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Ji Hoon Jung,
Kee Don Choi,
Seungbong Han,
Hwoon-Yong Jung,
Mi Young Do, Hye-Sook Chang,
Jae-Won Choe,
Gin Hyug Lee,
Ho June Song,
Do Hoon Kim,
Kwi-Sook Choi,
Jeong Hoon Lee,
Ji Yong Ahn,
Mi-Young Kim,
Suh Eun Bae,
Jin-Ho Kim
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ABSTRACT: BACKGROUND: Studies on seroconversion and its reversion rate in Korean adults with Helicobacter pylori infection are very rare. The purpose of this study was to evaluate the overall seroprevalence, seroconversion rate, and seroreversion rate of H. pylori infection in an adult population. MATERIALS AND METHODS: We performed this retrospective cohort study on healthy adults who had visited our health screening center at Asan Medical Center more than twice between January 2000 and December 2010. We reviewed the anti- H. pylori Ab IgG profiles of the enrolled people and their family members and the results of esophagogastroduodenoscopies and a self-reported questionnaire. RESULTS: A total of 67,212 people were enrolled in this study. The mean follow-up duration was 4.6 years, and each participant visited the center for a mean of 3.8 visits. The overall proportions of participants demonstrating persistent seropositivity, persistent seronegativity, seroconversion, and seroreversion were 53.1%, 32.5%, 4.3%, and 10.1%, respectively. The annual seroconversion rate was 2.79%. The annual crude and spontaneous seroreversion rates of the entire study population were 3.64% and 2.42%, respectively. According to multivariate logistic regression, old age (HR = 1.015), smoking (HR = 1.216), alcohol consumption more than four times per week (HR = 1.263), marriage (HR = 2.735), and living with H. pylori-infected family members (HR = 1.525) were identified as statistically significant risk factors associated with seroconversion. CONCLUSION: The annual seroconversion rate was 2.79% in our study population. Marriage and living with H. pylori-infected family members were important risk factors affecting seroconversion in our adult population.
Helicobacter 03/2013; · 3.15 Impact Factor
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ABSTRACT: Only 30% to 40% of patients with advanced proximal neoplasms (APN) have distal colon neoplasms.
To develop a risk score model for APN and propose an individualized screening protocol for colorectal cancer.
Retrospective cohort study.
Tertiary-care center.
Derivation cohort (6200 adults) and validation cohort (1389 adults).
Screening colonoscopy.
An APN risk score model was developed from the derivation cohort (6200 adults) and was tested in the validation cohort (1389 adults), who underwent screening colonoscopy.
Age, male sex, and smoking were clinical risk factors for APN. The presence of a distal neoplasm was a sigmoidoscopic risk factor for APN. We calculated APN risk scores (0-8) based on these variables and classified patients as low risk (0-2) or high risk (3-8). In the validation cohort, the relative risk of APN was 3.5-fold higher in the high-risk group than in the low-risk group. Our model suggests that colonoscopy should be performed as an initial screening test in patients with a high clinical risk for APN. Sigmoidoscopy should be performed initially in patients with low clinical risk for APN followed by supplementary colonoscopy in those with high APN risk scores based on both clinical and sigmoidoscopic risk factors. This protocol detected APN in 22 of 34 APN+ patients (64.7%) with little increase in the endoscopy burden, whereas only 16 of 34 APN+ patients (47.1%) would be identified by initial sigmoidoscopy followed by colonoscopy only in cases with distal neoplasms.
Retrospective design.
Our APN risk score model provides an algorithm for efficient screening of colorectal cancer by sigmoidoscopy and colonoscopy.
Gastrointestinal endoscopy 08/2012; 76(4):818-28. · 6.71 Impact Factor
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Gastrointestinal endoscopy 11/2011; 75(1):211-6. · 6.71 Impact Factor
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Hye-Sook Chang,
Don Lee,
Jong Cheol Kim,
Hye-Kyung Song,
Hyun Ju Lee,
Eun-Ju Chung,
Tae Hyup Kim,
Hye-Won Park,
Jeong-Sik Byeon,
Suk-Kyun Yang,
Jae-Won Choe
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ABSTRACT: Although isolated terminal ileal ulcerations (ITIUs) are occasionally observed on colonoscopic examination of asymptomatic individuals, their clinical course and guidelines for treatment are unclear.
