[Show abstract][Hide abstract] ABSTRACT: Colonoscopy is the current standard method for evaluation of the colon. The diagnostic accuracy and therapeutic safety of colonoscopy depend on the quality of colonic cleansing and preparation. Generally, all these preparations have been demonstrated to be safe for use in healthy individuals without significant comorbid conditions. Based on safety and efficacy concerns, polyethylene glycol (PEG) is most commonly utilized as a bowel preparation solution for colonoscopy. Adverse events in patients receiving PEG are mostly clinically non-significant. However, fatal adverse events rarely have been shown to occur in the few individuals who experience vomiting or aspiration. Anaphylactic shock associated with ingestion of PEG electrolyte solution is an extremely rare fatal complication, and reported mainly in Western countries. Here, we report the first case of anaphylactic shock following the ingestion of PEG solution in Korea.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic cholecystectomy (LC) is the treatment of choice for acute cholecystitis. However, the morbidity and mortality rates are high in elderly patients or in those with co-morbidities at the time of surgery. Percutaneous cholecystostomy (PC) is a safe treatment for acute inflammation of the gall bladder. This study aimed to evaluate the safety and efficacy of PC for acute cholecystitis and investigate the post-PC factors leading to subsequent LC.
Ninety-three patients with acute cholecystitis who underwent PC between August 2006 and December 2012 were retrospectively reviewed for clinical course, outcomes, and prognosis. We evaluated patient age, the presence of co-morbidities, American Society of Anesthesiologists (ASA) score, duration of drainage of the PC tube, performance of LC, conversion rate, hospital stay, recurrence, and 30-day mortality. We compared these characteristics in two study groups: 31 were treated with only conservative PC (group I) and 62 with PC followed by elective LC (group II).
Patients in group I were older than those in group II (80.38 ± 10.05 vs. 70.50 ± 11.81 years, p < 0.001). More group I patients had an ASA score of III or IV (deemed high risk for surgery) compared to group II patients (80.6 %, n = 25 vs. 37.0 %, n = 23, p = 0.0012). Age, ASA score, and cerebrovascular accident (CVA) were significantly correlated when analyzing factors used to decide surgery (R (2) = 0.15, p < 0.001; R (2) = 0.21, p < 0.001; R (2) = 0.05, p = 0.05, respectively). Two patients in group I died within 30 days. Six patients (19.3 %) in group I experienced recurrent cholecystitis after PC tube removal.
PC is a safe and effective therapeutic option in high-risk patients with acute cholecystitis, or for preoperative management. The decisive risk factors for surgery after PC were age, ASA score, and CVA.
[Show abstract][Hide abstract] ABSTRACT: To clarify the efficacy of proton pump inhibitors (PPIs) after endoscopic variceal obturation (EVO) with N-butyl-2-cyanoacrylate.
A retrospective study was performed on 16 liver cirrhosis patients with gastric variceal bleeding that received EVO with injections of N-butyl-2-cyanoacrylate at a single center (Kyung Hee University Hospital at Gangdong) from January 2008 to December 2012. Medical records including patient characteristics and endoscopic findings were reviewed. Treatment results, liver function, serum biochemistry and cirrhosis etiology were compared between patients receiving PPIs and those that did not. Furthermore, the rebleeding interval was compared between patients that received PPI treatment after EVO and those who did not.
The patient group included nine males and seven females with a mean age of 61.8 ± 11.7 years. Following the EVO procedure, eight of the 12 patients that received PPIs and three of the four non-PPI patients experienced rebleeding. There were no differences between the groups in serum biochemistry or patient characteristics. The rebleeding rate was not significantly different between the groups, however, patients receiving PPIs had a significantly longer rebleeding interval compared to non-PPI patients (22.2 ± 11.2 mo vs 8.5 ± 5.5 mo; P = 0.008). The duration of PPI use was not related to the rebleeding interval. A total of six patients, who had ulcers at the injection site, exhibited a shorter rebleeding interval (16.8 ± 5.9 mo) than patients without ulcers (19.9 ± 3.2 mo), though this difference was not statistically significant.
