Chang Soo Eun

Hanyang University, Sŏul, Seoul, South Korea

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Publications (136)545.01 Total impact

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    ABSTRACT: Background Data regarding outcomes for patients with multiple findings for high-risk adenomas are scarce. Aim To compare the risk for colorectal neoplasm (CRN) recurrence according to the number of high-risk findings. Methods This was a retrospective and multicenter study. Patients who had one or more high-risk adenomas at the index colonoscopy and underwent follow-up colonoscopy 2.5 or more years after the index colonoscopy were included. The number of high-risk findings was defined as follows: number of adenomas larger than 1 cm + number of adenomas with HGD + number of adenomas with a villous component + existence (counted as 1) or nonexistence (counted as 0) of three or more adenomas. Results A total of 1646 patients were included, and the mean duration between index and follow-up colonoscopy was approximately 4 years. The cumulative incidence rate of recurrent advanced CRN in patients with three or more high-risk findings was higher than that in patients with one or two high-risk findings (p < 0.001). However, the difference in 3-year cumulative incidence rates of recurrent advanced CRN between the two groups was not great, although it was statistically significant (4.8 vs. 2.3 %, p = 0.039). Conclusions A 3-year surveillance interval for patients with multiple high-risk findings, regardless of the number of high-risk findings, appears reasonable.
    No preview · Article · Jan 2016 · Digestive Diseases and Sciences
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    ABSTRACT: Background Although propofol-based sedation can be used during emergency endoscopy for upper gastrointestinal bleeding (UGIB), there is a potential risk of sedation-related adverse events, especially in patients with variceal bleeding. Aim We compared adverse events related to propofol-based sedation during emergency endoscopy between patients with non-variceal and variceal bleeding. Methods Clinical records of patients who underwent emergency endoscopy for UGIB under sedation were reviewed. Adverse events, including shock, hypoxia, and paradoxical reaction, were compared between the non-variceal and variceal bleeding groups. Results Of 703 endoscopies, 539 and 164 were performed for non-variceal and variceal bleeding, respectively. Shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding (12.2 vs. 3.5 %, P < 0.001). All patients except one recovered from shock after normal saline hydration, and emergency endoscopy could be finished without interruption in most cases. The incidence of hypoxia and paradoxical reaction did not differ based on the source of bleeding (non-variceal bleeding vs. variceal bleeding: hypoxia, 3.5 vs. 1.8 %, P = 0.275; paradoxical reaction interfering with the procedure, 4.1 vs. 5.5 %, P = 0.442). Conclusions Although shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding, most cases could be controlled without procedure interruption. Paradoxical reaction, rather than shock or hypoxia, was the most common cause of procedure interruption in patients with variceal bleeding, but the rate did not differ between patients with non-variceal and variceal bleeding.
    No preview · Article · Nov 2015 · Digestive Diseases and Sciences
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    ABSTRACT: Background and aim: Advanced adenoma (>10 mm in diameter, villous structure or high-grade dysplasia) in young patients may have different characteristics and prognosis compared with those in older patients. We aimed to compare the incidence of colorectal neoplasms in young patients with older patients after removing high-risk adenoma (advance adenoma or ≥3 adenomas). Methods: A retrospective, multicenter study was conducted at 13 university hospitals in Korea. The 1479 patients who removed high-risk adenoma at index colonoscopy and followed by surveillance colonoscopy ≥2.5 years after were included. The cumulative incidence of overall and advanced colorectal neoplasms was compared according to the age groups (group 1: <50 years, group 2: 50-70 years, and group 3: ≥ 70 years). Results: The prevalence of advance adenoma detected at index colonoscopy was significantly higher in group 1 than in groups 2 and 3 (85.4%, 78.1%, and 77.2%, respectively; p = 0.035). The 5 years cumulative incidence of overall and advanced colorectal neoplasms were 61.9%, 67.9%, and 74.7% (p < 0.001), and 11.7%, 17.9%, and 27.1% (p = 0.001) in groups 1, 2, and 3, respectively. In multivariate analysis, age >70 years was a significant risk factor for developing overall (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.12-1.82, P = 0.004) and advanced colorectal neoplasms (HR = 2.56, 95% CI 1.43-4.59, p = 0.002). Conclusion: The cumulative incidence of overall and advanced colorectal neoplasms was significantly higher in older patients than in young patient groups. Age was a significant risk factor for developing colorectal neoplasms after removing high-risk adenoma. This article is protected by copyright. All rights reserved.
    No preview · Article · Sep 2015 · Journal of Gastroenterology and Hepatology
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    Chang Soo Eun · Dong Soo Han