To evaluate the clinical course and significance of ITIUs in asymptomatic individuals.
Single-center retrospective analysis.
University hospital.
All patients diagnosed with ITIUs on colonoscopy from July 2001 to December 2007 were identified. Patients with colorectal symptoms, a history of nonsteroidal anti-inflammatory drug consumption, a history of colorectal surgery, oral or genital ulcerations, and coincidental ulceration in the ileocecal valve or colon were excluded.
Colonoscopic findings and clinical courses of patients were analyzed.
Of the 148 included patients, 93 were followed (mean duration, 29.9 months). Of these, 62 showed resolution of ITIU on follow-up colonoscopy, including 60 who resolved without any treatment and 2 who resolved after antituberculosis medication. Follow-up colonoscopy continued to show ITIUs in the remaining 31 patients, only 1 of whom developed typical Crohn's disease, whereas the other 30 showed no significant changes in the lesions (n = 22), partial improvement (n = 6), or waxing and waning endoscopic appearance (n = 2).
Retrospective design, relatively short-term follow-up.
Most ITIUs incidentally observed in asymptomatic individuals resolve without any treatment. Even if these lesions persist, it is unusual for them to progress or to cause any symptoms.
Gastrointestinal endoscopy 12/2010; 72(6):1226-32. · 6.71 Impact Factor
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ABSTRACT: A recent genomewide association study from a Japanese population identified tumor necrosis factor superfamily member 15 (TNFSF15) as an inflammatory bowel disease gene. Previous studies have shown that expression of TNFSF15 was upregulated in macrophages and lymphocytes of the intestinal lamina propria of Crohn's disease (CD) patients. Here, we have tested four single nucleotide polymorphisms (SNPs) of TNFSF15 in Korean patients to determine whether the gene is associated with susceptibility to CD in a closely related population.
Four SNPs across TNFSF15 were genotyped in 380 patients with CD and 380 healthy controls.
Carriers of three polymorphisms, including rs3810936, rs6478108, and rs7848647, showed statistically significant association with CD (adjusted OR [aOR] 2.81, 95% confidence interval [CI] 1.94-4.07, P= 4.4 x 10(-8); aOR 3.49, 95% CI 2.42-5.04, P= 2.7 x 10(-11); and aOR 3.49, 95% CI 2.42-5.03, P= 2.2 x 10(-11), respectively). Following haplotype analysis, homozygotes carrying two copies of the haplotype consisting of the risk alleles of those three SNPs showed statistically significant association with CD (aOR 5.39, 95% CI 3.19-9.10, P= 3.07 x 10(-10)).
Our data support the hypothesis that the TNFSF15 genotypes play an important role in the pathogenesis of CD in Koreans.
The American Journal of Gastroenterology 07/2008; 103(6):1437-42. · 7.28 Impact Factor
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Jae Won Choe, Hye-Sook Chang,
Suk-Kyun Yang,
Seung-Jae Myung,
Jeong-Sik Byeon,
Don Lee,
Hye-Kyung Song,
Hyun Ju Lee,
Eun-Ju Chung,
Sun Young Kim,
Hwoon-Yong Jung,
Gin-Hyug Lee,
Weon-Seon Hong,
Jin-Ho Kim,
Young Il Min
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ABSTRACT: Although the incidence of colorectal cancer is rising in Asian countries, there are no guidelines for its screening in this region due in part to the lack of epidemiological data regarding colorectal neoplasms. This study aimed to evaluate the prevalence of colorectal neoplasms in average-risk Koreans and to assess the effectiveness of screening colonoscopy in Korea.
The prevalence of colorectal neoplasms was assessed by primary screening colonoscopy in 5,086 consecutive asymptomatic adults (males 70.5%; age 20-84 years) with no risk factors for colorectal cancer.
