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Folfirinox chemotherapy prolongs stent patency in patients with malignant biliary obstruction due to unresectable pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2020年第6期19卷 590-595页

作者： jinwoo Kang Sang Hyub Lee jin Ho Choi Woo Hyun Paik Dong-Won Ahn ji Bong Jeong ji kon ryu Yong-Tae Kim Department of Internal Medicine and Liver Research Institute Seoul National University HospitalSeoul National University College of MedicineSeoulKorea Department of Internal Medicine SMG-SNU Boramae Medical CenterSeoulKorea

Background:Stent insertion for biliary decompression to relieve jaundice and subsequent biliary infection is necessary for patients with biliary obstruction caused by pancreatic cancer,and it is important to keep the stent patent as long as ***,few studies have compared stent patency in terms of chemotherapy in patients with pancreatic *** study aimed to evaluate the differences in stent patency in terms of recently evolving ***:Between January 2015 and May 2017,161 patients with pancreatic cancer who had undergone biliary stent insertion with a metal stent were retrospectively *** relationship between chemotherapy and stent patency was ***,overall survival according to the treatment,risk factors for stent patency,and long-term adverse events were ***:Median stent patency was 42 days for patients with the best supportive care and 217 days for patients with chemotherapy(conventional gemcitabine-based chemotherapy and folfirinox)(P<0.001).Furthermore,the folfirinox group showed the longest median stent patency and overall survival,with 283 days and 466 days,respectively(P<0.001)despite higher adverse events *** who underwent folfirinox chemotherapy after stent insertion had better stent patency in multivariate analysis(HR=0.26;95%CI:0.12–0.60;P=0.001).Conclusions:Compared with patients who received best supportive care only,patients who underwent chemotherapy after stent insertion had better stent *** prolonged stent patency can be expected for patients with folfirinox than conventional gemcitabine-based chemotherapy.

关键词： Stent patency Malignant distal biliary obstruction Pancreatic cancer Folfirinox Chemotherapy

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Revision of bilateral self-expandable metallic stents placed using the stent-in-stent technique for malignant hilar biliary obstruction

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Hepatobiliary & Pancreatic Diseases International 2018年第5期17卷 437-442页

作者： Jun Hyuk Son Hee Seung Lee Sang Hyub Lee Seungmin Bang jinwoo Kang Woo Hyun Paik ji kon ryu Yong-Tae Kim Department of Internal Medicine and Liver Research Institute Seoul National University HospitalSeoul National University College of MedicineSeoulKorea Department of Internal Medicine Inje University Ilsan Paik HospitalGoyangKorea Department of Internal Medicine Institute of GastroenterologyYonsei University College of MedicineSeoulKorea Department of Gastroenterology and Hepatology SMG-SNU Boramae Medical CenterSeoulKorea

Background: Endoscopic biliary decompression using bilateral self-expandable metallic stent(SEMS) placed using the stent-in-stent(SIS) technique is considered favorable for unresectable malignant hilar biliary obstruction(MHBO). However, occlusion of the bilateral SIS placement is frequent and revision can be challenging. This study was performed to investigate the efficacy, the long-term patency and the appropriate approach for revision of occluded bilateral SIS placement in unresectable MHBO. Methods: From January 2011 to July 2016, thirty-eight patients with unresectable MHBO underwent revision of occluded bilateral SIS placement. Clinical data including success rates and patency of revision, were retrospectively analyzed. Results: The technical success rate of revision was 76.3%. The clinical success rate of revision was 51.7% and mean patency of revision was 49.1 days. No significant predictive factor for clinical failure of revision was observed. The cell size of SEMS was not found to have significant effects on clinical success rates or revision patency. Conclusions: Revision of occluded bilateral SIS placement for MHBO showed fair patency and clinical success rate. Revision method and cell size of SEMS were not found to influence clinical outcomes.

