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Endoscopic en bloc resection of an exophytic gastrointestinal stromal tumor with suction excavation technique

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World Journal of Gastroenterology 2016年第23期22卷 5454-5458页

作者： Hyuk Soon Choi Hoon Jai Chun Kyoung-Oh Kim Eun Sun Kim Bora Keum yoon-tae jeen Hong Sik Lee Chang Duck Kim Division of Gastroenterology and Hepatology Department of Internal MedicineInstitute of Gastrointestinal Medical Instrument ResearchKorea University College of MedicineKorea University Medical Center Department of Internal Medicine Gachon University Gil Medical CenterGachon University of Medicine and Science

Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor (GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further management of a gastric subepithelial tumor on the lesser curvature of the lower body, originally detected via routine upper gastrointestinal endoscopy. Abdominal computed tomography and endoscopic ultrasound showed a 4-cm extraluminally protruding mass originating from the muscularis propria layer. The patient firmly refused surgical resection owing to potential cardiac problems, and informed consent was obtained for endoscopic removal. Careful dissection and suction of the tumor was repeated until successful extraction was achieved without serosal injury. We named this procedure the suction excavation technique. The tumor’s dimensions were 3.5 cm × 2.8 cm × 2.5 cm. The tumor was positive for C-KIT and CD34 by immunohistochemical staining. The mitotic count was 6/50 high-power fields. The patient was followed for 5 years without tumor recurrence. This case demonstrated the use of endoscopic resection of an exophytic GIST using the suction excavation technique as a potential therapy without surgical resection.

关键词： Gastrointestinal stromal tumor Endoscopic resection Submucosal tumor Subepithelial tumor En bloc resection

A novel cleansing score system for capsule endoscopy

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World Journal of Gastroenterology 2010年第7期16卷 875-880页

作者： Sung Chul Park Bora Keum Jong Jin Hyun Yeon Seok Seo Yong Sik Kim yoon tae jeen Hoon Jai Chun Soon Ho Um Chang Duck Kim Ho Sang Ryu Division of Gastroenterology and Hepatology Department of Internal MedicineKorea University Anam HospitalInstitute of Digestive Disease and NutritionKorea University College of MedicineSeoul 136-705South Korea

AIM:To suggest a new cleansing score system for small bowel preparation and to evaluate its clinical ***:Twenty capsule endoscopy cases were reviewed and small bowel preparation was assessed with the new scoring *** the assessment,two visual parameters were used:proportion of visualized mucosa and degree of *** frames from small bowel images were serially selected and scored at 5-min *** correlation coefficient(ICC)was obtained to assess the reliability of the new scoring *** efficacy evaluation and validation,scores of our new scoring system were compared with another previously reported cleansing grading ***:Concordance with the previous system,inter-observer agreement,and intra-patient agreement were excellent with ICC values of 0.82,0.80,and 0.76,*** intra-observer agreements at four-week intervals were also *** cutoff value of adequate image quality was found to be ***:Our new scoring system is simple,efficient,and can be considered to be applicable in clinical practice and research.

关键词： Capsule endoscopy Cleansing score system

Comparison of sequential and 7-,10-,14-d triple therapy for Helicobacter pylori infection

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World Journal of Gastroenterology 2012年第19期18卷 2377-2382页

作者： Hyuk Soon Choi Hoon Jai Chun Sang Hoon Park Bora Keum Yeon Seok Seo Yong Sik Kim yoon-tae jeen Soon Ho Um Hong Sik Lee Chang Duck Kim Ho Sang Ryu Division of Gastroenterology and Hepatology Department of Internal MedicineInstitute of Digestive Disease and NutritionKorea University College of MedicineSeoul 136-705South Korea

AIM:To compare the effectiveness of sequential therapy for Helicobacter pylori(***) infection with that of triple therapy of varying ***:The 460 patients enrolled in this study had ***-associated gastritis or a gastric or duodenal *** screening,***-infected patients were randomly assigned to receive either conventional triple therapy for 7,10 or 14 d,or a new 10-d sequential *** of the 4 treatment groups included 115 *** outcomes of eradication therapy were assessed 4 wk after treatment by the urea breath test and ***:The overall eradication rate was 81.0%,and eradication rates were 75.7% for 7-d conventional triple therapy,81.9% for 10-d conventional triple therapy,84.4% for 14-d conventional triple therapy,and 82.0% for 10-d sequential *** intention-to-treat analysis nor per protocol analysis showed significant differences in eradication rates using sequential therapy or the standard triple therapy(P = 0.416 and P = 0.405,respectively).CONCLUSION:There are no significant differences between 10-d sequential eradication therapy for *** and any duration of standard triple treatment in Korean patients.