The overall prevalence of colorectal neoplasms in the 5,086 subjects was 21.9% and this increased linearly with age. Among the 2,435 subjects aged >or=50 years (males 66.7%; mean age 57.7 years), the prevalence of all colorectal neoplasms was 30.2% (males 35.9% vs females 18.7%; P < 0.001), while advanced neoplasms accounted for only 4.1% (males 5.1% vs females 2.0%; P < 0.001). The prevalence of advanced neoplasms in Korean men of a specific age group was similar to that of Korean women in the 10-years older age group. Also, Koreans in a specific age group showed a prevalence of advanced neoplasms similar to that of Westerners in the 10-years younger age group.
Colonoscopy is a useful modality for colorectal cancer screening in Korea, as established in Western countries. However, the screening colonoscopy may begin at an older age for Koreans than for Westerners. Similarly, the optimal starting age for screening in Korean women may be higher than that in men by 10 years.
Journal of Gastroenterology and Hepatology 07/2007; 22(7):1003-8. · 2.87 Impact Factor
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Seung-Jae Myung,
Suk-Kyun Yang, Hye-Sook Chang,
Jeong-Sik Byeon,
Kyu-Jong Kim,
Seong Soo Hong,
Jin-Yong Jeong,
Sun-Mi Lee,
Weon-Seon Hong,
Jin-Ho Kim,
Young Il Min
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ABSTRACT: Colorectal carcinoma (CRC) is a complication of ulcerative colitis (UC). Although stool occult blood and colonoscopy are used to detect CRC in UC, these methods have drawbacks, in that bleeding is associated with UC and the underlying mucosa is irregular, making it difficult to detect dysplasia. Telomerase and its catalytic subunit, telomerase reverse transcriptase (hTERT), are specifically expressed in cancers, making them candidate markers for the early detection of cancer. We previously reported that assays of telomerase in pancreatic juice may be useful for the early detection of pancreatic cancer. The aims of our study were to determine whether assays for telomerase and TERT may be useful in the diagnosis of CRC developed in UC patients.
Luminal washings and biopsies were collected during colonoscopy in 66 patients; 34 with CRC, 21 with UC, and 11 controls. Telomerase activity was detected by telomeric repeat amplification protocol (TRAP) and hTERT mRNA was assayed by reverse transcription-polymerase chain reaction (RT-PCR).
Telomerase activity was detected in biopsies from 33 of 34 (97%) CRC patients, 14 of 21 (67%) UC patients, and three of 11 (27%) normal controls. Expression of hTERT mRNA was observed in biopsies from 32 of 34 (94%) CRC patients, 12 of 21 (57%) UC patients, and five of 11 (45%) controls. In analyses of washing fluid, 21 of 34 (62%) of CRC patients were positive for telomerase, but all UC patients and controls were negative. The sensitivity of telomerase for CRC was 97% in tissues and 62% in washing fluid. The specificity of telomerase in washing fluid was 100%, whereas the specificity of telomerase or hTERT mRNA in tissues was 47% each.
For the detection of CRC arising in UC, telomerase and hTERT in colonic tissue showed high sensitivity, and telomerase in colonoscopic luminal washings revealed a high specificity. These might be candidate markers in clinical decision making for the diagnosis of CRC from UC.
Journal of Gastroenterology and Hepatology 11/2005; 20(10):1578-83. · 2.87 Impact Factor
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ABSTRACT: Patients with intractable constipation often complain of social, physical, and psychologic stress. Recently, biofeedback therapy has been widely used for the management of intractable constipation, particularly in cases of constipation associated with pelvic floor dyssynergia. However, some constipated patients often complain of absent or diminished sense of wanting to defecate. It is unclear whether impaired rectal sensation is a cause or outcome of constipation and what specific treatment is available for these patients. We treated a 25-year-old female patient who complained of intractable constipation for ten years. Colon transit time study and defecography showed nonspecific findings. Her anorectal manometric findings were within normal ranges with the exception of impaired rectal sensation. Rectal sensory threshold volumes for desire and urge to defecate and maximal tolerated volume were greatly increased. She was treated by electric stimulation therapy for the purpose of improving impaired rectal sensory function. After 14 sessions of electric stimulation therapy, her constipated symptoms improved dramatically. Furthermore, the desire and urge threshold volumes were remarkably decreased. We report this case of constipation with impaired rectal sensation possibly treated by electric stimulation therapy.