关键词： Malignant hilar biliary obstruction Self-expandable metallic stent Stent-in-stent Revision

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Acetylsalicylic acid for metal stent in malignant distal common bile duct obstruction:A randomized controlled trial

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Hepatobiliary & Pancreatic Diseases International 2022年第5期21卷 493-499页

作者： jin Ho Choi Kyong Joo Lee Woo Hyun Paik Namyoung Park Jung Won Chun Sang Hyub Lee ji kon ryu Yong-Tae Kim Department of Internal Medicine Liver Research InstituteSeoul National University College of MedicineSeoulKorea Department of Internal Medicine Yonsei University Wonju College of MedicineWonjuKorea

Background:Endoscopic biliary drainage is the treatment of choice for patients with malignant distal common bile duct ***-expandable metal stents have clinical advantages including an increased duration of patency that may be prolonged by acetylsalicylic acid(ASA)*** aim of this study was to investigate whether ASA had a positive effect on the patency of self-expandable metal stents compared with ***:This prospective,multicenter,double-blinded,and randomized placebo-controlled trial was conducted from October 2017 to May 2020 in *** who underwent palliative endoscopic biliary drainage with self-expandable metal stents for malignant distal bile duct obstruction were enrolled,and allocated to ASA treatment or *** study outcomes were the rate of stent dysfunction at 6 months,duration of stent patency,risk factors for stent dysfunction,and any adverse ***:Interim analysis included 24 and 28 patients in the ASA and placebo groups,*** was no significant difference between the ASA and placebo groups in stent dysfunction(25.0%vs.20.7%,P=0.761)or the duration of stent patency(150.97±10.55 vs.158.07±8.70 days,P=0.497).Six patients experienced suspected ASA-related adverse events,and there was one lethal ***:ASA did not prolong stent *** study was terminated early because of the possibility of serious adverse events related to ASA treatment of these patients receiving palliative care.

关键词： Endoscopic retrograde cholangiopancreatography Self expandable metallic stents Randomized controlled trial Acetylsalicylic acid

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Clinical and pathological differences between serum immunoglobulin G4-positive and -negative type 1 autoimmune pancreatitis

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World Journal of Gastroenterology 2013年第25期19卷 4031-4038页

作者： Woo Hyun Paik ji kon ryu jin Myung Park Byeong Jun Song Joo Kyung Park Yong-Tae Kim Kyoungbun Lee Department of Internal Medicine Liver Research Institute Division of Gastroenterology Department of Internal Medicine Seoul National University College of Medicine Department of Pathology Seoul National University College of Medicine

AIM: To identify clinical and pathological differences between serum immunoglobulin G4 (IgG4)-positive (SIP) and IgG4-negative (SIN) type 1 autoimmune pancreatitis (AIP) in South Korea. METHODS: AIP was diagnosed by the international consensus diagnostic criteria. The medical records and pathology were retrospectively reviewed and IgG4-positive cells were counted in a high power field (HPF). Type I AIP was defined as a high serum level of IgG4or histological finding. SIN type 1 AIP was defined as a histological evidence of type 1 AIP and a normal serum IgG4 level. The clinical and pathological findings were compared between the two groups. The analysis was performed using Student's t test, Fischer's exact test and Mann-Whitney's U test. A P value of < 0.05 was considered statistically significant. As repeated com- parison was made, P values of less than 5% (P < 0.05) were considered significant. RESULTS: Twenty five patients with definite type 1 AIP (19 histologically and six serologically diagnosed cases) were enrolled. The mean tissue IgG4 concentrations were significantly higher in SIP than SIN group (40 cells per HPF vs 18 cells per HPF, P = 0.02). Among eight SIN patients, the tissue IgG4 concentrations were less than 15 cells per HPF in most of cases, except one. The sensitivity of serum IgG4 was 68% (17 SIP and eight SIN AIP). Other organ involvement was more frequent- ly associated with SIP than SIN AIP (59% vs 26%, P = 0.016). However, the relapse rate and diffuse swelling of the pancreas were not associated with serum IgG4 level. The concentrations of IgG4-positive cells per HPF were higher in SIP than SIN AIP (40 vs 18, P = 0.02). CONCLUSION: The sensitivity of serum IgG4 was 68% in type 1 AIP. High serum IgG4 level was associated with other organ involvement and tissue IgG4 concentration but did not affect the relapse rate in type 1 AIP.

