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Common bile duct stones on multidetector computed tomography:Attenuation patterns and detectability

World Journal of Gastroenterology 2013年第11期19卷 1788-1796页

作者： Chang Whan Kim Jae Hyuck Chang Yeon Soo Lim Tae Ho Kim In Seok Lee sok won han Department of Internal Medicine College of MedicineThe Catholic University of Korea505 BanpoDongSeocho-GuSeoul 137-701South Korea Department of Radiology College of MedicineThe Catholic University of Korea505 Banpo-DongSeocho-GuSeoul 137-701South Korea

AIM:To investigate the attenuation patterns and detectability of common bile duct(CBD) stones by multidetector computed tomography(MDCT).METHODS:Between March 2010 and February 2012,191 patients with suspicion of CBD stones undergoing both MDCT and endoscopic retrograde cholangiopancreatography(ERCP) were enrolled and reviewed *** attenuation patterns of CBD stones on MDCT were classified as heavily calcified,radiopaque,less radiopaque,or *** association between the attenuation patterns of CBD stones on MDCT and stone type consisting of pure cholesterol,mixed cholesterol,brown pigment,and black pigment and the factors related to the detectability of CBD stones by MDCT were ***:MDCT showed CBD stones in 111 of 130 patients in whom the CBD stones were demonstrated by ERCP with 85.4% *** attenuation patterns of CBD stones on MDCT were heavily calcified 34(26%),radiopaque 31(24%),less radiopaque 46(35%),and undetectable 19(15%).The radiopacity of CBD stones differed significantly according to stone type(P < 0.001).From the receiver operating characteristic curve,stone size was useful for the determination of CBD stone by MDCT(area under curve 0.779,P < 0.001) and appropriate cut-off stone size on MDCT was 5 *** factors related to detectability of CBD stones on MDCT were age,stone type,and stone size on multivariate analysis(P < 0.05).CONCLUSION:The radiopacity of CBD stones on MDCT differed according to stone *** type and stone size were related to the detectability by MDCT,and appropriate cut-off stone size was 5 mm.

关键词： Common bile duct gallstones Gallstones Multidetector computed tomography Endoscopic retrograde cholangiography

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Current diagnosis and treatment of benign biliary stricturesafter living donor liver transplantation

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World Journal of Gastroenterology 2016年第4期22卷 1593-1606页

作者： Jae Hyuck Chang Inseok Lee Myung-Gyu Choi sok won han Division of Gastroenterology Department of Internal MedicineCollege of MedicineThe Catholic University of KoreaSeoul 137-701South Korea

Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation(LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Benign biliary strictures after transplantation are classified into anastomotic or non-anastomotic strictures. These two types differ in presentation, outcome, and response to therapy. The leading causes of biliary strictures include impaired blood supply, technical errors during surgery, and biliary anomalies. Because patients usually have non-specific symptoms, a high index of suspicion should be maintained. Magnetic resonance cholangiography has gained widespread acceptance as a reliable noninvasive tool for detecting biliary complications. Endoscopy has played an increasingly prominent role in the diagnosis and treatment of biliary strictures after LDLT. Endoscopic management in LDLT recipients may be more challenging than in deceased donor liver transplantation patients because of the complex nature of the duct-to-duct reconstruction. Repeated aggressive endoscopic treatment with dilation and the placement of multiple plastic stents is considered the first-line treatment for biliary strictures. Percutaneous and surgical treatments are now reserved for patients for whom endoscopic management fails and for those with multiple, inaccessible intrahepatic strictures or Roux-en-Y anastomoses. Recent advances in enteroscopy enable treatment, even in these latter cases. Direct cholangioscopy, another advanced form of endoscopy, allows direct visualization of the inner wall of the biliary tree and is expected to facilitate stenting or stone extraction. Rendezvous techniques can be a good option when the endoscopic approach to the biliary stricture is unfeasible. These developments have resulted in almost all patients being managed by the endoscopic approach.