关键词： He/icobacter pylori Sequential therapy Triple therapy Gastric ulcer Duodenal ulcer Gastritis

Sensitivity of the suspected blood indicator:An experimental study

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World Journal of Gastroenterology 2012年第31期18卷 4169-4174页

作者： Sung Chul Park Hoon Jai Chun Eun Sun Kim Bora Keum Yeon Seok Seo Yong Sik Kim yoon tae jeen Hong Sik Lee Soon Ho Um Chang Duck Kim Ho Sang Ryu Division of Gastroenterology and Hepatology Department of Internal MedicineKangwon National University School of MedicineChuncheon 200-722South Korea Division of Gastroenterology and Hepatology Department of Internal MedicineKorea University College of MedicineSeoul 136-705South Korea

AIM： To investigate whether suspected blood indicator （SBI） in capsule endoscopy （CE） is affected by back- ground color and capsule passage velocity. METHODS： Experimental models of the small intestine constructed from paper in a variety of colors were used to simulate the background colors observed in CE im- ages. The background colors studied included very pale yellow, yellow, very pale magenta, light grayish pink, burnt sienna, and deep and dark brown, and red spots were attached inside them. An endoscopic capsule was manually passed through the models. The rate of detection of the red spots by the SBI was evaluated based on the colors of the models and the capsule pas- sage velocities （0.5 cm/s, 1 cm/s, and 2 cm/s）.RESULTS： The rate of detection of the red spots byground color of the model （P 〈 0.001）. Detection rates were highest for backgrounds of very pale magenta, burnt sienna, and yellow, in that order. They were lowest for backgrounds of dark brown and very pale yellow. The rate of detection of red spots by the SBI tended to decrease at rapid capsule passage velocities （1-2 cm/s） compared to slow velocities （0.5 cm/s） for backgrounds of very pale yellow （P = 0.042）, yellow （P = 0.001）, very pale magenta （P = 0.002）, and burnt sien- na （P = 0.001）. No significant differences in the rate of detection were observed according to velocity for light grayish pink （P = 0.643） or dark brown （P = 0.396）. CONCLUSION： SBI sensitivity was affected by back- ground color and capsule passage velocity in the models. These findings may facilitate the rapid detection of bleeding lesions by CE.

关键词： Capsule endoscopy Suspected blood indi-cator Sensitivity Background color Passage velocity

How good is cola for dissolution of gastric phytobezoars?

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World Journal of Gastroenterology 2009年第18期15卷 2265-2269页

作者： Beom Jae Lee Jong-Jae Park Hoon Jai Chun Ji Hoon Kim Jong Eun Yeon yoon tae jeen Jae Seon Kim Kwan Soo Byun Sang Woo Lee Jae Hyun Choi Chang Duck Kim Ho Sang Ryu Young-tae Bak Division of Gastroenterology Department of Internal MedicineKorea University College of MedicineSeoul 152-703South Korea

AIM:To evaluate the efficacy of cola treatment for gastric phytobezoars,including ***:A total of 17 patients(range:48 to 78 years) with symptomatic gastric phytobezoars treated with cola and adjuvant endoscopic therapy were *** liters of cola lavage(10 cases) or drink(7 cases) were initially used,and then endoscopic fragmentation was done for the remnant bezoars by using a lithotripsy basket or a polypectomy *** overall success of dissolving a gastric phytobezoars with using three liters of cola and the clinical and endoscopic findings were compared retrospectively between four cases of complete dissolution by using only cola and 13 cases of partial dissolution with ***:After 3 L of cola lavage or drinking,a complete dissolution of bezoars was achieved in four patients(23.5%),while 13 cases(76.5%) were only partially ***(4 of 6 cases) were observed more frequently than diospyrobezoars(0 of 11) in the group that underwent complete dissolution(P = 0.006).Gender,symptom duration,size of bezoar and method of cola administration were not significantly different between the two *** of 13 patients with residual bezoars were completely treated with a combination of cola and endoscopic ***:The rate of complete dissolution with three liters of cola was 23.5%,but no case of diospyrobezoar was completely dissolved using this ***,pretreatment with cola may be helpful and facilitate endoscopic fragmentation of gastric phytobezoars.