Diseases of the Colon & Rectum 07/2004; 47(6):933-6. · 3.13 Impact Factor
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Gyoo Moon,
Seung-Jae Myung,
Jin-Yong Jeong,
Suk-Kyun Yang,
Yoon Kyung Cho,
Sun-Mi Lee, Hye-Sook Chang,
Jeong-Sik Byeon,
Yun Jung Lee,
Gin Hyug Lee,
Weon-Seon Hong,
Jin-Ho Kim,
Young Il Min,
Jung-Sun Kim
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ABSTRACT: Lactobacillus rhamnosus GG (LGG) has been used in acute colitis treatment. However, it is unclear whether the LGG prevents chronic colitis. The aim of this study was to examine the prophylactic effect of LGG on animal colitis, cytokine secretion, and mucin gene expression.
BALB/c mice (n=64) were exposed to 5% dextran sulfate sodium (DSS) for 7 days followed by 10 days recovery period and repeatedly exposed for 4 days. Then, the mice were devided into three group; group of oral LGG adminstration throughout the recovery and repeated colitis period; PBS group of PBS administration; control group. Colon length, histologic score, tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10) levels, mucin gene expressions were determined at each period.
In acute colitis period, the LGG group showed higher levels of disease activity index (DAI), histologic score, TNF-alpha, IL-10, but shorter colon length, lower levels of mucin gene expressions than the control group. However, in repeated colitis period, the LGG group showed markedly lower levels of DAI and IL-10 but significantly longer colon length than PBS group (p<0.05). There was no difference in the mucin gene expression.
These results suggest that LGG prevents chronic murine colitis. It may be associated with cytokine modulation and competitive inhibition of pathogenic bacteria. However, it may not be related with gene expression.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 04/2004; 43(4):234-45.
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Hye-Sook Chang,
Seung-Jae Myung,
Suk-Kyun Yang,
Hwoon-Yong Jung,
Gin Hyug Lee,
Weon-Seon Hong,
Jin-Ho Kim,
Young Il Min,
Hee Cheol Kim,
Hyun Kwon Ha,
Jung-Sun Kim
Gastrointestinal Endoscopy 02/2004; 59(1):126-9. · 4.88 Impact Factor
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Dong Hoon Yang,
Seung-Jae Myung, Hye-Sook Chang,
Jin Woo Song,
Suk-Kyun Yang,
Gin Hyug Lee,
Hwoon-Yong Jung,
Weon-Seon Hong,
Jin-Ho Kim,
Young Il Min,
Hee Cheol Kim,
Jooryung Huh,
Heung-Bum Oh
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ABSTRACT: Enteropathy-associated T-cell lymphoma (EATL) is an unusual primary gastrointestinal lymphoma, particularly associated with celiac sprue. This tumor usually affects the jejunum and grossly presents as multiple circumferential ulcers without the formation of definite tumor masses. Moreover, mesenteric lymph nodes are commonly involved. The patients have typically suffered from abdominal pain, diarrhea, or weight loss whereas some patients may manifest with nonspecific symptoms for a period of years or an acute emergency of perforation, obstruction, or hemorrhage. The clinical course of EATL is very unfavorable and the prognosis is poor. Both celiac sprue and EATL are very rare diseases in Asia, except India and Middle East. We report a 60-year-old male diagnosed as having EATL after segmental small bowel resection, who presented with recurrent gastrointestinal bleeding.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 01/2004; 42(6):527-32.