关键词： Biliary strictures Living donor liver transplantation Endoscopic retrograde cholangiography Percutaneous transhepatic cholangiography Biliarycomplication

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Undiagnosed Borrmann type Ⅱ gastric cancer due to necrosis and regenerative epithelium

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World Journal of Gastroenterology 2014年第28期20卷 9621-9625页

作者： Joon Hur Jae Hyuck Chang Byung Kee Kim Hoon Young Ko Jong Hwan Lee Soo Jeong Kim Mi Ae Song Tae Ho Kim Chang Whan Kim sok won han Division of Gastroenterology Department of Internal MedicineBucheon St.Mary’s HospitalThe Catholic University of KoreaCollege of Medicine Department of Clinical Pathology Bucheon St.Mary’s HospitalThe Catholic University of KoreaCollege of Medicine

Endoscopic biopsy is essential to the proper diagnosis and treatment of gastric ***,the results of endoscopic biopsy are not always the same as what is expected based on gross endoscopic *** results of endoscopic biopsy can be negative for malignancy in Borrmann typeⅣadvanced gastric cancer(AGCa)or gastric ***,in the case of typeⅡAGCa,repeated biopsies negative for malignancy have not been reported.A 49-year-old male patient underwent esophagogastroduodenoscopy three times due to large gastric ulcer suspected to be Borrmann typeⅡ***,three repeat endoscopic biopsies with multiple specimens showed necrosis and superficial regenerative epithelium without malignant *** patient underwent laparoscopic distal gastrectomy with D2 lymph node *** surgical specimen revealed that the mucosal layer was completely replaced with regenerative epithelium without cancer cells.

关键词： Endoscopy Biopsy Stomach neoplasm Stomach ulcer Regeneration

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Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding

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World Journal of Gastroenterology 2008年第13期14卷 2080-2084页

作者： Young-Seok Cho Hiun-Suk Chae Hyung-Keun Kim Jin-Soo Kim Byung-Wook Kim Sung-Soo Kim sok-won han Kyu-Yong Choi Department of Internal Medicine Uijeongbu St. Mary's Hospital The Catholic University of Korea Ujeongbu 480-717 Korea Department of Internal Medicine Our Lady Mercy Hospital The Catholic University of Korea Bupyeong 403720 Korea Department of Internal Medicine Uijeongbu St. Mary’s Hospital The Catholic University of Korea Ujeongbu 480-717 Korea Department of Internal Medicine Holy Family Hospital The Catholic University of Korea Bucheon 420717 Korea

AIM: To compare the hemostatic efficacy and safety of two mechanical endoscopic methods: endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in patients with actively bleeding Mallory-Weiss syndrome (MWS). METHODS: A prospective randomized study to compare the efficacy and safety of EHP with EBL was performed from January 2002 to August 2005. Forty-one patients with active bleeding from MWS were treated with EHP (n = 21) or EBL (n = 20). RESULTS: There were no significant differences between groups with respect to clinical and endoscopic characteristics. The mean number of hemoclips applied was 3.2 ± 1.5 and the mean number of bands applied was 1.2 ± 0.4. Primary hemostasis was achieved in all patients. Recurrent bleeding was observed in one patient from the EHP group and two from the EBL group. Patients with recurrent bleeding were treated by the same modality as at randomization and secondary hemostasis was achieved in all. There were no significant differences between the two groups in total transfusion amount or duration of hospital stay. No complications or bleeding-related death resulted. CONCLUSION: EHP and EBL are equally effective and safe for the management of active bleeding in patients with Mallory-Weiss syndrome, even in those with shock or comorbid diseases.

关键词： Mallory-Weiss syndrome Hemostasis Endoscopic band ligation Endoscopic clipping

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Prolapse gastropathy syndrome may be a predictor of pathologic acid reflux

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World Journal of Gastroenterology 2008年第36期14卷 5601-5605页

作者： Jin-Soo Kim Hyung-Keun Kim Young-Seok Cho Hiun-Suk Chae Byung-Wook Kim Jin-Il Kim sok-won han Kyu-Yong Choi Department of Internal Medicine College of Medicine The Catholic University of Korea Uijeongbu St. Mary's Hospital Gyeonggi-do 480-717 South Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Uijeongbu St. Mary’s Hospital Gyeonggi-do 480-717 South Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Our Lady of Mercy Hospital Gyeonggi-do 403-720 South Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Yeoeuido St. Mary’s Hospital Seoul 150-713 South Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Holy Family Hospital Gyeonggi-do 420-717 South Korea