关键词： Gastric phytobezoars Diospyrobezoars Cola Dissolution Clinical efficacy

Self-expandable metal stents in patients with postoperative delayed gastric emptying after distal gastrectomy

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World Journal of Gastroenterology 2018年第40期24卷 4578-4585页

作者： Seung Han Kim Bora Keum Hyuk Soon Choi Eun Sun Kim Yeon Seok Seo yoon tae jeen Hong Sik Lee Hoon Jai Chun Soon Ho Um Chang Duck Kim Sungsoo Park Division of Gastroenterology and Hepatology Department of Internal MedicineInstitute of Gastrointestinal Medical Instrument ResearchKorea University College of MedicineSeoul 02841South Korea Department of Surgery Korea University College of MedicineSeoul 02841South Korea

AIM To investigate the efficacy and safety of endoscopic stent insertion in patients with delayed gastric emptying after *** In this study, we prospectively collected data from patients who underwent stent placement for delayed gastric emptying(DGE) after distal gastrectomy between June 2010 and April 2017, at a tertiary referral academic center. Clinical improvement, complications, and consequences after stent insertion were *** Technical success was achieved in all patients(100%). Early symptom improvement was observed in 15 of 20 patients(75%) and clinical success was achieved in all patients. Mean follow-up period was 1178.3 ± 844.1 d and median stent maintenance period was 51 d(range 6-2114 d). During the follow-up period, inserted stents were passed spontaneously per rectum without any complications in 14 of 20 patients(70%). Symptom improvement was maintained after stent placement without the requirement of any additional intervention in 19 of 20 patients(95%).CONCLUSION Endoscopic stent placement provides prompt relief of obstructive symptoms. Thus, it can be considered an effective and safe salvage technique for post-operative DGE.

关键词： Self-expandable metal stent Delayed gastric emptying Gastrectomy Salvage technique Symptom improvement

Treatment strategies using adefovir dipivoxil for individuals with lamivudine-resistant chronic hepatitis B

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World Journal of Gastroenterology 2012年第47期18卷 6987-6995页

作者： tae Jung Yun Jin Yong Jung Chang Ha Kim Soon Ho Um Hyonggin An Yeon Seok Seo Jin Dong Kim Hyung Joon Yim Bora Keum Yong Sik Kim yoon tae jeen Hong Sik Lee Hoon Jai Chun Chang Duck Kim Ho Sang Ryu Department of Internal Medicine Korea University College of MedicineSeoul 136-705South Korea Department of Biostatistics Korea University College of MedicineSeoul 136-705South Korea

AIM:To investigate retrospectively the long-term efficacy of various treatment strategies using adefovir dipivoxil(adefovir) in patients with lamivudine-resistant chronic hepatitis ***:We included 154 consecutive patients in two treatment groups:the "add-on" group(n = 79),in which adefovir was added to ongoing lamivudine treatment due to lamivudine resistance,and the "switch/combination" group(n = 75),in which lamivudine was first switched to adefovir and then re-added later as *** "switch/combination" group was then divided into two subgroups depending on whether participants followed(group A,n = 30) or violated(group B,n = 45) a proposed treatment strategy that determined whether to add lamivudine based on the serum hepatitis B virus(HBV) DNA levels(< 60 IU/mL or not) after 6 mo of treatment(roadmap concept).RESULTS:The cumulative probability of virologic response(HBV DNA < 60 IU/mL) was higher in group A than in the "add-on" group and in group B(P < 0.001).In contrast,the cumulative probability of virologic breakthrough was lower in the "add-on" group than in group B(P = 0.002).Furthermore,the risk of virologic breakthrough in the multivariate analysis was significantly lower in the "add-on" group than in group A(hazard ratio = 0.096;95%CI,0.015-0.629;P = 0.015).CONCLUSION:The selective combination of adefovir with lamivudine based upon early treatment responses increased the odds of virologic breakthrough relative to the use of uniform combination therapy from the beginning of treatment.

