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Endosonographic surveillance of 1-3 cm gastric submucosal tumors originating from muscularis propria

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World Journal of Gastroenterology 2017年第12期23卷 2194-2200页

作者： ming-luen hu keng-liang wu Chi-Sin Changchien seng-kee chuah yi-chun chiu division of hepato-gastroenterology department of internal medicine kaohsiung chang gung memorial hospital and chang gung university college of medicine

AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria(SMTMPs).METHODS By reviewing the computerized medical records over a period of 14 years(2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound(EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in 2016.RESULTS A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors(GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until 2016.CONCLUSION Most 1-3 cm gastric SMTMPs(71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size(> 14.0 mm) and irregular border.

关键词： Gastrointestinal stromal tumor Submucosal tumors originating from the muscularis propria Stomach Endosonographic surveillance

2011 update on esophageal achalasia

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World Journal of Gastroenterology 2012年第14期18卷 1573-1578页

作者： Seng-Kee Chuah Pin-I Hsu Keng-Liang Wu Deng-Chyang Wu Wei-Chen Tai Chi-Sin Changchien Division of Gastroenterology Kaohsiung ChangGung Memorial Hospital College of Medicine Chang GungUniversity Kaohsiung 833 Taiwan Division of Gastroenterology Department of Inter-nal Medicine Kaohsiung Veterans General Hospital NationalYang-Ming University Kaohsiung 813 Taiwan Cancer Center Division of Gastroenterol-ogy Department of Internal Medicine Kaohsiung MedicalUniversity Hospital Kaohsiung Medical University Kaohsiung807 Taiwan

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years.First,the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes.The most favorable outcome is predicted for patients receiving treatment for type Ⅱ achalasia (achalasia with compression).Patients with typeⅠ(classic achalasia) and type Ⅲ achalasia (spastic achalasia) experience a less favorable outcome.Second,the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD).Although the follow-up period was not long enough to reach a convincing conclusion,it merits the continued use of PD as a generally available technique in gastroenterology.Third,the novelendoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia,but it requires increased experience and cautious evaluation.Despite all this good news,the bottom line is a real break-through from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

关键词：弛缓随机对照试验诊断工具 ic技术 Ⅱ型糖尿病高分辨率胃肠病学基础研究

Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia

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World Journal of Gastroenterology 2009年第35期15卷 4461-4463页

作者： Ming-Tzung Lin King-Wah chiu Yeh-Pin Chou Ming-Chao Tsai Tsung-Hui Hu Chuan-Mo Lee Chi-Sin Changchien Seng-Kee Chuah Division of Hepatogastroenterology Chang Gang Memorial Hospital Kaohsiung 123Ta-Pei RoadNiaosung HsiangKaohsiung Country 833TaiwanChina Chang Gung University College of MedicineKaohsiung 833TaiwanChina

Pneumatic dilation(PD)is considered to be a safe and effective first line therapy for achalasia.The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation.It has been reported that delayed management of perforation for more than 24 h is associated with high mortality.Surgery is the treatment of choice within 24 h,but the management of delayed perforation remains controversial.Hereby,we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia.She completely recovered after intensive medical care.A review of the literature is also discussed.

关键词：穿孔弛缓食管延迟气囊局部放电死亡率治疗

Liu-stain quick cytodiagnosis of ultrasound-guided fine needle aspiration in diagnosis of liver tumors

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World Journal of Gastroenterology 2007年第3期13卷 448-451页

作者： Chi-Sin Changchien Jing-Houng Wang Chao-Hung Hung chien-Hung Chen Chuan-Mo Lee Division of Hepato-Gastroenterology Department of Internal Medicine Chang-Gung Memorial Hospital Kaohsiung Medical Center Chang Gung University College of Medicine Taiwan China

AIM: To combine ultrasound-guided fine-needle aspira- tion (US-FNA) and Liu (Riu) stain to make a quick study on liver tumor lesions. METHODS: Two hundred and twenty-eight aspirations from 232 patients were completely studied. The operator himself made the quick cytodiagnosis of US-FNA smear stained by Liu method within thirty minutes. The US-FNA specimen was also sent to the pathological department for cytological study and cellblock histology. The result of our Liu-stain quick cytodiagnosis in each patient was confirmed by the final cytopathological diagnosis from pathological report. RESULTS: Among 228 samples, the quick cytodiagnosis revealed 146 malignancies, 81 benign lesions and one inadequate specimen. Cytopathological diagnosis from the pathological department revealed 150 malignancies, and 78 benign lesions. Four well-differentiated hepa- tocellular carcinomas (HCCs) were under-diagnosed by quick cytodiagnosis as benign and 3 benign lesions were over-diagnosed as well-differentiated HCCs. Compared with cytopathological diagnosis, quick cytodiagnosis correctly diagnosed 143 malignancies and 77 benign le- sions. Except for the one inadequate specimen in quick cytodiagnosis, the accuracy of quick cytodiagnosis was 96.9% (220/227), and its sensitivity, specificity and posi- tive and negative predictive values were 97.9%, 95.1%, 97.3% and 96.3%, respectively. CONCLUSION: Liu-stain quick cytodiagnosis is a fast, convenient, safe and effective method for hepatologists in clinic practice to diagnose liver tumor. In few cases of well-differentiated HCC, Liu-stain quick cytodiagnosis has its limitation.

关键词：肝肿瘤诊断方法药物治疗组织病理

Expression and prognostic role of molecular markers in 99 KIT-positive gastric stromal tumors in Taiwan Residents

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World Journal of Gastroenterology 2006年第4期12卷 595-602页

作者： Tsung-Hui Hu Seng-Kee Chuah Jui-Wei Lin Yi-Chun chiu Chi-Sin Changchien chih-chi Wang Yaw-Sen Chen Li-Na Yi King-Wah chiu Chuan-Mo Lee Division of Gastroenterology Department of Internal MedicineChanggung Memorial Hospital Kaohsiung Taiwan China Department of Pathology Chang Gung Memorial Hospital Kaohsiung Taiwan China Department of Surgery Chang Gung Memorial Hospital Kaohsiung Taiwan China

瞄准：为了阐明，象肿瘤那样的三个分子的标记的预示的角色和关系压制，增殖或基因 p53 房间原子抗原(PCNA ) 和在胃的基质肿瘤的 Ki-67。方法：108 的一个总数通过手术 resected 胃的平滑肌肿瘤标本从 1987 年 1 月被收集到 1999 年 12... 详细信息

瞄准：为了阐明，象肿瘤那样的三个分子的标记的预示的角色和关系压制，增殖或基因 p53 房间原子抗原(PCNA ) 和在胃的基质肿瘤的 Ki-67。方法：108 的一个总数通过手术 resected 胃的平滑肌肿瘤标本从 1987 年 1 月被收集到 1999 年 12 月。Immunohistochemical 研究与 p53， PCNA，和 Ki-67 的抗体在 108 个 CD117 积极的肿瘤中的 99 个的石蜡节上被执行。三个分子的标记的 Immunoreactivity 被把索引标记记录(李， %) 并且为临床病理和幸存关联被分析。结果：99 个盒子，染色的免疫表明 52 个病人(52.5%) 有 p53，并且 37 个病人(37.3%) 有 Ki-67 免疫反应(定义为李的 >10%) 。所有病人(100%) 有 PCNA 免疫反应从 12% ～ 93% 李，划分了成由高或低中部。统计表明三个标记的李断然相关到对方(P=2 标记的病人(积极或高) 在肿瘤有早肿瘤复发(P5 厘米(P=0.003 ) 的病人，肿瘤有丝分裂 >5/50 HPF (P<0.001 ) ， p53 免疫反应(P=0.001 ) ， Ki-67 免疫反应(P=0.026 ) ，高级李普克纳(P=0.015 ) 和男性(P=0.036 ) 是为早疾病复发的六个预言者。随后多，变量分析表明有丝分裂的计数，肿瘤尺寸，和 p53 免疫反应是为免费的疾病和外套的三个独立预示的因素病人的幸存。由为组织的三个独立预示的因素的联合，我们发现更高的肿瘤再发率(P<0.001 ) 和更短的幸存(P<0.001 ) 与增加因素在组存在。结论：我们首先在大意提供三个分子的标记的预示的价值和连接。三个因素(p53，肿瘤尺寸，和肿瘤有丝分裂) 的联合比任何单个因素提供预后的更强大的预言。

关键词：基因表达分子标记胃肿瘤台湾省中国

Clinical characteristics and prognostic factors of splenic abscess:A review of 67 cases in a single medical center of Taiwan

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World Journal of Gastroenterology 2006年第3期12卷 460-464页

作者： Kuo-chin Chang Seng-Kee Chuah Chi-Sin Changchien Tung-Lung Tsai Sheng-Nan Lu Yi-Chun chiu Yaw-Sen Chen chih-chi Wang Jui-Wei Lin Chuan-Mo Lee Tsung-Hui Hu Division of Gastroenterology Department ofInternal Medicine Chang Gung Memorial Hospital KaohsiungTaiwan China Department of surgery ChangGung Memorial Hospital Kaohsiung Taiwan China Department of Pathology Chang Gung Memorial Hospital Kaohsiung Taiwan China

瞄准：在 19 年的一个时期期间在台湾的一个医学中心分析脾的脓肿的 67 个盒子。方法：从 1986 年 1 月到 2004 年 12 月，有脾的脓肿的 67 个病人的一个总数为回顾的学习被注册。临床的特征，内在的疾病，有机体系列，治疗学的方法， A... 详细信息

瞄准：在 19 年的一个时期期间在台湾的一个医学中心分析脾的脓肿的 67 个盒子。方法：从 1986 年 1 月到 2004 年 12 月，有脾的脓肿的 67 个病人的一个总数为回顾的学习被注册。临床的特征，内在的疾病，有机体系列，治疗学的方法， APACHE II 分数，和死亡率被分析。结果：与 54.1+/-14.1 年的吝啬的年龄有 41 男性和 26 女性。为 28.4% 的多重脾的脓肿(MSA ) 报道和在 71.6% 病人的独居的脾的脓肿。57 个病人(35.8%) 中的 26 个有额外的脾的脓肿，与肝(34.6%) 的领先的地点。微生物学文化在血文化在 58 个病人(86.6%) 是积极的，与 71.8% 并且 93.5% 在脓肿文化。与肺炎杆菌(22.4%) 的领先的病原体，支配的克否定杆菌(GNB ) 感染(55.2%) 由克跟随了积极球菌(GPC ) 感染(31%) 。脾切除术在 26 被执行在 21 的病人(38.8%) ，经皮的排水或渴望(31.3%) ，和在 20 个病人(29.9%) 独自一个的抗菌素治疗。最后， 67 个病人中的 12 个到期了(17.9 %) 。由统计，感染 GNB 的怒气是可能的与 GPC (P=0.036 ) 与感染相比开发多发性脓肿。有 GNB 感染(P=0.009 ) 和多发性脓肿(P=0.011 ) 的病人与 GPC 感染和独居的脓肿比病人经历了更高的死亡率。12 的吝啬的 APACHE II 分数到期了病人(16.3+/-3.2 ) 比 55 幸存(7.2+/-3.8 )(P<0.001 ) 的显著地高。结论：MSA， GNB 感染，和高 APACHE II 分数是差的预示的因素。当这些风险因素是在场的时，早外科的干预应该被鼓励。

关键词：疾病预防脾脓肿台湾省中国杆菌

Current status in the treatment options for esophageal achalasia

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World Journal of Gastroenterology 2013年第33期19卷 5421-5429页

作者： Seng-Kee Chuah chien-Hua chiu Wei-Chen Tai Jyong-Hong Lee Hung-I Lu Chi-Sin Changchien Ping-Huei Tseng Keng-Liang Wu Gastrointestinal Motility Unit Division of HepatogastroenterologyKaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine Division of General Medicine Department of MedicineKaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine Digestive Disease Center Department of Medical ResearchShow-Chwan Memorial Hospital Division of Thoracic and Cardiovascular Surgery Kaohsiung Chang Gung Memorial Hospital Department of Internal Medicine Graduate Institute of Clinical MedicineNational Taiwan University Hospital and College of MedicineNational Taiwan University

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy(POEM).The first multicenter randomized,controlled,2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy(LHM)was not superior to pneumatic dilations(PD).Publications on the long-term success of laparoscopic surgery continue to emerge.In addition,laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication.The optimal treatment option is an ongoing matter of debate.In this review,we provide an update of the current progress in the treatment of esophageal achalasia.Unless new conclusive data prove otherwise,LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications.However,PD is the first choice for non-surgical treatment and is more costeffective.Repeated PD according to an"on-demand"strategy based on symptom recurrence can achieve long-term remission.Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options.POEM has shown promise but its long-term efficacy and safety need to be assessed further.

关键词： Esophageal achalasia Endoscopic pneumatic dilations Botulinum injection Peroral endoscopic myotomy Minimally invasive Heller myotomy

Upper gastrointestinal carcinoid tumors incidentally found by endoscopic examinations

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World Journal of Gastroenterology 2005年第44期11卷 7028-7032页

作者： Tsung-Hui Hu Chung-Mou Kuo King-Wah chiu Chung-Huang Kuo Keng-Liang Wu Yeh-Pin Chou Sheng-Nan Lu Shue-Shian chiou Chi-Sin Changchien Hock-Liew Eng Department of Hepato-Gastroenterology Chang Gung Memorial Hospital 123 Ta-Pei Road Niao-sung Hsiang Kaohsiung HsienTaiwan China Department of Pathology Chang Gung Memorial Hospital 123 Ta-Pei Road Niao-sung Hsiang Kaohsiung HsienTaiwan China

AIM: This study shares Asian clinical experiences of carcinoid tumors that originated in the upper gastrointestinal tract.METHODS: From May 1987 to June 2002, we had found only 13 cases of histologically confirmed carcinoid tumors in the upper gastrointestinal tract by endoscopic examinations. There were eight males and five females.The mean age was 53.16±20.51 years that ranged from 26 to 82 years. Each of their clinical presentations,locations, tumor morphology, and size and the treatment outcome were analyzed and discussed.RESULTS: One patient had a polypoid lesion at the lower esophagus, nine were stomach lesions and three located at the duodenum. All patients with polypoid and submucosal tumor types were of small size (＜1.7 cm) and all patients survived after simple excision or polypectomy.Four of the five patients in tumor mass forms died and the tumors were more than 2.0 cm in size.CONCLUSION: Carcinoid tumors rarely originated from the upper gastrointestinal tract and are usually found accidentally after endoscopic study. Bigger size (more than 2 cm) tumor masses may indicate a more severe disease and poor prognosis.

关键词：胃肿瘤肠肿瘤内窥镜并发症

Pseudoachalasia in a patient after truncal vagotomy surgery successfully treated by subsequent pneumatic dilations

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World Journal of Gastroenterology 2006年第31期12卷 5087-5090页

作者： Seng-Kee Chuah Chung-Mou Kuo Keng-Liang Wu Chi-Sin Changchien Tsung-Hui Hu chi-chih Wang Yi-Chun chiu Yeh-Pin Chou Pin-I Hsu King-Wah chiu Chung-Huang Kuo Shue-Shian chiou Chuan-Mo Lee Gastrointestinal Motility UnitDivision of Hepatogastroenterology Department of Internal MedicineChang Gung Memorial HospitalChang Gung UniversityCollege of MedicineKaohsiungTaiwanChina Department of SurgeryChang Gung Memorial Hospital Chang Gung UniversityCollege of MedicineKaohsiungTaiwanChina Kaohsiung Veteran General HospitalTaiwan China

Pseudoachalasia 是一个困难的条件让临床医生甚至由测压法，放射学的研究或内视镜检查法区分开来与自发的弛缓不能。它的病原学通常与肿瘤被联系。在大多数情况中，诊断在外科的探索以后被做。疾病的建议致病被看作远侧的食管的机械阻... 详细信息

Pseudoachalasia 是一个困难的条件让临床医生甚至由测压法，放射学的研究或内视镜检查法区分开来与自发的弛缓不能。它的病原学通常与肿瘤被联系。在大多数情况中，诊断在外科的探索以后被做。疾病的建议致病被看作远侧的食管的机械阻塞或在盒子的多数影响 meyenteric 丛的禁止的神经原的恶意的渗入。外科作为 pseudoachalasia 的一个原因被报导了。我们报导受不了 pseudo-achalasia 在树干的迷走神经切断术以后引起的 deglutination 混乱的一个 70 岁的人。病人在九年的后续和从在灵魂膨胀以后的 pseudoachalasia 的食道的活动性地位的完全的恢复以后是没有症状的。我们也考察了 pseudoachalasia 的文学。

关键词：迷走神经切断术气压扩张病理治疗