    Preview · Article · Sep 2015 · Gut and liver
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    ABSTRACT: Background/aims: Two comparable anti-tumor necrosis factor (TNF) agents with different routes of administration (intravenous [iv] infliximab [IFX] vs subcutaneous [sc] adalimumab [ADA]) are available for patients with Crohn's disease (CD) in Korea. This study aimed to identify the preferences of Korean CD patients for a specific anti-TNF agent and the factors contributing to the decision. Methods: A prospective survey was performed among anti-TNF-naive CD patients in 10 tertiary referral hospitals. A 16-item questionnaire addressed patient preferences and the factors contributing to the decision in favor of a particular anti-TNF agent. A logistic regression was conducted to assess predictive factors for ADA preference. Results: Overall, 189 patients (139 males; mean age, 32.47±11.71 years) completed the questionnaire. IFX and ADA were preferred by 63.5% (120/189) and 36.5% (69/189) of patients, respectively. The most influential reason for choosing IFX was 'doctor's presence' (68.3%, 82/120), and ADA was "easy to use" (34.8%, 24/69). Amid various clinicodemographic data, having a >60-minute travel time to the hospital was a significant independent predictive factor for ADA preference. Conclusions: A large number of anti-TNF-naive Korean patients with CD preferred anti-TNFs with an iv route of administration. The reassuring effect of a doctor's presence might be the main contributing factor for this decision.
    No preview · Article · Sep 2015 · Gut and Liver
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    ABSTRACT: Although the malignant progression of serrated polyps has been clearly documented, the malignant potential of the traditional serrated adenoma (TSA) subtype has not been established. We compared the prevalence of metachronous polyps in surveillance colonoscopies between patients with TSA and those with conventional adenomas (CAs). Four hundred twenty patients were diagnosed with TSAs by current diagnostic criteria at 10 tertiary care university hospitals in Korea from January 2003 to December 2005; 186 patients who received surveillance colonoscopy after removal of initial polyps were enrolled. During the same time period, 372 age- and sex-matched patients diagnosed with CAs were used as a control group. TSA patients had a significantly higher recurrence rate of colorectal polyps compared with CA patients (66.1% vs 43.5%, respectively). TSA patients had a greater number (3 vs 2) and larger size (8.6 ± 5.7 vs 6.3 ± 5.2 mm) of recurrent polyps compared with CA patients. TSA patients also had a higher rate of CA (54.8% vs 37.9%), serrated adenoma (14.0% vs. 0.8%), and hyperplastic polyp (33.3% vs. 13.7%) recurrence compared with CA patients. TSA patients had significantly greater odds of having a recurrent high-risk polyp than CA patients (odds ratio, 2.37; 95% confidence interval, 1.55-3.63). In comparison with patients with CAs, patients with TSAs have higher metachronous occurrence rate of all polyp subtypes including CAs, serrated adenomas, and hyperplastic polyps. Moreover, the presence of TSAs is an independent predictor of a high-risk polyp occurrence. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · Gastrointestinal endoscopy
  • Chang Soo Eun · Dong Soo Han · A. Reum Lee · Kyo-Sang Yoo