AIM： To assess the occurrence of gastric acid reflux into the esophagus in endoscopically confirmed prolapse gastropathy syndrome （PGS）. METHODS： Using ambulatory esophageal pH measurement （BRAVOTM wireless esophageal pH monitoring system）, twenty-six patients with PGS were compared with twenty-one patients with erosive esophagitis （EE） as controls. We assessed several reflux parameters, including the percentage of total time at pH 〈 4, and the DeMeester score. RESULTS： There were no statistical differences between the PGS group and the EE group as to mean age, sex ratio and pH recording time. The EE group showed more severe reflux than the PGS group, as evaluated in terms of the longest duration of reflux, the number of reflux episodes, the number of reflux episodes lasting 〉 5 min, the total time with pH 〈 4 during acid reflux episodes, and the DeMeester score, but none of these parameters showed statistically significant difference. Although 53.8% （14/26） of the PGS group and 76.2% （16/22） of the EE group demonstrated pathologic acid reflux （DeMeester score 〉 14.72）, there was no statistically significant difference between the two groups in the incidence of pathologic acid reflux （P = 0.11）. CONCLUSION： There was no statistically significant difference in pathologic acid reflux between the PGS and EE group. These data suggest that endoscopically diagnosed PGS might be a predictor of pathologic acid reflux.

关键词： Prolapse gastropathy syndrome Pathologic acid reflux Erosive esophagitis Ambulatory esophageal pH monitoring Retching

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Extraction and clipping repair of a chicken bone penetrating the gastric wall

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World Journal of Gastroenterology 2008年第12期14卷 1955-1957页

作者： Jin-Soo Kim Hyung-Keun Kim Young-Seok Cho Hiun-Suk Chae Chang-Whan Kim Byung-Wook Kim sok-won han Kyu-Yong Choi Department of Internal Medicine College of Medicine The Catholic University of Korea Uijeongbu St. Mary's Hospital Gyeonggi-do 480-717 Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Holy Family Hospital Gyeonggi-do 420-717 Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Our lady of Mercy Hospital Gyeonggi-do 420-717 Korea

We report a case of gastric penetration caused by accidental ingestion of a chicken bone in a 42-year old woman with a partially wearing denture. Three days ago, she accidentally swallowed several lumps of poorly-chewed chicken. Physical examination disclosed mild tenderness in the periumbilical area. Abdominal Computed tomography (CT) showed a suspicious penetration or perforation of the stomach wall measuring about 3 cm, by a linear radiopaque material at the lesser curvature of the antrum. The end of a chicken bone was very close to but did not penetrate the liver. Endoscopic examination revealed a chicken bone that penetrated into the prepyloric antrum. The penetrating chicken bone was removed with grasping forceps. Five endoscopic clips were applied immediately at the removal site and the periumbilical pain resolved promptly. After removal of the chicken bone, the patient was treated with conservative care for three days, after which she was completely asymptomatic and discharged without complication. To treat gastric penetration by a foreign body, endoclipping can be a useful method in patients with no signs or symptoms of peritoneal irritation.

关键词： Gastric penetration Chicken bone Hemoclip

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Comparative study of rendezvous techniques in post-liver transplant biliary stricture

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World Journal of Gastroenterology 2012年第41期18卷 5957-5964页

作者： Jae Hyuck Chang In Seok Lee Ho Jong Chun Jong Young Choi Seung Kyoo Yoon Dong Goo Kim Young Kyoung You Myung-Gyu Choi sok won han Department of Internal Medicine College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea Department of Radiology College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea Department of Surgery College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea

AIM： To investigate the usefulness of a new rendezvous technique for placing stents using the Kumpe （KMP） catheter in angulated or twisted biliary strictures. METHODS： The rendezvous technique was performed in patients with a biliary stricture after living donor liver transplantation （LDLT） who required the exchange of percutaneous transhepatic biliary drainage catheters for inside stents. The rendezvous technique was performed using a guidewire in 19 patients （guidewire group） and using a KMP catheter in another 19 （KMP catheter group）. We compared the two groups retrospectively. RESULTS： The baseline characteristics did not differ between the groups. The success rate for placing insidestents was 100% in both groups. A KMP catheter was easier to manipulate than a guidewire. The mean pro- cedure time in the KMP catheter group （1012 s, range： 301-2006 s） was shorter than that in the guidewire group （2037 s, range： 251-6758 s, P = 0.022）. The cu- mulative probabilities corresponding to the procedure time of the two groups were significantly different （P = 0.008）. The factors related to procedure time were the rendezvous technique method, the number of inside stents, the operator, and balloon dilation of the stric- ture （P 〈 0.05）. In a multivariate analysis, the rendez- vous technique method was the only significant factor related to procedure time （P = 0.010）. The procedural complications observed included one case of mild acute pancreatitis and one case of acute cholangitis in the guidewire group, and two cases of mild acute pancre- atitis in the KMP catheter group. CONCLUSION： The rendezvous technique involving use of the KIVlp catheter was a fast and safe method for placing inside stents in patients with LDLT biliary stric- ture that represents a viable alternative to the guide- wire rendezvous technique,

