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Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

World Journal of Gastroenterology 2010年第43期16卷 5490-5495页

作者： Ming-Luen Hu king-wah chiu Yi-Chun chiu Yeh-Pin Chou Tsung-Hui Hu Shue-Shian Chiou Seng-Kee Chuah Division of Hepatogastroenterology Department of Internal Medicine Chang Gung Memorial Hospital-Kaohsiung Medical Center Chang Gung University College of Medicine

AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.

关键词： Epinephrine injection High-risk ulcers Initial hemostasis Predictors Rebleeding

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Diagnostic pitfall of sebaceous gland metaplasia of the esophagus

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World Journal of Clinical Cases 2014年第7期2卷 311-315页

作者： king-wah chiu Cheng-Kun Wu Long-Sheng Lu Hock-Liew Eng Shue-Shian Chiou Department of Internal Medicine Division of Gastroenterology and HepatologyKaohsiung Chang Gung Memorial Hospitaland Chang Gung UniversityCollege of MedicineKaohsiung 83305Taiwan Department of Pathology Kaohsiung Chang Gung Memorial Hospitaland Chang Gung UniversityCollege of MedicineKaohsiung 83305Taiwan

We investigated the sebaceous gland metaplasia(SGM) of the esophagus and clarified the evidence of misdiagnosis and its diagnosis pitfall. Cases of pathologically proven SGM were enrolled in the clinical analysis and reviewed description of endoscope. In the current study, we demonstrated that SGM is very rare esophageal condition with an incidence around 0.00465% and an occurrence rate of 0.41 per year. There were 57.1% of senior endoscopists identified 8 episodes of SGM. In contrast, 7.7% of junior endoscopists identified SGM in only 2 episodes. Moreover, we investigated the difference in endoscopic biopsy attempt rate between the senior and junior endoscopist(P = 0.0001). The senior endoscopists had more motivation to look for SGM than did junior endoscopists(P = 0.01). We concluded that SGM of the esophagus is rare condition that is easily and not recognized in endoscopy studies omitting pathological review.

关键词： Esophagus Sebaceous gland Metaplasia Endoscopy Endoscopist

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Swab culture monitoring of automated endoscope reprocessors after high-level disinfection

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World Journal of Gastroenterology 2012年第14期18卷 1660-1663页

作者： Lung-Sheng Lu Yi-Chun chiu Ming-Tzung Lin Tsung-Hui Hu king-wah chiu Division of HepatoGastroenterology Department of Internal MedicineChang Gung Memorial Hospital-Kaohsiung Medical CenterChang Gung University College of Medicine

AIM:To conduct a bacterial culture study for monitoring decontamination of automated endoscope reprocessors(AERs) after high-level disinfection(HLD).METHODS:From February 2006 to January 2011,authors conducted randomized consecutive sampling each month for 7 *** collected a total of 420 swab cultures,including 300 cultures from 5 gastroscope AERs,and 120 cultures from 2 colonoscope *** cultures were obtained from the residual water from the AERs after a full reprocessing *** were cultured to test for aerobic bacteria,anaerobic bacteria,and mycobacterium ***:The positive culture rate of the AERs was 2.0%(6/300) for gastroscope AERs and 0.8%(1/120) for colonoscope *** the positive cultures,including 6 from gastroscope and 1 from colonoscope AERs,showed monofloral *** the gastroscopeAER samples,50%(3/6) were colonized by aerobic bacterial and 50%(3/6) by fungal ***:A full reprocessing cycle of an AER with HLD is adequate for disinfection of the *** culture is a useful method for monitoring AER decontamination after each reprocessing *** contamination of AERs after reprocessing should also be kept in mind.

关键词： Automated endoscope reprocessor Gastrointestinal scope High-level disinfection Swab culture Monitoring Decontamination

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High-level disinfection of gastrointestinal endoscope reprocessing

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World Journal of Experimental Medicine 2015年第1期5卷 33-35页

作者： king-wah chiu Lung-Sheng Lu Shue-Shian Chiou Division of Gastroenterology and Hepatology Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital College of Medicine Chang Gung University

High level disinfection(HLD) of the gastrointestinal(GI)endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition,GI endoscopy is a semicritical medical device. Hence,such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and postprocedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself.