    No preview · Article · Apr 2015 · Gastroenterology
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    ABSTRACT: Objective: Real-world epidemiological data on tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) receiving TNF-α inhibitors are scarce. We investigated the risks for and case characteristics of TB in a large cohort of IBD patients treated with TNF-α inhibitors in Korea, where TB is endemic. Materials and methods: We performed an observational study on all TB cases identified in a cohort of 873 IBD subjects treated with TNF-α inhibitors from January 2001 to December 2013. The standardized incidence ratio (SIR) of TB was calculated using data from the matched general population. Results: A total of 25 newly developed TB cases were identified in the cohort (pulmonary TB, 84% [21/25]; extrapulmonary TB, 16% [4/25]). The adjusted SIR of TB was 41.7 (95% confidence interval, 25.3-58.0), compared with that of the matched general population. Nineteen of the 25 patients (76%) developed TB within 2-62 months of initiation of TNF-α inhibitor treatment despite screening negative for latent TB infection (LTBI), whereas three patients with LTBI (12%, 3/25) developed TB 3 months after completion of chemoprophylaxis. The outcomes of TB treatment were mostly favorable, although one death from peritoneal TB was noted. The type of TNF-α inhibitor prescribed (infliximab) was a significant predictor of TB (p = 0.033). Conclusions: TNF-α inhibitor treatment strikingly increases the risk of TB infection in an IBD population from a TB endemic area. Continuous evaluation of the development of de novo TB infection in IBD patients subjected to long-term TNF inhibitor therapy is mandatory.
    No preview · Article · Jan 2015 · Scandinavian Journal of Gastroenterology
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    ABSTRACT: Aim: To compare efficacy, patient compliance, acceptability, satisfaction, safety, and adenoma detection rate of sodium phosphate tablets (NaP, CLICOLON(TM)) to a standard 4 L polyethylene glycol (PEG) solution for bowel cleansing for adults undergoing colonoscopy. Methods: In this multicenter, randomized, prospective, investigator-blind study, the relatively young (19-60 years) healthy outpatients without comorbidity were randomly assigned to one of two arms. All colonoscopy were scheduled in the morning. The NaP group was asked to take 4 tablets, 5 times the evening before and 4 tablets, 3 times early on the morning of the colonoscopy. The PEG group was asked to ingest 2 L of solution the evening before and 2 L early in the morning of the procedure. Adequacy of bowel preparation was scored using the Boston bowel preparation scale. Results: No significant differences were observed between the NaP group (n = 158) and PEG group (n = 162) in bowel cleansing quality (adequate preparation 93.0% vs 92.6%, P = 0.877), patient compliance (P = 0.228), overall adverse events (63.3% vs 69.1%, P = 0.269), or adenoma detection rate (34.8% vs 35.2%, P = 0.944). Patient acceptability, satisfaction, and patient rating of taste were higher in the NaP group than in the PEG group (P < 0.001). Conclusion: NaP tablets, compared with PEG solution, produced equivalent colon cleansing, did not cause more side effects, and had better patient acceptability and satisfaction in the relatively young (age < 60 years) healthy individuals without comorbidity. An oral tablet formulation could make bowel preparation less burdensome, resulting in greater patient participation in screening programs.
    Preview · Article · Nov 2014 · World Journal of Gastroenterology
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    ABSTRACT: Background Patients with Crohn’s disease (CD) are frequently exposed to diagnostic radiation, mainly as a result of abdominopelvic computed tomography (APCT) examinations. However, there are limited data on the impact of APCT on clinical management in this population. Aim To investigate clinical predictors of urgent findings on APCT in patients with CD who presented to the emergency department (ED). Methods A retrospective study was performed among patients with CD presenting to 11 EDs with a gastrointestinal complaint. The primary outcome, OPAN (obstruction, perforation, abscess, or non-CD-related urgent findings), included new or worsening CD-related urgent findings or non-CD-related urgent findings that required urgent or emergency treatment. Variables with P Results Of the 266 APCTs performed, 103 (38.7 %) had OPAN and 113 (42.5 %) required changes in treatment plan. Stricturing or penetrating disease (odds ratio [OR] 2.72, 95 % confidence interval [CI] 1.21-6.13), heart rate >100 beats/min (OR 2.33, 95 % CI 1.10-4.93), leukocyte count >10,000/mm3 (OR 4.38, 95 % CI 2.10-9.13), and CRP >2.5 mg/dL (OR 3.11, 95 % CI 1.23-7.86) were identified as the independent predictors of OPAN, whereas biologic agent use (OR 0.37; 95 % CI 0.15-0.90) was identified as the negative predictor in patients with CD. Conclusions Only 39 % of the APCTs performed in the ED among patients with CD showed urgent findings. Stricturing or penetrating disease, tachycardia, leukocytosis, and high CRP level were predictors of urgent CT findings, while biologic agent use was a negative predictor. To reduce unnecessary radiation exposure, the selection process for CD patients referred for APCT must be improved.
    Full-text · Article · Jul 2014 · Digestive Diseases and Sciences
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    ABSTRACT: Background: Helicobacter pylori (H. pylori) infection plays an important role in the early stage of cancer development. However, various bacteria that promote the synthesis of reactive oxygen and nitrogen species may be involved in the later stages. We aimed to determine the microbial composition of gastric mucosa from the patients with chronic gastritis, intestinal metaplasia, and gastric cancer using 454 GS FLX Titanium. Methods: Gastric mucosal biopsy samples were collected from 31 patients during endoscopy. After the extraction of genomic DNA, variable region V5 of the 16S rRNA gene was amplified. PCR products were sequenced using 454 high-throughput sequencer. The composition, diversity, and richness of microbial communities were compared between three groups. Results: The composition of H. pylori-containing Epsilonproteobacteria class appeared to be the most prevalent, but the relative increase in the Bacilli class in the gastric cancer group was noticed, resulting in a significant difference compared with the chronic gastritis group. By analyzing the Helicobacter-dominant group at a family level, the relative abundance of Helicobacteraceae family was significantly lower in the gastric cancer group compared with chronic gastritis and intestinal metaplasia groups, while the relative abundance of Streptococcaceae family significantly increased. In a UPGMA clustering of Helicobacter-dominant group based on UniFrac distance, the chronic gastritis group and gastric cancer group were clearly separated, while the intestinal metaplasia group was distributed in between the two groups. The evenness and diversity of gastric microbiota in the gastric cancer group was increased compared with other groups. Conclusions: In Helicobacter predominant patients, the microbial compositions of gastric mucosa from gastric cancer patients are significantly different to chronic gastritis and intestinal metaplasia patients. These alterations of gastric microbial composition may play an important, as-yet-undetermined role in gastric carcinogenesis of Helicobacter predominant patients.
    No preview · Article · Jul 2014 · Helicobacter
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    ABSTRACT: Background/Aims Although normal endoscopic findings are, as a rule, part of the diagnosis of microscopic colitis, several cases of macroscopic lesions (MLs) have been reported in collagenous colitis, but hardly in lymphocytic colitis (LC). The aim of this study was to investigate the endoscopic, clinical, and histopathologic features of LC with MLs. Methods A total of 14 patients with LC who were diagnosed between 2005 and 2010 were enrolled in the study. Endoscopic, clinical, and histopathologic findings were compared retrospectively according to the presence or absence of MLs. Results MLs were observed in seven of the 14 LC cases. Six of the MLs exhibited hypervascularity, three exhibited exudative bleeding and one exhibited edema. The patients with MLs had more severe diarrhea and were taking aspirin or proton pump inhibitors. More intraepithelial lymphocytes were observed during histologic examination in the patients with MLs compared to the patients without MLs, although this difference was not significant. The numbers of mononuclear cells and neutrophils in the lamina propria were independent of the presence or absence of MLs. Conclusions LC does not always present with normal endoscopic findings. Hypervascularity and exudative bleeding are frequent endoscopic findings in patients with MLs.
    Preview · Article · Jun 2014 · Gut and liver