关键词： Chronic hepatitis B Lamivudine-resistant Adefovir Combination therapy Roadmap concept

Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein improves diagnostic accuracy for hepatocellular carcinoma

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World Journal of Gastroenterology 2021年第28期27卷 4687-4696页

作者： Han Ah Lee Yoo Ra Lee Young-Sun Lee Young Kul Jung Ji Hoon Kim Hyunggin An Hyung Joon Yim yoon tae jeen Jong Eun Yeon Kwan Soo Byun Yeon Seok Seo Department of Internal Medicine Korea University College of MedicineSeoul 02841South Korea Department of Biostatistics Korea University Anam HospitalSeoul 02841South Korea

BACKGROUND Diagnostic accuracy of various tumor markers and their combinations for hepatocellular carcinoma(HCC)was not fully *** To evaluate the diagnostic accuracy of alpha-fetoprotein(AFP),the Lens culinaris agglutinin-reactive fraction of AFP(AFP-L3),and protein induced by vitamin K absence or antagonist-II(PIVKA-II)and their combination for HCC *** Patients with newly detected liver mass or elevated serum AFP levels were considered *** AFP level,AFP-L3 fraction,and PIVKA-II level were measured at the first *** In total,622 patients were included;355 patients(57.1%)had chronic liver disease,and 208(33.4%)had liver *** was diagnosed in 160 patients(25.7%).The area under the receiver operating characteristics curves(AUROCs)of the serum AFP,AFP-L3 fraction,AFP-L3,and PIVKA-II levels for the diagnosis of HCC were 0.775,0.792,0.814,and 0.834,respectively.A novel diagnostic model was developed by classifying patients in a 1:1 ratio into training and validation *** the binary regression analysis of the training cohort,the AFP,AFP-L3 fraction,and PIVKA-II(ALPs)score was calculated as follows:ALPs score=3.8×[serum AFP level(ng/mL)×AFP-L3 fraction(%)×0.01]+0.2×PIVKA-II level(mAU/mL).The AUROC of the ALPs score for diagnosis of HCC was 0.878,significantly higher than that of serum AFP level(P<0.001),AFP-L3 fraction(P<0.001),PIVKA-II level(P=0.036),and AFP-L3 level(P=0.006).The optimal ALPs score cut-off was 5.3(sensitivity,85.0%,specificity 80.1%).The validation cohort showed similar *** The ALPs score calculated using serum AFP level,AFP-L3 fraction,and PIVKA-II level showed improved accuracy in HCC diagnosis.

关键词： Alpha-fetoprotein Lens culinaris agglutinin-reactive fraction of alphafetoprotein Protein induced by vitamin K absence or antagonist-II Hepatocellular carcinoma

Radiotherapy for 65 patients with advanced unresectable hepatocellular carcinoma

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World Journal of Gastroenterology 2008年第15期14卷 2394-2400页

作者： Yeon Seok Seo Jin Nam Kim Bora Keum Sanghoon Park Yong Dae Kwon Yong Sik Kim yoon tae jeen Hoon Jai Chun Chul Yong Kim Chang Duck Kim Ho Sang Ryu Soon Ho Um Department of Internal Medicine Korea University College of Medicine Seoul 136-705 Korea Department of Radiation Oncology Korea University College of Medicine Seoul 136-705 Korea

AIM: To evaluate the efficacy of radiotherapy (RT) in patients with advanced unresectable hepatocellular carcinoma (HCC). METHODS: A total of 65 patients were treated with RT in the Korea University Medical Center. The median age of the patients was 60 years, and 86.2% were men. 18.5% and 81.5% of the patients were diagnosed as TNM stage Ⅲ and Ⅳ-A, respectively. Treatment response was assessed 4 mo after initiation of RT. Tumor regression rate 1 mo after initiation of RT (TRR1m) was also assessed. Duration of survival was calculated from the initiation of RT. RESULTS: The objective treatment response was 56.9%. The 12 mo survival rate was 34.7%. Predictive factors for survival were Child-Pugh grade, α-fetoprotein level and treatment response. An objective response was achieved more frequently in patients with TRR1m ≥ 20% than in those with TRR1m < 20% (P < 0.001). CONCLUSION: RT is effective in treating advanced HCC with a tumor response rate of 56.9%.

关键词： Hepatocellular carcinoma Radiotherapy Treatment response Survival