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Do Hyun Park,
Seung-Jae Myung,
In-Ja Yoon,
Oh-Rhyun Kwon,
Jung-Eun Ko, Hye-Sook Chang,
Suk-Kyun Yang,
Tae-Hwoon Kim,
Hye-Kyung Song,
Jin-Hyuk Lee,
Hwoon-Yong Jung,
Weon-Seon Hong,
Jin-Ho Kim,
Young-Il Min
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ABSTRACT: Biofeedback therapy has been widely used for the treatment of constipated patients. However, there are only a few reports about the clinical factors that can predict the effectiveness of biofeedback therapy. The aim of this study was to evaluate prognostic factors before the initiation of biofeedback treatment in constipated patients.
Biofeedback treatment was performed in 114 patients with constipation. After classifying the patients into two groups, responder and non-responder by subjective and objective parameters, univariate and multivariate analysis were performed to evaluate the factors associated with effectiveness of biofeedback therapy.
Eighty-five patients (74.6%) responded to biofeedback therapy. Pre-treatment balloon expulsion test, paradoxical contraction on manometry, defecation index and anal residual pressure during straining were the factors that influenced the results of biofeedback treatment. On multivariate analysis, defecation index (odds ratio=67.5, p<0.05) and paradoxical contraction on manometry (odds ratio=0.053, p<0.05) were the factors that showed significant difference between the responders and non-responders.
This study suggests that several pre-treatment prognostic factors are associated with response to biofeedback for the constipated patients. Using prognostic factors, we may be able to evaluate the patterns of pelvic floor dysfunction and responsiveness of biofeedback therapy for the patients with constipation.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 10/2003; 42(4):289-96.
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ABSTRACT: A subgroup of constipated patients complain of absent or diminished sense of wanting to defecate, suggesting that one of the causes of constipation is impaired rectal sensation. Electrical stimulation therapy (EST) has recently been used to treat patients with urinary and/or fecal incontinence. This study evaluated the efficacy of EST in constipated patients, especially those with impaired rectal sensation.
Of the 130 patients with functional constipation as defined by Rome II criteria, 22 patients who had impaired rectal sensation (rectal desire threshold volume > or =90 ml) on an anorectal manometry were selected. We treated 12 with EST and 10 with biofeedback therapy (BFT) according to a randomized order.
Overall symptoms of patients significantly improved after each therapy in both groups. Interestingly, frequency of sense of wanting to defecate improved only after EST. On objective findings there was significant improvement in anal residual pressures on attempted defecation only after BFT solely. On the other hand, rectal sensory threshold volumes for desire and urge to defecate and maximal tolerated volume improved significantly only in the EST group.
Our findings show that the efficacy of EST can be comparable to BFT in a subgroup of constipated patients, especially those with impaired rectal sensation. EST might be considered as an adjunctive therapeutic modality for the management of functional constipation with impaired rectal sensation.
International Journal of Colorectal Disease 09/2003; 18(5):433-8. · 2.38 Impact Factor
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Seung-Jae Myung,
Kwang Ro Joo,
Suk-Kyun Yang,
Hwoon-Yong Jung, Hye-Sook Chang,
Hyun Ju Lee,
Weon-Seon Hong,
Jin-Ho Kim,
Young Il Min,
Hee Cheol Kim,
Chang Sik Yu,
Jin Cheon Kim,
Jung-Sun Kim
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ABSTRACT: The aims of this study were to classify primary ileocolonic lymphomas according to colonoscopic findings and to determine the clinicopathologic relationship according to classes.
Thirty-two patients (22 men, 10 women; age range 29 to 75 years) with primary malignant lymphoma of the terminal ileum and/or colorectum were studied. The clinicopathologic features were evaluated according to colonoscopic findings.
Thirty-six lesions in 32 patients were endoscopically classified as follows: fungating (14, 39%), ulcerofungating (11, 31%), infiltrative (5, 14%), ulceroinfiltrative (4, 11%), and ulcerative (2, 6%). Location of the lesions was as follows: terminal ileum, 15 (42%); colorectum, 14 (39%); both regions, 7 (19%). The most common histopathologic types were diffuse large cell (22, 69%) and large cell immunoblastic (5, 16%). There was no relationship between the endoscopic findings and histologic types. In 9 patients (28%), the clinical manifestation was intussusception, and all were found endoscopically to have the fungating type lesion.