关键词： Automated endoscope reprocessor Bacterial culture Gastrointestinal endoscopy High-level disinfection Liquid chemical germicide

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Homogeneous phenomenon of the graft when using different genotype characteristic of recipients/donors in living donor liver transplantation

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World Journal of Hepatology 2013年第11期5卷 642-648页

作者： king-wah chiu Toshiaki Nakano Kuang-Den Chen Li-Wen Hsu Chia-Yun Lai Ho-Ching chiu Ching-Yin Huang Yu-Fan Cheng Shigeru Goto Chao-Long Chen Liver Transplant Program Kaohsiung Chang Gung Memorial Hospital College of Medicine Chang Gung University

AIM:To investigate the evidence of homogeneous phenomenon on CYP3A5*3 MDR1-3435 and CYP3A4*18of the liver graft after living donor liver transplantation(LDLT).METHODS:We identified the proportional change of the CYP3A5*3,MDR1-3435 and CYP3A4*18 from the peripheral blood mononuclear cell of 41 pairs recipient/donor with different genotype polymorphisms and 119liver graft biopsy samples used with the pyrosequencing technique after *** chain reaction/ligase detection reaction assay and restriction fragment length polymorphism was employed for genotyping the CYP3A5*3 and CYP3A4*18 single nucleotide poly-morphisms(SNPs).All of the recipients and donors expressed with the similar SNP genotype of CYP3A5*3,MDR1-3435 or CYP3A4*18 were ***:The final genetic polymorphisms of the liver graft biopsy samples of CYP3A5*3,MDR1-3435 and CYP3A4*18 was predominated depends on the donor with restriction fragment length polymorphism and seems to be less related to the *** proportional changes of G to A alleles of the 119 samples of CYP3A5*3(included A>A/G,A/G>A,A/G>G,G>A,G>A/G and A>G),C to T alleles of the 108 samples of MDR1-3435(included C>C/T,C/T>C,C/T>T,T>C/T and T>C),and T to C alleles of 15 samples of CYP3A4*18(included T/C>T and T>C/T)were significant different between the recipients and the liver graft biopsy samples(P<0.0001)and less difference when compared with the donors in the pyrosequencing analysis after ***:The CYP3A5*3,MDR1-3435 and CYP3A4*18 of the recipient could be modified by the donor so-called homogenous phenomenon when the recipient’s blood drained into the liver graft.

关键词： Pyrosequencing CYP3A5*3 MDR1-3435 CYP3A4*18 Liver biopsy Living donor liver transplantation

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Effect of ginger on gastric motility and symptoms of functional dyspepsia

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World Journal of Gastroenterology 2011年第1期17卷 105-110页

作者： Ming-Luen Hu Christophan K Rayner Keng-Liang Wu Seng-Kee Chuah Wei-Chen Tai Yeh-Pin Chou Yi-Chun chiu king-wah chiu Tsung-Hui Hu Division of Hepatogastroenterology Department of Internal Medicine Chang Gung Memorial Hospital- Kaohsiung Medical Center Chang Gung University College of Medicine Kaohsiung 83301 Taiwan Discipline of Medicine University ofAdelaide Royal Adelaide Hospital Adelaide SA 5000 Australia

AIM:To evaluate the effects of ginger on gastric motility and emptying,abdominal symptoms,and hormones that influence motility in ***:Eleven patients with functional dyspepsia were studied twice in a randomized double-blind *** an 8-h fast,the patients ingested three capsules that contained ginger(total 1.2 g) or placebo,followed after 1 h by 500 mL low-nutrient *** area,fundus area and diameter,and the frequency of antral contractions were measured using ultrasound at frequent intervals,and the gastric half-emptying time was calculated from the change in antral *** sensations and appetite were scored using visual analog questionnaires,and blood was taken for measurement of plasma glucagon-like peptide-1(GLP-1),motilin and ghrelin concentrations,at intervals throughout the ***:Gastric emptying was more rapid after ginger than placebo [median(range) half-emptying time 12.3(8.5-17.0) min after ginger,16.1(8.3-22.6) min after placebo,P ≤ 0.05].There was a trend for more antral contractions(P = 0.06),but fundus dimensions and gastrointestinal symptoms did not differ,nor did serum concentrations of GLP-1,motilin and ***:Ginger stimulated gastric emptying and antral contractions in patients with functional dyspepsia,but had no impact on gastrointestinal symptoms or gut peptides.

