Seunghyun Kwon

University of Ulsan, Urusan, Ulsan, South Korea

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Publications (16)75.99 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: There is a wide variation in risk factors for intrahepatic cholangiocarcinoma (ICC) among various populations. Several studies have suggested that hepatitis C virus (HCV) infection may play a role in the development of ICC, whereas the role of hepatitis B virus (HBV) infection is less clear. To determine whether HBV or HCV infection is a risk factor of ICC, we compared baseline demographic and clinical factors in 622 patients diagnosed between 2000 and 2004 with histologically confirmed ICC and 2,488 healthy controls, matched 4:1 with ICC patients for sex and year of birth. HBV infection (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.6-3.3), but not HCV infection, was significantly related to ICC. Other significant risk factors for ICC included liver cirrhosis (OR 13.6), heavy alcohol consumption (OR 6.6), diabetes (OR 3.2), Clonorchis sinensis infection (OR 13.6), hepatolithiasis (OR 50.0), and choledochal cysts (OR 10.7). Our results indicate that development of ICC seems to be more closely related to HBV infection than to HCV infection in Korea, where both HBV and ICC are endemic.
    The American Journal of Gastroenterology 07/2008; 103(7):1716-20. · 9.21 Impact Factor
  • Gastroenterology 01/2008; 134(4). · 12.82 Impact Factor
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    ABSTRACT: This study aimed to evaluate the adequacy of pancreatic core biopsy in histological diagnosis of autoimmune chronic pancreatitis (AIP). Histopathologic study as well as immunohistochemical staining using anti-IgG4 antibody was done with pancreatic tissue specimens of 26 AIP patients (19 transabdominal ultrasound (US)-guided core biopsies, 3 intraoperative wedge biopsies, and 4 surgical resections). Eight patients with alcoholic chronic pancreatitis and 10 patients with pancreatic cancer served as controls. Lymphoplasmacytic sclerosing pancreatitis (LPSP) histology was observed in 26% (5/19) of US-guided core biopsy specimens, 33% (1/3) of open biopsy specimens, and all 4 resection specimens in AIP patients. None of the patients in the control group showed the full spectrum of changes of LPSP. Abundant IgG4-positive cells (>10 cells/high-power field) in the pancreas were observed in 21% (4/19) of AIP patients with US-guided core biopsy specimen. Abundant IgG4-positive cells in the pancreas were also observed in 2 of 8 patients with chronic alcoholic pancreatitis and 1 of 10 patients with pancreatic cancer. Transabdominal US-guided pancreatic core biopsy may not provide enough tissue to evaluate characteristic histopathologic features of AIP that include LPSP or abundant IgG4-positive cell infiltration. The LPSP histology may be specific to AIP, but abundant IgG4-positive cells in the pancreas may not.
    Pancreas 01/2008; 36(1):84-9. · 2.95 Impact Factor
  • Gastroenterology 01/2008; 134(4). · 12.82 Impact Factor
  • Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP. 01/2008; 67(5).
  • Gastroenterology 01/2008; 134(4). · 12.82 Impact Factor
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    ABSTRACT: Recently, the evidence has been accumulating that endoscopic resection may be curative in treating ampullary adenoma that contains high-grade intraepithelial neoplasia/in situ tumor (HGIN/Tis). However, there are only anecdotal reports of endoscopic management of "focal" T1 ampullary cancer (T1 cancer), and radical surgery is still considered the only accepted treatment modality. To assess the possibility of endoscopic papillectomy as an alternative to radical surgery for the treatment of ampullary adenoma with HGIN/Tis or focal T1 cancer. Retrospective evaluation of case series of our hospital from 1996 to 2006. Tertiary-care university teaching hospital. Twenty-three patients who had HGIN/Tis or focal T1 cancer in ampullary adenoma resected by endoscopic papillectomy and 60 patients who initially underwent radical surgery for HGIN/Tis or T1 cancer of the ampulla of Vater. "Focal" was defined as a lesion involving only mucosa, with a size less than a fourth the diameter of main adenoma. Review of medical records and analysis of surgically or endoscopically resected specimens of ampullary tumors. Locoregional extension and follow-up data. Patients with HGIN/Tis of the ampulla of Vater had no lymphovascular invasion or lymph-node metastasis, and there were no occurrences of cancer or deaths during a mean (standard error [+/-SE]) 27.1 +/- 5.9 months after endoscopic papillectomy. T1 cancer was shown to have lymphovascular invasion and/or lymph-node metastasis in 10.7% and duct mucosal involvement in another 17.9%. Among them, patients with focal T1 cancer showed no lymphovascular invasion or lymph-node metastasis and no ductal involvement, and none of the patients who underwent endoscopic papillectomy alone had cancer recurrence or disease-related death for mean (+/-SE) 32.2 +/- 6.7 months. Single-center, retrospective study, small number of patients, and medium-term follow-up period. Endoscopic papillectomy may be a curative treatment for ampullary adenoma with HGIN/Tis and should also be considered as an alternative to surgery in focal T1 cancer in ampullary adenoma.