Primary ileocolonic lymphomas can be classified endoscopically into fungating, ulcerative, infiltrative, ulcerofungating, and ulceroinfiltrative types. Among these, fungating and ulcerofungating are the most frequent. Intussusception is a common clinical finding in ileocolonic lymphomas, occurring mainly in patients with the fungating type of lesion.
Gastrointestinal Endoscopy 04/2003; 57(3):343-7. · 4.88 Impact Factor
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Hye-Sook Chang,
Suk-Kyun Yang,
Seung-Jae Myung,
Hwoon-Yong Jung,
Weon-Seon Hong,
Jin Ho Kim,
Young Il Min,
Hyun Kwon Ha,
Jin Cheon Kim,
Chang Sik Yu,
Hee Cheol Kim,
Jung-Sun Kim
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ABSTRACT: Acute appendicitis is one of the most common causes of acute abdomen. Despite recent advances in radiologic imaging, the diagnosis of acute appendicitis may be difficult on occasion. The aims of this study were to describe the colonoscopic features of appendicitis and to determine whether colonoscopy can be used as an adjunct for the diagnosis of appendicitis in patients with atypical presentations.
The colonoscopic findings in 21 patients (14 men, 7 women; average age 55 years) with a colonoscopic or histopathologic diagnosis of appendicitis were analyzed retrospectively. Colonoscopy was performed because diagnoses suggested by CT were other than acute appendicitis (11 patients), and/or the presenting clinical features were atypical for acute appendicitis with the duration of symptoms being 10 days or longer (17 patients).
The colonoscopic diagnosis was acute appendicitis for all 21 patients. Seventeen underwent appendectomy, the diagnosis being verified in all cases. Of the 4 patients whose symptoms improved without appendectomy, 3 were considered to have acute appendicitis because pus was seen to drain from the appendiceal orifice at colonoscopy. A definite diagnosis could not be made in the remaining 1 patient. Therefore, the diagnosis of appendicitis was considered confirmed in 20 of 21 patients. Colonoscopic findings in these 20 patients included hyperemia (15) and bulging (18) at the appendiceal orifice area with surrounding mucosal edema (19), and drainage of pus from the appendiceal orifice (7).
Colonoscopy may be useful in the diagnosis of appendicitis when the clinical presentation is atypical for appendicitis and/or imaging studies are nondiagnostic.
Gastrointestinal Endoscopy 10/2002; 56(3):343-8. · 4.88 Impact Factor
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ABSTRACT: Several studies have documented the high incidence of several HLA class II alleles in Japanese patients with ulcerative colitis (UC). Although the characteristics of the HLA system in Koreans are quite similar to those in the Japanese, it is not clear whether the HLA pattern in Korean UC is similar to that in Japanese UC. We investigated an association between HLA class II genes and UC patients and the clinical meaning of these genes in Korea.
Unrelated Korean patients with UC ( n=70) and ethnically matched unrelated controls ( n=182) were genotyped for HLA-DR by PCR followed by reverse hybridization using sequence-specific oligonucleotide probes. The clinical characteristics of the patients were analyzed with regard to anti-neutrophil cytoplasmic antibody (ANCA) status and total colectomy for intractability.
HLA-DR2 and DRB1*1502 were found significantly more frequently in patients (42.9% and 21.4%) than controls (20.3% and 5.5%). DRB1*1502 was more frequent in p-ANCA-positive (5/23) than in p-ANCA-negative (1/11) patients. Total colectomy for intractability was performed more commonly in patients without DRB1*1502 (14/55) than in those with it (0/15).
Our data are consistent with those of Japanese studies in that DR2 and DRB1*1502 are positively associated with UC patients. In contrast to the Japanese study, however, our results demonstrates that DRB1*1502 is negatively associated with the risk of colectomy in Korean patients with UC.
