenoscopy was performed and showed a large gastric ulcer at the incisura extending to the gastric antrum. The histopathological result of the ulcer confirmed the presence of poorly differentiated adenocarcinoma with signet ring cell. She remains healthy and refused to have a follow-up disease staging or additional treatment.
    Case Reports 01/2013; 2013(jul08_2).
  • Source
    Rapat Pittayanon, Rungsun Rerknimitr
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    ABSTRACT: In Japan and countries such as South Korea and Taiwan, China, the standard technique for detecting early gastric cancer (EGC) is chromoendoscopy. This technique involves a magnified endoscope and the use of an indigo-carmine spray to distinguish between EGC and non-EGC areas. However, this technique is not widely adopted in many parts of the world. One important reason for limited use is that this technique needs an experienced endoscopist to interpret the images during the procedure. In addition, the sensitivity for detecting gastric intestinal metaplasia (GIM), a precancerous lesion of EGC, is graded as suboptimal. Moreover, the requirement of a cumbersome spraying method is inconvenient and needs preparation time. Easier digital chromoendoscopy techniques, such as Narrow-band Imaging and Flexible spectral Imaging Color Enhancement, have been reported to facilitate targeted GIM and EGC biopsy. They provide higher sensitivities over conventional white light endoscopy. Recently, the novel technology of confocal laser endomicroscopy has been introduced as a high-magnification (1000 ×) real-time evaluation for many early gastrointestinal (GI) cancers and precancerous GI lesions, including colonic polyp, Barrett's esophagus, and GIM. The advantage of this technique is that it can be used as an in vivo confirmation of the presence of GIM and EGC during endoscopic surveillance. This review aims to explain the current information on the usefulness of digital chromoendoscopy and confocal laser endomicroscopy for evaluating GIM and EGC during endoscopic surveillance and the possible future role of these techniques for GI cancer screening programs.
    World journal of gastrointestinal endoscopy. 10/2012; 4(10):472-8.
  • Endoscopy 09/2012; 44(9):884. · 5.74 Impact Factor
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    ABSTRACT: ERCP practically requires moderate to deep sedation controlled by a combination of benzodiazepine and opiod. Propofol as a sole agent may cause oversedation. A combination (cocktail) of infused propofol, meperidine, and midazolam can reduce the dosage of propofol and we hypothesized that it might decrease the risk of oversedation. We prospectively compare the efficacy, recovery time, patient satisfactory, and side effects between cocktail and conventional sedations in patients undergoing ERCP. ERCP patients were randomized into 2 groups; the cocktail group (n = 103) and the controls (n = 102). For induction, a combination of 25 mg of meperidine and 2.5 mg of midazolam were administered in both groups. In the cocktail group, a bolus dose of propofol 1 mg/kg was administered and continuously infused. In the controls, 25 mg of meperidine or 2.5 mg/kg of midazolam were titrated to maintain the level of sedation. In the cocktail group, the average administration rate of propofol was 6.2 mg/kg/hr. In the control group; average weight base dosage of meperidine and midazolam were 1.03 mg/kg and 0.12 mg/kg, respectively. Recovery times and patients' satisfaction scores in the cocktail and control groups were 9.67 minutes and 12.89 minutes (P = 0.045), 93.1and 87.6 (P <0.001), respectively. Desaturation rates in the cocktail and conventional groups were 58.3% and 31.4% (P <0.001), respectively. All desaturations were corrected with temporary oxygen supplementation without the need for scope removal. Cocktail sedation containing propofol provides faster recovery time and better patients' satisfaction for patients undergoing ERCP. However, mild degree of desaturation may still develop., NCT01540084.
    BMC Anesthesiology 08/2012; 12:20. · 1.19 Impact Factor

Publication Stats

567 Citations
279.15 Total Impact Points


  • 2011–2014
    • King Chulalongkorn Memorial Hospital
      Krung Thep, Bangkok, Thailand
    • National University of Singapore
      • Department of Medicine
      Singapore, Singapore
    • Tokyo Medical University
      • Department of Gastroenterology and Hepatology
      Tokyo, Tokyo-to, Japan
  • 2001–2014
    • Chulalongkorn University
      • • Department of Medicine
      • • Faculty of Medicine
      • • Department of Surgery
      Krung Thep, Bangkok, Thailand
    • Bangkok University
      Krung Thep, Bangkok, Thailand
  • 2012
    • University of New South Wales
      • Faculty of Medicine
      Kensington, New South Wales, Australia
    • Mahidol University
      Krung Thep, Bangkok, Thailand