  • No preview · Article · Jun 2014 · Pancreatology
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    ABSTRACT: Background and AimPrior studies have reported 2-L PEG plus ascorbic acid (PEG + Asc) is an effective alternative to standard 4-L PEG for bowel preparation before colonoscopy, but they are limited due to some confounders. Therefore, we compared the efficacy, patient compliance, satisfaction, and safety of 2-L PEG + Asc versus 4-L PEG for bowel cleansing in optimal preparation strategies. Methods In this prospective, randomized, single-blind trial, consenting outpatients were randomly assigned to one of two arms. All colonoscopies were scheduled in the morning and cleansing solutions were administered as a split-dose regimen. Bowel cleansing efficacy in three different segments was measured on a five-point scale with four-point overall grading. Patients’ opinions of the preparation regimens were obtained by questionnaire. ResultsThere was no significant difference between the 2-L PEG + Asc (159/163; 97.5%) and 4-L PEG (162/164; 98.8%) with respect to the overall success of bowel cleansing (mean difference = – 1.3 [– 4.1 - ∞]). Patient compliance, acceptability, and satisfaction were better in the 2-L PEG + Asc arm than the 4-L PEG arm (P < 0.05). Additionally, the incidence of side-effects was lower in the 2-L PEG + Asc than the 4-L PEG (overall, 57.7% vs. 73.2%, P < 0.05). However, no significant difference was seen in patients’ rating of taste. Conclusions In an optimal preparation setting, 2-L PEG + Asc has equal efficacy as a bowel cleanser prior to colonoscopy as 4-L PEG, with the advantages of better patient compliance, satisfaction, and safety.
    No preview · Article · Jun 2014 · Journal of Gastroenterology and Hepatology