International Journal of Colorectal Disease 08/2002; 17(4):233-7. · 2.38 Impact Factor
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ABSTRACT: The utility of magnetic resonance cholangiography for assessment of longitudinal tumor extension of hilar cholangiocarcinoma was investigated with reference to findings by percutaneous transhepatic cholangioscopy.
Ninety-nine patients with hilar cholangiocarcinoma underwent both magnetic resonance cholangiography and percutaneous transhepatic cholangioscopy. Longitudinal tumor extension was described with the Bismuth-Corlette classification. Hilar cholangiocarcinoma was classified morphologically into stenotic, diffuse sclerosing, and polypoid types based on selective cholangiographic findings obtained during percutaneous transhepatic cholangioscopy. Agreement between percutaneous transhepatic cholangioscopy and magnetic resonance cholangiography according to the Bismuth-Corlette classification was compared. The degree of agreement between magnetic resonance cholangiography and percutaneous transhepatic cholangioscopy according to each morphologic type was also compared in each subgroup without reference to Bismuth-Corlette type.
The overall agreement between magnetic resonance cholangiography and percutaneous transhepatic cholangioscopy with regard to Bismuth-Corlette types was 87.9% (kappa = 0.832, p < 0.01). The agreement of magnetic resonance cholangiography for each Bismuth-Corlette type with reference to percutaneous transhepatic cholangioscopy was as follows: type I (n = 18), 16/18 (88.9%); type II (n = 16), 14/16 (87.5%); type IIIa (n = 23), 19/23 (82.6%); type IIIb (n = 14), 14/14 (100%); and type IV (n = 28), 24/28 (85.7%). The overall agreement between magnetic resonance cholangiography and percutaneous transhepatic cholangioscopy for Bismuth-Corlette type according to selective cholangiographic findings was as follows: stenotic type, 58/61 (95.1%, kappa = 0.929, p < 0.01); diffuse sclerosing type, 12/16 (75%, kappa = 0.619, p < 0.01); and polypoid type, 17/22 (77.3%, kappa = 0.696, p < 0.01).
There is good overall agreement between magnetic resonance cholangiography and percutaneous transhepatic cholangioscopy on longitudinal extension of hilar cholangiocarcinoma. Especially for the stenotic type of hilar cholangiocarcinoma (based on selective cholangiographic findings), magnetic resonance cholangiography may replace percutaneous transhepatic cholangioscopy in the determination of longitudinal tumor extension. For polypoid or diffuse sclerosing types, however, percutaneous transhepatic cholangioscopy is required for accurate evaluation of longitudinal tumor extension.
Gastrointestinal Endoscopy 07/2002; 56(1):25-32. · 4.88 Impact Factor
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ABSTRACT: This study investigated the clinical significance of papillitis of the major duodenal papilla and analyzed the correlation between endoscopic and histologic papillitis in patients with biliary or pancreatic disorders.
Eighty-seven patients and 12 healthy control subjects were enrolled. The endoscopic appearance of papillitis was classified by two blinded endoscopists, and biopsy specimens were taken of the papilla. Various factors were prospectively analyzed to identify any relationship with the endoscopic severity of the papillitis.
By univariate analysis, a clinically acute inflammatory condition and elevation of serum transaminase levels were significantly associated with moderate and severe endoscopic papillitis (p < 0.05). However, by multivariate analysis, only a clinically acute inflammatory condition was significantly associated with moderate and severe endoscopic papillitis (p < 0.001). The endoscopic severity of papillitis was poorly correlated with monocyte infiltration, but there was a good correlation with neutrophil infiltration. Moderate and severe papillitis were not observed in healthy volunteers.
Moderate and severe endoscopic papillitis were significantly more common in patients with biliary or pancreatic disorders plus a clinically acute inflammatory condition, whereas moderate and severe papillitis were not observed in healthy volunteers. Moderate and severe endoscopic papillitis are characteristic of biliary or pancreatic disorders.
Gastrointestinal Endoscopy 07/2002; 55(7):877-82. · 4.88 Impact Factor
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Gastrointestinal Endoscopy 04/2002; 55(3):409. · 4.88 Impact Factor