关键词： Autoimmunity Chronic pancreatitis Immunoglobulin G4-related systemic disease Lymphoplas-macytic sclerosing pancreatitis Immunoglobulin G4

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Endoscopic bilateral stent-in-stent placement for malignant hilar obstruction using a large cell type stent

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 633-639页

作者： jin Myung Park Sang Hyub Lee Kwang Hyun Chung Dong Kee Jang ji kon ryu Yong-Tae Kim Jae Min Lee Woo Hyun Paik Department of Internal Medicine and Liver Research Institute Seoul National University HospitalSeoul National University College of Medicine Department of Internal Medicine Kangwon National University HospitalKangwon National University School of Medicine Department of Internal Medicine Gyeongsang National University HospitalGyeongsang National University College of Medicine Department of Internal Medicine Inje University Ilsan Paik Hospital

BACKGROUND： Bilateral stent-in-stent （SIS） self-expandable metal stent placement is technically chghallenging for palliation of unresectable malignant hilar obstruction. In the SIS technique, the uniform large cell type biliary stent facilitates contralateral stent deployment through the mesh of the first metallic stent. This study aimed to assess the technical success and clinical effectiveness of this technique with a uniform large cell type biliary stent. METHODS： Thirty-one patients who underwentlbilateral SIS placement using a large cell type stent were reviewed retrospectively. All patients showed malignant hilarl obstruction （Bismuth types Ⅱ, Ⅲ, Ⅳ） with different etiologies. RESULTS： Sixteen （51.6%） patients were male. The mean age of the patients was 67.0±14.0 years. Most patients were diagnosed as having hilar cholangiocarcinoma （58.1%） and gallbladder cancer （29.0%）. Technical success rate was 83.9%. Success was achieved more frequently in patients without masses obstructing the biliary confluence （MOC） than those with MOC （95.2% vs 60.0%, P=0.03）. Functional success rate was 77.4%. Complications occurred in 29.0% of the patients. These tended to occur more frequently in patients with MOC （50.0% vs 19.0%, P=0.11）. Median time to recurrent biliary obstruction was 188 days and median survival was 175 days. CONCLUSIONS： The large cell type stent can be used efficiently for bilateral SIS placement in malignant hilar obstruction. However, the risk of technical failure increases in patients with MOC, and caution is needed to prevent complications for these patients.

关键词： biliary tract disease cholangiocarcinoma endoscopic biliary drainage stent insertion

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Safety of endoscopic ultrasound-guided ethanol ablation for pancreatic cystic lesions: A single-center experience of 214 patients

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Hepatobiliary & Pancreatic Diseases International 2019年第6期18卷 562-568页

作者： jin Ho Choi Sang Hyub Lee Young Hoon Choi Min Su You Bang-Sup Shin Woo Hyun Paik ji kon ryu Yong-Tae Kim Department of Internal Medicine Liver Research Institute Seoul National University College of Medicine

Background:Endoscopic ultrasound-guided ethanol ablation(EUS-EA)for pancreatic cystic lesions(PCLs)has been used in recent years as a feasible treatment modality for low malignant probability PCLs or patients considered high-risk for *** present study aimed to confirm the safety of EUS-EA and to find predictive factors for adverse event(AE).Methods:A retrospective review was performed from the prospectively maintained database of patients who underwent EUS-EA for PCLs from June 2006 to April 2018 at Seoul National University *** primary outcomes of the study were the rates of AEs and severe AEs by *** secondary outcome was the predictive factors of AEs including acute pancreatitis and abdominal ***:A total of 214 patients were evaluated and the diagnoses of PCLs according to cystic fluid analysis and clinical features were as follows:serous cystic neoplasm(32.2%),mucinous cystic neoplasm(26.6%),branch duct type intraductal papillary mucinous neoplasm(BD-IPMN)(29.4%),and pseudocyst(11.7%).Three patients(1.4%)experienced severe ***,AEs occurred in 71(33.2%)***-IPMN(OR:2.87;95%CI:1.05–7.84;P=0.040),multilocular cysts(OR:3.59;95%CI:1.09–11.85;P=0.036),suspected ethanol leakage during procedure(OR:10.68;95%CI:1.98–57.53;P=0.006),and sticky cystic fluid(OR:3.83;95%CI:1.20–12.24;P=0.024)were predictive factors for post-procedural acute *** of uncinate process(OR:2.99;95%CI:1.22–7.35;P=0.017)and PCLs with exophytic portion(OR:3.70;95%CI:1.96–7.01;P<0.001)were predictive factors for post-procedural abdominal ***:EUS-EA is a safe procedure with a very low rate of severe *** seems possible to predict the AEs according to the features of the procedure and PCLs.