  • No preview · Article · May 2014 · Gastroenterology
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    ABSTRACT: We evaluated whether a simplified human microbiota consortium (SIHUMI) induces colitis in germfree (GF) 129S6/SvEv (129) and C57BL/6 (B6) interleukin-10-deficient (IL-10−/−) mice, determined mouse strain effects on colitis and the microbiota, examined the effects of inflammation on relative bacterial composition, and identified immunodominant bacterial species in “humanized” IL-10−/− mice. GF wild-type (WT) and IL-10−/− 129 and B6 mice were colonized with 7 human-derived inflammatory bowel disease (IBD)-related intestinal bacteria and maintained under gnotobiotic conditions. Quantification of bacteria in feces, ileal and colonic contents, and tissues was performed using 16S rRNA gene selective quantitative PCR. Colonic segments were scored histologically, and gamma interferon (IFN-γ), IL-12p40, and IL-17 levels were measured in supernatants of unstimulated colonic tissue explants and of mesenteric lymph node (MLN) cells stimulated by lysates of individual or aggregate bacterial strains. Relative bacterial species abundances changed over time and differed between 129 and B6 mice, WT and IL-10−/− mice, luminal and mucosal samples, and ileal and colonic or fecal samples. SIHUMI induced colitis in all IL-10−/− mice, with more aggressive colitis and MLN cell activation in 129 mice. Escherichia coli LF82 and Ruminococcus gnavus lysates induced dominant effector ex vivo MLN TH1 and TH17 responses, although the bacterial mucosal concentrations were low. In summary, this study shows that a simplified human bacterial consortium induces colitis in ex-GF 129 and B6 IL-10−/− mice. Relative concentrations of individual SIHUMI species are determined by host genotype, the presence of inflammation, and anatomical location. A subset of IBD-relevant human enteric bacterial species preferentially stimulates bacterial antigen-specific TH1 and TH17 immune responses in this model, independent of luminal and mucosal bacterial concentrations.
    Preview · Article · Mar 2014 · Infection and immunity
  • C.S. Eun · D.S. Han · A.R. Lee · D.I. Park · S.-K. Yang