    Gastrointestinal Endoscopy 11/2007; 66(4):701-7. · 5.21 Impact Factor
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    ABSTRACT: Serum immunoglobulin G (IgG) and/or IgG4 elevation is one of the notable characteristics of autoimmune chronic pancreatitis (AIP). The purpose of this study was to compare the sensitivity and specificity of IgG with those of IgG4 in the diagnosis of AIP. From December 2005 to March 2006, patients who were diagnosed as having ordinary chronic pancreatitis of a certain cause (n = 67) and pancreatic cancer (n = 76) in Asan Medical Center were enrolled. The IgG and IgG4 levels of these patients were compared with those of 35 AIP patients diagnosed in Asan Medical Center. The percentage of patients with serum IgG level more than 1800 mg/dL was 10.4% (7/67), 2.6% (2/76), and 54.3% (19/35) in patients with ordinary chronic pancreatitis, pancreatic cancer, and AIP, respectively. As for serum IgG4 levels more than 135 mg/dL, it was 11.9% (8/67), 1.3% (1/76), and 73.3% (22/30), respectively. The specificity of IgG at 1800 mg/dL and IgG4 at 135 mg/dL was both 93.7%. The serum IgG4 showed high specificity (98.7%) in differentiating AIP from pancreatic cancer. The IgG4 level at 141 mg/dL was determined as the most optimal cutoff value with resulting sensitivity and specificity of 73.3% and 95.1%, respectively (area under the curve, 0.816), whereas for IgG, it was determined as 1770 mg/dL, with sensitivity and specificity of 57.1% and 93.7% (area under the curve, 0.788). The sensitivity of serum IgG4 tended to be higher than that of IgG in the diagnosis of AIP. The IgG4 showed high specificity in the differential diagnosis of AIP from pancreatic cancer. Serum IgG4 should be included in the diagnostic workup for AIP.
    Pancreas 09/2007; 35(2):156-61. · 2.95 Impact Factor
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    ABSTRACT: Small pancreatic cancers (longest diameter </=2 cm) have been regarded as preliminary to early pancreatic cancer, which was thought to be highly curable. During our experience since 1989, we evaluated 542 cases of pancreatic cancer. Among them we found 74 cases of tumors </=2 cm in diameter, small pancreatic cancer (TS1 pancreatic cancer). Well-differentiated adenocarcinomas (18.9%) and absence of symptoms (8.1%) were more frequent in patients with TS1 than in those with larger pancreatic tumors. Only 16 of the 74 patients (21.6%) with small pancreatic cancers had T1 tumors. According to the International Union Against Cancer (UICC) staging, only 11 patients (14.9%) were stage IA: their 5-yr survival rate was 23.3% and their median survival was 30.0 months. Among these 11 patients, 3 had tumors <1cm; their median survival time was 30.0 months and their 5-yr survival rate was 50.0%. These findings may indicate that 'small' pancreatic cancer is not equivalent to 'early' pancreatic cancer.
    Journal of Korean Medical Science 09/2007; 22 Suppl:S79-85. · 1.25 Impact Factor
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    ABSTRACT: New insight in the field of chronic pancreatitis was provided by the discovery of protease serine 1 (PRSS1) mutation, inherited by autosomal dominant trait in hereditary pancreatitis. Serine protease inhibitor, Kazal type 1 (SPINK1) is a potent protease inhibitor which prevents premature intrapancreatic activation of trypsin and pancreatic autodigestion. Strong associations of SPINK1 mutation and different forms of pancreatitis were suggested. However, it is unlikely that SPINK1 mutation alone can cause chronic pancreatitis. This mutation acts as a disease-modifier or plays a role within polygenic or multifactorial models. A 23 year-old young woman with chronic pancreatitis was recently discovered to have SPINK1 N34S heterozygous mutation cosegregated with two intronic mutations, IVS1-37TC and IVS3-69insTTTT, during the evaluation for potential cause of chronic idiopathic pancreatitis. The same mutation was identified in her mother. This is the first report in Korea suggesting that SPINK1 mutation would be a possible cause of chronic pancreatitis in a patient with familial background.
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 07/2007; 49(6):384-9.
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    ABSTRACT: Hereditary pancreatitis is a rare, autosomal dominant, inherited disease characterized by recurrent attacks of acute pancreatitis with the development of chronic pancreatitis and an increased risk of pancreatic cancer. R122H or N29I mutation in cationic trypsinogen (protease serine 1, PRSS1) gene causes hereditary pancreatitis. R122H mutation is the most common mutation that causes pancreatitis by preventing deactivation of trypsin within the pancreas and prolonging its action. Three members of the family, the patient, her elder son, and her niece experienced recurrent attacks of pancreatitis. We analyzed five exons of the PRSS1 gene in DNA samples of five family members including her husband and younger son who were asymptomatic. We found out that four members of the family, the patient, her two sons, and her niece, had R122H mutation in the exon 3 of PRSS1 gene. Finally, we diagnosed hereditary pancreatitis in two households in the same family.