关键词： Pancreatic cyst EUS-guided ethanol ablation Adverse events

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Survival benefit of adjuvant treatment for ampullary cancer with lymph nodal involvement:A systematic review and meta-analysis

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Hepatobiliary & Pancreatic Diseases International 2024年第6期23卷 559-565页

作者： Min Kyu Kim jin Ho Choi In Rae Cho Sang Hyub Lee ji kon ryu Yong-Tae Kim Woo Hyun Paik Department of Gastroenterology Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea Department of Internal Medicine Liver Research InstituteSeoul National University HospitalSeoul National University College of MedicineSeoulKorea

Background:The efficacy of adjuvant treatment(AT)in ampullary cancer(AmC)remains *** systematic review and meta-analysis aimed to evaluate the role of AT for *** sources:A comprehensive systematic search was performed in PubMed,EMBASE,Cochrane Library,and Web of Science *** comparing overall survival(OS)and recurrence-free survival(RFS)of patients who underwent AT or not following AmC resection were ***:A total of 3971 patients in 21 studies were *** pooled data showed no significant difference in effect on the OS by AT[hazard ratio(HR)=0.998,95%confidence interval(CI):0.768–1.297].No significant difference in recurrence between the AT and non-AT(nAT)groups was noted(HR=1.158,95%CI:0.764–1.755).In subgroup analysis,patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC(HR=0.627,95%CI:0.451–0.870).Neither AT consisted of adjuvant chemotherapy with radiotherapy(HR=0.804,95%CI:0.563–1.149)nor AT with adjuvant chemotherapy(HR=0.883,95%CI:0.642–1.214)showed any significant effect on the ***:The effect of AT in AmC on survival and recurrence did not show a significant ***,effectiveness according to AT strategies did not show enhancement in *** had an advantage in survival compared with nAT strategy in nodal-positive *** cases of AmC with positive lymph nodal involvement,AT may be warranted regardless of detailed strategies.

关键词： Ampulla of Vater Adjuvant chemotherapy Adjuvant chemoradiotherapy Meta-analysis

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Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach

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Hepatobiliary & Pancreatic Diseases International 2012年第6期11卷 636-642页

作者： Jongkyoung Choi ji kon ryu Sang Hyub Lee Dong-Won Ahn jin-Hyeok Hwang Yong-Tae Kim Yong Bum Yoon Joon Koo Han Department of Internal Medicine and Liver Research Institute Seoul National University College of Medicine Seoul Korea Department of Internal Medicine National Medical Center Seoul Korea Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Gyeonggi-do Korea Department of Internal Medicine Seoul National University Boramae Medical Center Seoul Korea Department of Radiology Seoul National University College of Medicine Seoul Korea

BACKGROUND: For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. METHODS: Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. RESULTS: Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).CONCLUSION: Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.

关键词： hepatocellular carcinoma obstructive jaundice endoscopic retrograde biliary drainage percutaneous transhepatic biliary drainage

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Clobenpropit enhances anti-tumor effect of gemcitabine in pancreatic cancer

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World Journal of Gastroenterology 2014年第26期20卷 8545-8557页

作者： Woo Hyun Paik ji kon ryu Kyoung-Sin Jeong jin Myung Park Byeong Jun Song Sang Hyub Lee Yong-Tae Kim Yong Bum Yoon Department of Internal Medicine Inje University Ilsan Paik Hospital Division of Gastroenterology Department of Internal Medicine and Liver Research InstituteSeoul National University College of Medicine

AIM: To evaluate the anti-tumor effect of clobenpropit, which is a specific H3 antagonist and H4 agonist, in combination with gemcitabine in a pancreatic cancer cell line.

关键词： Clobenpropit Epithelial-mesenchymal transition Histamine Histamine receptors Pancreatic neoplasm

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Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

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World Journal of Gastroenterology 2014年第22期20卷 6924-6931页

作者： Young Ook Eum Joo Kyung Park Jaeyoung Chun Sang-Hyub Lee ji kon ryu Yong-Tae Kim Yong-Bum Yoon Chang jin Yoon Ho-Seong Han jin-Hyeok Hwang Department of Internal medicine Cheongju St. Mary's HospitalChungcheongbuk-do 360-568South Korea Department of Internal Medicine Seoul National University Hospital Seoul National University College of Medicine Seoul 110-744South Korea Department of Internal Medicine Seoul National University College of Medicine Seoul National University Bundang Hospital Gyeonggi-do 463-707South Korea Department of Radiology Seoul National University Bundang HospitalGyeonggi-do 463-707South Korea Department of Surgery Seoul National University Bundang HospitalGyeonggi-do 463-707South Korea

AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).

关键词： Endoscopic retrograde cholangiography Percutaneous transhepatic cholangiography Percutaneous transhepatic biliary drainage Bile duct Biliary stricture.

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