    No preview · Article · Feb 2014
  • C.S. Eun · D.S. Han · A.R. Lee · H.-J. Park

    No preview · Article · Feb 2014 · Journal of Crohn s and Colitis
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    ABSTRACT: Background/aims: The polyp detection rate (PDR) has been suggested as a surrogate for adenoma detection rate (ADR). The purpose of this study was to determine the level of agreement between PDR and ADR in the proximal and distal colon. Methods: A total of 1,937 consecutive, asymptomatic individuals aged 40 years and older who underwent colonoscopies at six academic teaching hospitals in Korea were included in this study. PDR and ADR were calculated for each colonic segment. PDR was compared with ADR in the proximal and distal colon. Results: During 1,937 colonoscopies, 1,862 polyps were removed; 1,421 (76%) were adenomas. The PDR and ADR in the proximal colon was 25.8% and 22.8%, respectively (kappa value=0.917, p=0.26), and that in the distal colon was 28.9% and 22.2%, respectively (p<0.001). There was a strong correlation between PDR and ADR in the proximal colon, but diverged in sigmoid colon and rectum. Conclusions: PDR and ADR correlate well in the proximal colon, but not in the distal colon, especially sigmoid and rectum. PDR should be measured for each colonic segment when using PDR as a surrogate for ADR. PDR is a valid proxy for ADR in the proximal colon.
    Preview · Article · Jan 2014 · The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi
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    Young Jae Byun · Chang Soo Eun
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    ABSTRACT: Psychological stress induces alterations in the function of the hypothalamic-pituitary-adrenal axis via corticotorphin releasing factor and alterations in the enteric nervous system via actions of the autonomic nervous system. Mucosal mast cells and adrenal glands release several inflammatory cytokines and cortisol, causing increased intestinal permeability. Increased intestinal permeability as well as increased inflammatory cytokines and hormones cause changes in bacterial-mucosal interactions, leading to the aggravation of disease activity and gastrointestinal symptoms in inflammatory bowel syndrome (IBD) and irritable bowel syndrome (IBS). Several studies have demonstrated that stress has an important roles in the pathogenesis of IBD and IBS. Personal traits, health beliefs and personal stress-coping mechanisms can also have adverse effects on the disease course of IBD and IBS. Stress reduction therapies have been adapted for treatment of IBD and IBS. Antidepressants and psychological therapies such as cognitive-behavior therapy, hypnotherapy, and multi-component psychological therapy have been used for control of disease activity and symptoms in IBD and IBS patients. The efficacy of such treatments is controversial, because there has not been an adequate standardization in treatment protocol, and studies suffer from the difficulties involved in selection of appropriate control groups, questions related to a high placebo effect, as well as differences in interpretation. Well-designed prospective controlled studies evaluating the role of stress in the pathogenesis of IBD and IBS and the role of stress reduction therapies are warranted for improvement of clinical treatments and outcomes.
    Preview · Article · Jan 2014

Publication Stats

1k Citations
545.01 Total Impact Points

Institutions

  • 2001-2015
    • Hanyang University
      • • Major in Internal Medicine
      • • Department of Food and Nutrition
      Sŏul, Seoul, South Korea
  • 2014
    • University of North Carolina at Chapel Hill
      • Division of Gastroenterology and Hepatology
      North Carolina, United States
  • 2007-2013
    • Hanyang University Medical Center
      Sŏul, Seoul, South Korea
  • 2008
    • Hallym University
      Sŏul, Seoul, South Korea
  • 2005-2006
    • Hallym University Medical Center
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
    • University of Ulsan
      • College of Medicine
      Urusan, Ulsan, South Korea