PPI therapy can extend the rebleeding interval, and should therefore be considered after EVO treatment for gastric varices.
World journal of gastroenterology : WJG. 12/2014; 20(45):17127-31.
[Show abstract][Hide abstract] ABSTRACT: Although current guideline recommends selective use of pre-endoscopic prokinetics to increase diagnostic yield in upper gastrointestinal bleeding (UGIB) patients, no data to guide the use of these drugs are available.
Digestive Diseases and Sciences 10/2014; · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies on the association between dyslipidemia and the presence of colorectal adenoma showed conflicting results, and were limited due to small sample sizes, inconsistent definitions of dyslipidemia, or a lack of data on full lipid profiles. The aim of this study was to determine the association between colorectal adenomas and dyslipidemia according to the definition by the National Cholesterol Education Program- Adult Treatment Panel III.
We conducted a retrospective, cross-sectional study in subjects who underwent screening colonoscopy and blood tests for full lipid profiles. Serum dyslipidemia profiles were compared between the adenoma group and the control group, and multivariate analysis was performed to identify independent predictors of the presence of colorectal adenomas.
Patients with hyper-LDL cholesterolemia were more frequently included in the adenoma group than the control group (46.7% vs. 32.1%, respectively, p=0.023), and hyper-LDL cholesterolemia (OR = 1.954, 95% CI=0.981-3.893, p=0.057) showed a statistical trend for the positive association with the presence of colorectal adenomas by multivariate analysis. Furthermore, proximal colorectal adenomas were more prevalent in the hyper-LDL cholesterolemia group than in the normal LDL cholesterolemia group (p=0.026).
Hyper-LDL cholesterolemia was associated with the presence of colorectal adenomas, especially in the proximal colon.
[Show abstract][Hide abstract] ABSTRACT: To develop and validate a risk stratification-based screening model for predicting colorectal advanced neoplasia in Korea.
Colorectal advanced neoplasia is the relevant finding of screening colonoscopy. Risk estimation for advanced neoplasia may be helpful to improve compliance and to develop more cost-effective approaches toward screening.
We developed Korean Colorectal Screening (KCS) score by optimizing and adjusting Asia-Pacific Colorectal Screening (APCS) score to predict advanced neoplasia in an asymptomatic Korean population who received screening colonoscopies from September 2006 to September 2009. Moreover, we validated the KCS score in another Korean cohort who received screening colonoscopies from October 2009 to February 2011. We also assessed the predictive power and diagnostic performance of both KCS and APCS scores.
There were 3561 subjects in the derivation cohort and 1316 subjects in the validation cohort, with a prevalence of advanced neoplasia of 4.7% and 4.3%, respectively. After a multivariate analysis, KCS was developed as 0 to 8 points comprising of age, sex, body mass index, smoking, and family history of CRC. Using KCS scores to stratify the validation cohort, the prevalences of advanced neoplasia in the 3 risk tiers (average, moderate, and high) were 2.0%, 3.7%, and 10.9%, respectively. Moderate-risk and high-risk tiers showed 2.1- and 6.5-fold increased prevalences, respectively, of advanced neoplasia compared with average risk tier. In addition, KCS score showed relatively good discriminative power (ROC=0.681) and higher sensitivity compared with APCS score for the high-risk tier.
KCS score may be clinically simple and useful for assessing advanced neoplasia risk in Korea. However, racial disparity should be considered in risk stratification-based screening in each country.
Journal of clinical gastroenterology 02/2014; · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Untreated benign biliary stricture can lead to serious complications including recurrent cholangitis, biliary cirrhosis, hepatic failure, and death. Benign stricture of a postoperative anastomosis site is also a problematic issue after biliary surgery. Percutaneous transhepatic cholangioscopy (PTCS) with balloon dilatation is a recently introduced noninvasive therapeutic option for biliary stricture. Guidewire insertion through the stricture site is essential for the success of PTCS treatment. Recently, we treated a difficult case with complete bilioenteric anastomosis stricture that failed to allow passage of the guidewire for balloon dilation. The stricture was treated with artificial bilioenteric fistula using a needle-knife papillotome during the PTCS.
[Show abstract][Hide abstract] ABSTRACT: Gallbladder polyps and colorectal adenomas share many common risk factors; however, their association has never been studied. The aim of this study was to investigate this association in asymptomatic healthy subjects.
[Show abstract][Hide abstract] ABSTRACT: To identify the predicting factors of present hepatitis C virus (HCV) infection among patients with positivity for antibodies to HCV (anti-HCV).
We analyzed patients who showed positive enzyme immunoassay (EIA) results and performed an HCV RNA test as a confirmatory test at Kyung Hee University Hospital at Gangdong from June 2006 to July 2012. The features distinguishing the groups with positive and negative HCV RNA results were reviewed.
In total, 490 patients were included. The results of the HCV RNA test were positive and negative in 228 and 262 patients, respectively. The index value of anti-HCV, mean age, platelet counts, total bilirubin, prothrombin time international normalized ratio, albumin and alanine transaminase (ALT) levels differed significantly between the two groups. On multivariable analysis, an index value of anti-HCV >10 [odds ratio (OR)=397.27, P<0.001), ALT >40 IU/L (OR=3.64, P=0.001), and albumin <3.8 g/dL (OR=2.66, P=0.014) were related to present HCV infection.
Although EIA is not a quantitative test, considering the anti-HCV titer with ALT and albumin levels may be helpful in predicting present of HCV infection.
Clinical and molecular hepatology. 12/2013; 19(4):376-81.
[Show abstract][Hide abstract] ABSTRACT: We investigated the prognostic role of F-FDG PET/CT in the prediction of progression-free survival (PFS) and chemotherapeutic response in patients with locally advanced or metastatic pancreatic cancer.
We enrolled 21 newly diagnosed patients with locally advanced or metastatic pancreatic cancer who underwent F-FDG PET/CT scanning before palliative gemcitabine-based chemotherapy between 2006 and 2012. Maximum standardized uptake value (SUVmax) of the primary tumor was measured by F-FDG PET/CT. Chemotherapeutic response was evaluated according to the Response Evaluation Criteria in Solid Tumors. Survival analysis was performed for time to progression using the Kaplan-Meier method. Cox proportional hazard models were used to determine independent prognostic factors.
All pancreatic tumors showed detectable FDG uptake (mean SUVmax = 6.8 ± 3.0, range 2-12) The mean SUVmax values among response groups showed no significant difference (P = 0.853) and chemotherapeutic response was not different according to SUVmax level (P = 0.807). PFS was significantly shorter in the high SUVmax (≥6.8) group than in the low SUVmax (<6.8) group (2.9 vs. 6 months, P = 0.012). Multivariate analysis revealed that SUVmax was an independent prognostic factor for predicting PFS (P = 0.046).
Higher SUVmax of primary pancreatic tumor is associated with poor PFS and pretreatment SUVmax is an independent prognostic factor for predicting PFS in patients with locally advanced or metastatic pancreatic cancer who received gemcitabine-based palliative chemotherapy. However, pretreatment SUVmax is not associated with chemotherapeutic response.
Clinical nuclear medicine 10/2013; 38(10):778-783. · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate whether patients with obstructive sleep apnea (OSA) are at risk of sedation-related complications during diagnostic esophagogastroduodenoscopy (EGD).
A prospective study was performed in consecutive patients with OSA, who were confirmed with full-night polysomnography between July 2010 and April 2011. The occurrence of cardiopulmonary complications related to sedation during diagnostic EGD was compared between OSA and control groups.
During the study period, 31 patients with OSA and 65 controls were enrolled. Compared with the control group, a higher dosage of midazolam was administered (P = 0.000) and a higher proportion of deep sedation was performed (P = 0.024) in the OSA group. However, all adverse events, including sedation failure, paradoxical responses, snoring or apnea, hypoxia, hypotension, oxygen or flumazenil administration, and other adverse events were not different between the two groups (all P > 0.1). Patients with OSA were not predisposed to hypoxia with multivariate logistic regression analysis (P = 0.068).
In patients with OSA, this limited sized study did not disclose an increased risk of cardiopulmonary complications during diagnostic EGD under sedation.
World Journal of Gastroenterology 08/2013; 19(29):4745-51. · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The advantage of the quantitative fecal immunochemical test (FIT) is the flexibility to set the positivity threshold. However, the diagnostic success of the FIT has not been compared for standard and low cut-off thresholds.
The purpose of this study was to compare the diagnostic success of FIT for standard and low cut-off thresholds.
In 2009 and 2010 a standard cut-off threshold (20 μg Hb/g feces) was used as positivity criterion for the FIT; in 2012 a low cut-off (10 μg Hb/g feces) was used. Diagnostic success was compared between the two groups.
Of the total of 14,289 participants, 195 (1.4 %) had positive FIT results. Positivity of the FIT was significantly higher in the low cut-off group than in the standard cut-off group (1.8 vs. 1.0 %, p = 0.000). Although detection of advanced neoplasia lesions was comparable, proximal neoplasia was more frequently detected in the low cut-off group (33.3 vs. 20.9 %, p = 0.016). With the low cut-off threshold, 39 (0.7 %) participants were also classified as having positive results, and 18 (46.2 %) of these had colorectal neoplasias. The number of positive results from the FIT was increased by 54.9 %, and detection of advanced neoplasia was increased by 60 % with the low cut-off threshold compared with the standard cut-off.
A low cut-off threshold for the FIT resulted in better detection of proximal neoplasia in population-based screening. These results indicate the cut-off threshold for positive FIT should be properly chosen and adjusted in colorectal cancer screening.
Digestive Diseases and Sciences 08/2013; · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increasing evidence supports the contribution of the pro-/anti-inflammatory cytokine balance and genetic factors to hepatocellular carcinoma (HCC). Here, we investigated whether genetic interferon gamma polymorphisms were associated with HCC in Korean patients with chronic hepatitis B.
We genotyped a single nucleotide polymorphism (SNP, rs2430561, +874A/T) and a microsatellite (rs3138557, (CA) (n) repeat), located in the first intron of the interferon gamma gene, by direct sequencing and the gene scan method. A population-based case-control study of HCC was conducted and included 170 patients with chronic hepatitis and HCC, and 171 with chronic hepatitis B patients without hepatocellular carcinoma in a Korean population.
Genotype and allele distributions of the interferon gamma gene SNP were associated with HCC. The frequencies of the AA genotype and the A allele were significantly increased in hepatocellular carcinoma subjects (p < 0.05). Combined analysis using the genotype of rs2430561 and the number of microsatellites revealed that the frequencies of AT-CA12, and TT-CA12 increased significantly in hepatocellular carcinoma subjects (p < 0.0001).
Our results suggest that the interferon gamma gene may be a susceptibility gene and a risk factor for HCC in the Korean population.
[Show abstract][Hide abstract] ABSTRACT: Background/Aims: The aim of this study was to determine whether the major HLA-G gene was associated with hepatocellular carcinoma (HCC). Abnormal HLA-G expression is present in various diseases, such as renal cell carcinoma, asthma and classical Hodgkin's lymphoma. Methodology: To investigate the possible association with susceptibility to HCC, 181 chronic hepatitis patients and 180 HCC patients were enrolled in this study. The HLA-G 14-bp insertion/deletion polymorphism is located in the 3' untranslated region of the HLA-G gene and was analyzed using polymerase chain reaction. For analysis of genetic data, SNPStats and SPSS 18.0 were used. Logistic regression models were performed to determine the odds ratio, 95% confidence interval, and p value. Results: Allele and genotype frequencies of the HLA-G 14-bp insertion/deletion polymorphism in the hepatitis group had a similar pattern, as compared to those in the HCC group. Furthermore, no differences were observed between patients with and without liver cirrhosis. Conclusions: These results suggest that the HLA-G 14-bp insertion/deletion polymorphism may not be associated with HCC susceptibility and liver cirrhosis development in the Korean population.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Type 2 diabetes mellitus is associated with an increased risk of colorectal neoplasia. However, association between prediabetes and colorectal adenoma has not been reported. AIMS: The aim of this study was to evaluate the relationship between prediabetes and the presence of colorectal adenomas. METHODS: Consecutive prediabetic subjects who underwent screening colonoscopy were enrolled at Kyung Hee University Hospital in Gangdong, Seoul, Korea, between June 2006 and May 2012. Non-prediabetic subjects were separately pooled from the database of the Center for Health Promotion between January 2012 and May 2012. Prediabetes was defined according to the recommendations of the American Diabetes Association. The prevalence of colorectal adenomas and their characteristics were compared between prediabetic and non-prediabetic groups. RESULTS: The prevalence of colorectal adenoma was higher in prediabetic subjects than in non-prediabetic subjects (39.6 vs. 30.6 %, respectively, p = 0.019). Prediabetic subjects had more multiple and high-risk adenomas than the control group in non-matched analysis (p = 0.000, respectively). In age-matched analysis, the prevalence of multiple and high-risk adenomas were significantly higher in a prediabetic group than those in a control group (44.4 vs. 28.4 %, p = 0.034; 51.9 vs. 34.6 %, p = 0.026, respectively). Furthermore, prediabetes (odds ratio = 2.198; 95 % confidence interval = 1.042-4.637; p = 0.039) was found to be an independent risk factor for a high-risk adenoma by multivariate analysis. CONCLUSIONS: The prevalence of multiple and high-risk colorectal adenomas is significantly higher in the prediabetic subjects than those in the control group. Furthermore, prediabetes was found to be an independent risk factor for a high-risk colorectal adenoma.
Digestive Diseases and Sciences 02/2013; · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: : Recently, it was reported that postmenopausal women with lower bone mineral density have an increased risk of colorectal cancer. An association between lower bone mineral density and colorectal cancer suggests that colorectal adenoma, which is a precursor of colorectal cancer, may also be associated with lower bone mineral density.
: The aim of this study was to determine the association between colorectal adenoma and osteoporosis.
: We conducted a retrospective cross-sectional study between January 2007 and May 2011. Women older than 50 years of age who underwent dual-energy x-ray absorptiometry for bone mineral density and screening colonoscopy at Gangdong Kyung Hee University Hospital in Korea during a routine health checkup were eligible for this study. We performed multivariate analysis adjusted for age, family history of colorectal cancer, alcohol consumption, current smoking, regular aspirin use, exercise, menopause, and postmenopausal hormone use to identify independent predictors for the presence of colorectal adenoma.
: The primary outcome measured was the prevalence of colorectal adenoma according to the bone mineral density level.
: A total of 992 women older than 50 years were assigned to an osteoporosis group (n = 231) or a control group (n = 231) after menopause matching. In univariate analysis, the proportion of colorectal adenoma was significantly higher in the osteoporosis group than in the control group (29.9% vs 20.8%, p = 0.025). Furthermore, osteoporosis (OR = 1.592, 95% CI = 1.004-2.524, p = 0.048) was found to be an independent risk factor for the presence of colorectal adenoma.
: Osteoporosis is associated with an increased risk of colorectal adenoma in women older than 50 years.
Diseases of the Colon & Rectum 02/2013; 56(2):169-74. · 3.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Development of biliary casts is very unusual, especially in patients who have not undergone liver transplantation. Variable causes of biliary cast formation in nonliver transplantation patients have been suggested. However, stasis of bile flow and/or gallbladder hypocontractility is known to eventually result in the promotion of biliary sludge and subsequent cast formation. Here we present one case of biliary cast syndrome, which developed in a nonliver transplant patient who had biliary sludge for a long period of time, providing evidence that long-standing biliary sludge may lead to cast formation.