关键词： Rendezvous Biliary stricture Liver trans-plantation Endoscopic retrograde cholangiography Percutaneous transhepatic biliary drainage

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A squamous metaplasia in a gastric ulcer scar of the antrum

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World Journal of Gastroenterology 2008年第8期14卷 1296-1298页

作者： Young-Seok Cho Jin-Soo Kim Hyung-Keun Kim Jeong-Seon Ji Byung-Wook Kim Hiun-Suk Chae sok-won han Kyu-Yong Choi In-Sik Chung Department of Internal Medicine College of Medicine The Catholic University of Korea Uijeongbu St. Mary's Hospital Gyeonggi-do 480-717 Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Our Lady of Mercy Hospital Gyeonggi-do Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Holy Family Hospital Gyeonggi-do Korea Department of Internal Medicine College of Medicine The Catholic University of Korea Kangnam St. Mary’s Hospital Seoul Korea

An 81-year-old man presented with epigastric pain and weight loss for one month. He had a past history of pulmonary tuberculosis, 10 years ago. We performed a gastroscopy, which showed a linear depressed whitish gastric ulcer scar (0.8 cm in length) in the posterior wall of the prepyloric antrum. The result of biopsy was reported as squamous epithelium. Immunohistochemical staining using an antibody to high molecular weight cytokeratin (HMC) revealed positive staining in the squamous epithelium. Two years later, the lesion was followed up. The lesion remained at same site endoscopically, but no squamous epithelium could be seen microscopically.

关键词： Squamous metaplasia Gastric ulcer scar High molecular weight cytokeratin

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Newly developed autoimmune cholangitis without relapse of autoimmune pancreatitis after discontinuing prednisolone

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World Journal of Gastroenterology 2012年第41期18卷 5990-5993页

作者： Ji Hun Kim Jae Hyuck Chang Sung Min Nam Mi Jeong Lee Il Ho Maeng Jin Young Park Yun Sun Im Tae Ho Kim Chang Whan Kim sok won han Department of Internal Medicine College of MedicineThe Catholic University of KoreaSeoul 137-701South Korea

A 57-year-old man presented with a 2-wk history of painless jaundice and weight Iossl He had a large ill- defined enhancing mass-like lesion in the uncinate pro- cess of the pancreas with stricture of the distal common bile duct. Aspiration cytology of the pancreatic mass demonstrated inflammatory cells without evidence of malignancy. Total serum immunoglobulin G level was slightly elevated, but IgG4 level was normal. After the 2-wk 40 mg prednisolone trial, the patient＇s symptoms and bilirubin level improved significantly. A follow-up computed tomography （CT） scan showed a dramatic resolution of the pancreatic lesion. A low dose steroid was continued. After six months he self-discontinued prednisolone for 3 wk, and was presented with jaundice again. ACT scan showed newly developed intrahepatic biliary dilatation and marked concentric wall thickening of the common hepatic duct and the proximal common bile duct without pancreatic aggravation. The patient＇ s IgG4 level was elevated to 2.51 g/L. Prednisolone was started again, after which his serum bilirubin level became normal and the thickening of the bile duct was resolved. This case suggests that autoimmune pancre- atitis can progress to other organs that are not involved at the initial diagnosis, even with sustained pancreatic remission.

关键词： Autoimmune disease Pancreatitis Cholan-gitis Prednisolone

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Duodenal obstruction following acute pancreatitis caused by a large duodenal diverticular bezoar

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World Journal of Gastroenterology 2012年第38期18卷 5485-5488页

作者： Ji Hun Kim Jae Hyuck Chang Sung Min Nam Mi Jeong Lee Il Ho Maeng Jin Young Park Yun Sun Im Tae Ho Kim Il Young Park sok won han Department of Internal Medicine College of Medicine The Catholic University of Korea Seoul 137-701 South Korea Department of Surgery College of Medicine The Catholic University of Korea Seoul 137-701 South Korea

Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.

关键词： Bezoar Diverticulum Pancreatitis Duodenal obstruction

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