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 07/2007; 49(6):395-9.
  • Myung-Hwan Kim, Seunghyun Kwon
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    ABSTRACT: Autoimmune chronic pancreatitis (AIP) is a clinically attractive entity because of its dramatic response to oral steroid therapy. Recently, as awareness of AIP is increasing, more cases are being reported. However, there are still no established worldwide diagnostic criteria for AIP. Since the Japan Pancreas Society (JPS) published diagnostic criteria for autoimmune chronic pancreatitis in the year 2002, increased attention toward this relatively new disease entity has enabled more cases of AIP to be correctly diagnosed. As previously unrecognized or misdiagnosed cases of autoimmune chronic pancreatitis are found, an increasing number of cases that are not in full accordance with the JPS diagnostic criteria are revealed. As a result, some groups have developed and cited their own criteria in the reporting of autoimmune chronic pancreatitis. The absence of consistent, uniform criteria has made comparison of different cases diagnosed under various guidelines difficult. In this review, we discuss and compare the four current sets of diagnostic criteria, focusing on their individual strengths and weaknesses.
    Journal of Gastroenterology 06/2007; 42 Suppl 18:42-9. · 3.79 Impact Factor
  • Seunghyun Kwon, Myung-Hwan Kim, Eugene K Choi
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    ABSTRACT: Autoimmune chronic pancreatitis (AIP) is increasingly being recognized as a worldwide entity. In 2002, the Japan Pancreas Society published diagnostic criteria for AIP. Since then, increased attention toward this relatively new disease entity has enabled more cases of AIP to be correctly diagnosed, allowing for proper management and avoidance of surgery. Retrospective inclusion of previously unrecognized or misdiagnosed cases of AIP has revealed an increasing number of cases that are not in full accordance with the Japanese diagnostic criteria. As a result, some groups have developed and cited their own criteria in the reporting of AIP, and the Japan Pancreas Society criteria have also undergone revision recently. The absence of consistent and uniform criteria has made the comparison of different cases diagnosed under various guidelines difficult. In this review, we discuss and compare the 4 current diagnostic criteria, focusing on their own strength and weakness with the aim of providing a framework for the development of unified criteria that represent an international consensus.
    Pancreas 05/2007; 34(3):279-86. · 2.95 Impact Factor
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    ABSTRACT: Suprapancreatic biliary stricture associated with blunt abdominal trauma is extremely rare. Therefore, no definitive treatment modality for this stricture has been fully established. This study was designed to evaluate the efficacy and long-term follow-up of endoscopic treatment for suprapancreatic biliary stricture following blunt abdominal trauma. Data from the institution's prospectively collected endoscopic retrograde cholangiopancreatography (ERCP) database, medical records, radiological findings, and trauma registry with operative records were used to identify patients with suprapancreatic biliary stricture associated with blunt abdominal trauma. Eight patients (six men and two women) with a median age of 36 yr (interquartile range [IQR] 29-53 yr) were included in this study. The median interval between the initial trauma and the onset of symptoms was 23 days (IQR 16-51 days). The median length of biliary stricture was 1 cm (IQR 0.6-1 cm). Endoscopic plastic stent placement was successfully performed in all patients included in the study. The median duration of stent placement was 2 months (IQR 2-2.8 months). Follow-up ERCP showed improved or resolved biliary stricture in all patients. There was no recurrence of symptoms after the removal of the stents; therefore, surgery was unnecessary in these patients. Long-term follow-up (median 33 months) was also excellent. Endoscopic plastic stent placement may be a good candidate for first-line management for suprapancreatic biliary strictures following blunt abdominal trauma. Furthermore, the long-term results for this type of biliary stricture with endoscopic stent placement may be excellent.
    The American Journal of Gastroenterology 04/2007; 102(3):544-9. · 9.21 Impact Factor
  • Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP. 01/2007; 65(5).
  • Suizo 01/2007; 22(6):721-722.

Publication Stats

325 Citations
75.99 Total Impact Points

Institutions

  • 2007
    • University of Ulsan
      Urusan, Ulsan, South Korea
    • Asan Medical Center
      • Department of Gastroenterology
      Seoul, Seoul, South Korea
    • Soon Chun Hyang University Hospital
      Sŏul, Seoul, South Korea
    • Jeju National University
      Tse-tsiu, Jeju, South Korea
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea