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Double layered self-expanding metal stents for malignant esophageal obstruction, especially across the gastroesophageal junction

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World Journal of Gastroenterology 2012年第28期18卷 3732-3737页

作者： Min Dae kim Su Bum Park Dae Hwan Kang Jae hyung Lee Cheol Woong Choi hyung wook kim Chung Uk Chung Young Il Jeong Department of Internal Medicine Bongseng Memorial Hospital Busan 601-723 South Korea Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Yangsan 626-770 South Korea

AIM: To evaluate the clinical outcomes of double-layered self-expanding metal stents (SEMS) for treatment of malignant esophageal obstruction according to whether SEMS crosses the gastroesophageal junction (GEJ). METHODS: Forty eight patients who underwent the SEMS insertion for malignant esophageal obstruction were enrolled. Patients were classified as GEJ group (SEMS across GEJ, 18 patients) and non-GEJ group (SEMS above GEJ, 30 patients) according to SEMS position. Double layered (outer uncovered and inner covered stent) esophageal stents were placed. RESULTS: The SEMS insertion and the clinical improvement were achieved in all patients in both groups. Stent malfunction occurred in seven patients in the GEJ group and nine patients in the non-GEJ group. Tumor overgrowth occurred in five and eight patients, respectively, food impaction occurred in one patient in each group, and stent migration occurred in one and no patient, respectively. There were no significant differences between the two groups. Reflux esophagitis occurred more frequently in the GEJ group (eight vs five patients, P = 0.036) and was controlled by proton pump inhibitor. Aspiration pneumonia occurred in zero and five patients, respectively, and tracheoesophageal fistula occurred in zero and two patients, respectively. CONCLUSION: Double-layered SEMS are a feasible and effective treatment when placed across the GEJ for malignant esophageal obstruction. Double-layered SEMS provide acceptable complications, especially migration, although reflux esophagitis is more common in the GEJ group.

关键词： Metal stent Gastroesophageal junction Malignant esophageal obstruction

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Associated factors for a hyperechogenic pancreas on endoscopic ultrasound

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World Journal of Gastroenterology 2010年第34期16卷 4329-4334页

作者： Cheol Woong Choi Gwang Ha kim Dae Hwan Kang hyung wook kim Dong Uk kim Jeong Heo Geun Am Song Do Youn Park Suk kim Department of Internal Medicine Pusan National University School of Medicine and the Medical Research Institute Pusan National University Hospital Department of Internal Medicine Pusan National University School of Medicine and the Medical Research Institute Department of Pathology Pusan National University School of Medicine and the Medical Research Institute Department of Radiology Pusan National University School of Medicine and the Medical Research Institute

AIM: To identify the associated risk factors for hyperechogenic pancreas (HP) which may be observed on endoscopic ultrasound (EUS) and to assess the relationship between HP and obesity. METHODS: From January 2007 to December 2007, we prospectively enrolled 524 consecutive adults who were scheduled to undergo EUS. Patients with a history of pancreatic disease or with hepatobiliary or advanced gastrointestinal cancer were excluded. Finally,284 patients were included in the analyses. We further analyzed the risk of HP according to the categories of visceral adipose tissue (VAT) and subcutaneous adipose tissue in 132 patients who underwent abdominal computed tomography scans. RESULTS: On univariate analysis, age older than 60 years, obesity (body mass index > 25 kg/m 2 ), fatty liver, diabetes mellitus, hypertension and hypercholesterolemia were identified as risk factors associated with HP (P < 0.05). On multivariate analysis, fatty liver [P = 0.008, odds ratio (OR) = 2.219], male gender (P = 0.013, OR = 2.636), age older than 60 years (P = 0.001, OR = 2.874) and hypertension (P = 0.044, OR = 2.037) were significantly associated with HP. In the subgroup analysis, VAT was a statistically significant risk factor for HP (P = 0.010, OR = 5.665, lowest quartile vs highest quartile). CONCLUSION: HP observed on EUS was associated with fatty liver, male gender, age older than 60 years, hypertension and VAT.

关键词： Endoscopic Ultrasound Hyperechogenic pancreas Obesity

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Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors

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World Journal of Gastroenterology 2015年第31期21卷 9387-9393页

作者： Su Bum Park hyung wook kim Dae Hwan Kang Cheol Woong Choi Su Jin kim Hyeong Seok Nam Department of Internal Medicine Pusan National University School of Medicine Research institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital

AIM: To compare the outcomes of endoscopic mucosal resection with a cap(EMR-C) with those of endoscopic submucosal dissection(ESD) for the resection of rectal neuroendocrine ***: One hundred and sixteen lesions in 114 patients with rectal neuroendocrine tumor(NET) resected with EMR-C or ESD were included in the study. This study was performed at Pusan National University Yangsan Hospital between July 2009 and August 2014. We analyzed endoscopic complete resection rate,pathologic complete resection rate,procedure time,and adverse events in the EMR-C(n = 65) and ESD(n = 51) groups. We also performed a subgroup analysis by tumor ***: Mean tumor size was 4.62 ± 1.66 mm in the EMR-C group and 7.73 ± 3.14 mm in the ESD group(P < 0.001). Endoscopic complete resection rate was 100% in both groups. Histologic complete resection rate was significantly greater in the EMR-C group(92.3%) than in the ESD group(78.4%)(P = 0.042). Mean procedure time was significantly longer in the ESD group(14.43 ± 7.26 min) than in the EMR-C group(3.83 ± 1.17 min)(P < 0.001). Rates of histologic complete resection without complication were similar for tumor diameter ≤ 5 mm(EMR-C,96%; ESD,100%,P = 0.472) as well as in cases of 5 mm < tumor diameter ≤ 10 mm(EMR-C,80%; ESD,71.0%,P = 0.524).CONCLUSION: EMR-C may be simple,faster,and more effective than ESD in removing rectal NETs and may be preferable for resection of small rectal NETs.

关键词： Neuroendocrine tumor Endoscopic mucosal resection

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Is endoscopic ultrasonography essential for endoscopic resection of small rectal neuroendocrine tumors?

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World Journal of Gastroenterology 2017年第11期23卷 2037-2043页

作者： Su Bum Park Dong Jun kim hyung wook kim Cheol Woong Choi Dae Hwan Kang Su Jin kim Hyeong Seok Nam Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanGyeongsangnam-do 626-770South Korea

AIM To evaluate the importance of endoscopic ultrasonography(EUS) for small(≤ 10 mm) rectal neuroendocrine tumor(NET) *** Patients in whom rectal NETs were diagnosed by endoscopic resection(ER) at the Pusan National University Yangsan Hospital between 2008 and 2014 were included in this study. A total of 120 small rectal NETs in 118 patients were included in this study. Histologic features and clinical outcomes were analyzed, and the findings of endoscopy, EUS and histology were compared. RESULTS The size measured by endoscopy was not significantly different from that measured by EUS and histology(r = 0.914 and r = 0.727 respectively). Accuracy for the depth of invasion was 92.5% with EUS. No patients showed invasion of the muscularis propria or metastasis to the regional lymph nodes. All rectal NETswere classified as grade 1 and demonstrated an L-cell phenotype. Mean follow-up duration was 407.54 ± 374.16 d. No patients had local or distant metastasis during the follow-up periods. CONCLUSION EUS is not essential for ER in the patient with small rectal NETs because of the prominent morphology and benign behavior.

关键词： Neuroendocrine tumor Small Rectal Endoscopic ultrasonography Histology Endoscopy

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Endoscopic resection using band ligation for esophageal SMT in less than 10mm

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World Journal of Gastroenterology 2015年第10期21卷 2982-2987页

作者： Joung Boom Hong Cheol Woong Choi hyung wook kim Dae Hwan Kang Su Bum Park Su Jin kim Dong Jun kim Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital

AIM:To evaluate the safety and feasibility of endoscopic resection using band ligation(EMR-B) for the diagnostic and therapeutic removal of tumors located in the esophageal subepithelial region having originated from the ***:From May 2009 to September 2014,after medical chart and endoscopic ultrasonography report review,a total of 15 esophageal tumors located in the submucosal layer were resected by *** symptom,location,pathology,complete resection rate,incidence of complications,incidence of minor complication,size,length of procedures time and follow up months were *** evaluate local recurrence at the resection site,periodic follow-up endoscopic examination was undertaken in all of the *** first endoscopic examination was performed about 6 mo after the endoscopic ***,the endoscopic follow up were scheduled ***:The mean age was 50.3 ± 9.67 *** mean tumor size was 6.93 ± 3.15 mm and most of the lesions size was between 5-10 mm in diameter(10/15,66.6%).In all patients,endoscopic en bloc resection was *** one patient,the vertical margin was *** mean procedural time was 8.86 ± 3.66 *** all patients,no evidence of severe complications such as perforation or bleeding *** complications such as chest pain(2/15,13.3%) and heartburn(3/15,13.3%) were reported but they symptoms were controlled by proton pump inhibitors,ulcermin and/or *** assessments of the removed specimens revealed 10 granular cell tumors(66.6%),4 leiomyomas(16.6%) and one lipoma(6.6%).No recurrence was observed during the mean follow up period of 45 ± 3.5 mo(range:5-64 mo).CONCLUSION:EMR-B might be considered safe and effective for the diagnosis and treatment of lesions measuring less than 10 mm in diameter.

关键词： Band ligation Endoscopic mucosal resection Esophag

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Is forceps more useful than visualization for measurement of colon polyp size?

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World Journal of Gastroenterology 2016年第11期22卷 3220-3226页

作者： Jae Hyun kim Seun Ja Park Jong Hoon Lee Tae Oh kim Hyun Jin kim hyung wook kim Sang Heon Lee Dong Hoon Baek Department of Gastroenterology Kosin University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Dong-A University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Haeundae Paik Hospital Inje University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Gyeongsang National University Hospital Jinju 660-702 South Korea Department of Gastroenterology Pusan National University Yangsan Hospital Yangsan 626-770 South Korea Department of Gastroenterology Inje University Busan Paik Hospital Inje University College of Medicine Busan 602-702 South Korea Department of Gastroenterology Pusan National University School of Medicine Busan 602-702 South Korea

AIM: To identify whether the forceps estimation is more useful than visual estimation in the measurement of colon polyp ***: We recorded colonoscopy video clips that included scenes visualizing the polyp and scenes using open biopsy forceps in association with the polyp, which were used for an exam. A total of 40 endoscopists from the Busan Ulsan Gyeongnam Intestinal Study Group Society(BIGS) participated in this study. Participants watched 40 pairs of video clips of the scenes for visual estimation and forceps estimation, and wrote down the estimated polyp size on the exam paper. When analyzing the results of the exam, we assessed interobserver differences, diagnostic accuracy, and error range in the measurement of the polyp size.R E S U LT S : The overall intra-class correlation coefficients(ICC) of inter-observer agreement for forceps estimation and visual estimation were 0.804(95%CI: 0.731-0.873, P < 0.001) and 0.743(95%CI: 0.656-0.828, P < 0.001), respectively. The ICCs of each group for forceps estimation were higher than those for visual estimation(Beginner group, 0.761 vs 0.693; Expert group, 0.887 vs 0.840, respectively). The overall diagnostic accuracy for visual estimation was 0.639 and for forceps estimation was 0.754(P < 0.001). In the beginner group and the expert group, the diagnostic accuracy for the forceps estimation was significantly higher than that of the visual estimation(Beginner group, 0.734 vs 0.613, P < 0.001; Expert group, 0.784 vs 0.680, P < 0.001, respectively). The overall error range for visual estimation and forceps estimation were 1.48 ± 1.18 and 1.20 ± 1.10, respectively(P < 0.001). The error ranges of each group for forceps estimation were significantly smaller than those for visual estimation(Beginner group, 1.38 ± 1.08 vs 1.68 ± 1.30, P < 0.001; Expert group, 1.12 ± 1.11 vs 1.42 ± 1.11, P < 0.001, respectively).CONCLUSION: Application of the open biopsy forceps method when measuring colon polyp size could help reduce int

关键词： Colon polyp Colonoscopy Measurement Endoscopy

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Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy

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World Journal of Gastroenterology 2011年第29期17卷 3441-3447页

作者： Cheol Woong Choi Dae Hwan Kang hyung wook kim Su Bum Park Kee Tae Park Gwang Ha kim Geun Am Song Mong Cho Department of Internal Medicine Pusan National University School of Medicine and Medical Research InstituteYangsan-siGyeongsangnam-do 626-770South Korea

AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university *** October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on *** 24 h of hospital admission,all patients underwent endoscopic *** successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were ***:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.

关键词： Somatostatin Pantoprazole Gastrointestinal bleeding Rebleeding

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Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations

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World Journal of Gastroenterology 2015年第19期21卷 5918-5925页

作者： Su Jin kim Dae Hwan Kang hyung wook kim Cheol Woong Choi Su Bum Park Byeong Jun Song Young Mi Hong Department of Internal Medicine Medical Research Institute Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Hospital

AIM: To compare the success rates and adverse events of early needle-knife fistulotomy(NKF) and double-guidewire technique(DGT) in patients with repetitive unintentional pancreatic ***: From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography(ERCP) at a single tertiary care hospital(Pusan National University Yangsan Hospital, Yangsan, South Korea) between January2009 and December 2012, 134(8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not ***: The success rates with early NKF andthe DGT were 79.1%(53/67) and 44.8%(30/67)(P< 0.001), respectively. The incidence of post-ERCP pancreatitis(PEP) was lower in the early NKF group than in the DGT group [4.5%(3/67) vs 14.9%(10/67),P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and312 s(P = 0.013), ***: Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations.

关键词： Endoscopic retrograde cholangiopancreatography Cannulation Pancreatitis Needle knifefistulotomy Double guidewire technique

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Assessment of disease activity by fecal immunochemical test in ulcerative colitis

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World Journal of Gastroenterology 2016年第48期22卷 10617-10624页

作者： Dae Gon Ryu hyung wook kim Su Bum Park Dae Hwan Kang Cheol Woong Choi Su Jin kim Hyeong Seok Nam Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital

AIM To evaluate the efficacy of quantitative fecal immunochemical test(FIT) as biomarker of disease activity in ulcerative colitis(UC).METHODS Between February 2013 and November 2014, a total of 82 FIT results, obtained in conjunction with colonoscopies, were retrospectivelyevaluated for 63 patients with UC. The efficacy of FIT for evaluation of disease activity was compared to colonoscopic findings. Quantitative fecal blood with automated equipment examined from collected feces. Endoscopic disease severity were assessed using the Mayo endoscopic subscore(MES) classification. The extent of disease were classified by proctitis(E1), left sided colitis(E2), and extensive colitis(E3). Clinical activity were subgrouped by remission or *** All of 21 patients with MES 0 had negative FIT( 134.89 ng/m L. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and accuracy of negative FIT about mucosal healing were 73.33%, 81.82%, 91.49%, 51.43% and 73.17%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of predictive value of positive FIT(cutoff value > 100 ng/mL) about active disease status were 45.45%, 93.33%, 71.43%, 82.35%and 26.83%, respectively. Among patients with clinical remission, FIT was negative in 31(81.6%) of 38 cases, with a mean fecal hemoglobin concentration of 6.12 ng/mL(range, negative to 80.9 ng/mL) for this group of patients. Among patients with clinical active disease, FIT was negative in 16(36.4%) out of 44 cases, with a mean fecal hemoglobin concentration > 167.4 ng/mL for this group of patients. FIT was positively correlated with endoscopic activity(r = 0.626, P < 0.01) and clinical activity(r = 0.496, P < 0.01). But, FIT did not correlate with the extent of disease(r =-0.047, P = 0.676)CONCLUSION Quantitative FIT can be a non-invasive and effective biomarker for evaluation of clinical and endoscopic activity in UC, but not

关键词： Ulcerative colitis Fecal immunochemical test Mayo endoscopic subscore Biomarker Disease activity

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Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

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World Journal of Gastroenterology 2017年第9期23卷 1627-1636页

作者： Hyeong Seok Nam Dae Hwan Kang hyung wook kim Cheol Woong Choi Su Bum Park Su Jin kim Dae Gon Ryu Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsan-siGyeongsangnam-do 50612South Korea

To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS).METHODSThis was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were *** the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and non-pancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma vs pancreatic cancer vs others, P = 0.696) or the type of SEMS used (uncovered vs covered, P = 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMS vs two SEMS, P = 0.031). No other factors were predictive of post-ERCP *** ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.

关键词： Endoscopic sphincterotomy Endoscopic retrograde cholangio pancreatography Complications Pancreatitis Bleeding Cholestasis Self-expandable metal stent

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