关键词： Ginger(Zinger offinale) Functional dyspepsia Gastric emptying Antral contraction Abdominal ultrasound Ghrelin Glucagon-like peptide-1 Motilin

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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

AIM： TO elucidate the prognostic role and relationship of three molecular markers such as tumor suppressor gene p53, proliferating cell nuclear antigen （PCNA） and Ki-67 in gastric stromal tumor. METHODS： A total of 108 surgically resected gastric smooth muscle tumor specimens were collected from January 1987 to December 1999. Immunohistochemical studies were performed on the paraffin sections of 99 of 108 CDl17-positive tumors with antibodies of p53, PCNA, and Ki-67. Immunoreactivity of three molecular markers was recorded by labeling index （LI, %） and was analyzed for clinicopathologic and survival correlation. RESULTS： Of the 99 cases, immunostaining revealed that 52 patients （52.5%） had p53, and 37 patients （37.3%） had Ki-67 immunoreactivity （defined as 〉10% of LI）. All patients （100%） had PCNA immunoreactivity ranging from 12% to 93% of LI, divided into high or low by median. Statistics revealed that LI of three markers positively correlate to each other （P〈0.01） and to microscopic tumor mitotic counts （P〈0.001）. By combination, patients with ≥2 markers （positive or high） in tumors had early tumor recurrence （P〈0.001） and unfavorable outcome （P〈0.001）. Univariate analysis indicated that patients with tumor size 〉5 cm （P=0.003）, tumor mitosis 〉5/50 HPF （P〈0.001）, p53 immunoreactivity （P=0.001）, Ki-67 immunoreactivity （P=0.026）, high PCNA LI （P=0.015） and male gender （P=0.036） were six predictors for early disease recurrence. Subsequent multivariate analysis revealed that mitotic counts, tumor size, and p53 immunoreactivity were three independent prognostic factors for both disease free and overall survival of patients. By combination of three independent prognostic factors for grouping, we found higher tumor recurrence rate （P〈0.001） and shorter survival （P〈0.001） existed in groups with increasing factors. CONCLUSION： We first provide the prognostic value and linkage of three molecular markers in GISTs. The combination of three factors （p53, tumor size, and t

关键词： Gastrointestinal stromal tumor GIST p53 PCNA Ki-67 Prognosis

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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 *** major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a *** has been reported that delayed management of perforation for more than 24 h is associated with high *** is the treatment of choice within 24 h,but the management of delayed perforation remains ***,we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from *** completely recovered after intensive medical care.A review of the literature is also discussed.

关键词： Intrathoracic esophageal perforation Delayed presentation Pneumatic dilation Esophagealachalasia

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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 is a difficult condition for the clinician to differentiate from idiopathic achalasia even by manometry, radiological studies or endoscopy. Its etiology is usually associated with tumors. In most cases, the diagnosis is made after surgical explorations. The proposed pathogenesis of the disease is considered as mechanical obstruction of the distal esophagus or infiltration of the malignancy that affects the inhibitory neurons of the meyenteric plexus in the majority of cases. Surgery has been reported as a cause of pseudoachalasia. We report a 70-year-old man who suffered from deglutination disorder caused by pseudo-achalasia after truncal vagotomy. The patient was symptom-free after a nine-year follow-up and complete recovery of esophageal motility status from pseudoachalasia after pneumatic dilations. We also reviewed the literature of pseudoachalasia.

关键词： Truncal vagotomy Pseudo-achalasia Deglutination disorder Pneumatic dilations Sustain reversed esophageal motility

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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 ***: 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 *** 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 ***: 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 *** of the five patients in tumor mass forms died and the tumors were more than 2.0 cm in ***: 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： Upper gastrointestinal carcinoid tumors Tumor morphology Sizes Treatment courses Prognosis

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