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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

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

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

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

Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth Ⅱ gastrectomy

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World Journal of Gastroenterology 2013年第48期19卷 9405-9409页

作者： Su Bum Park Hyung Wook Kim Dae Hwan Kang cheol woong choi Ki Tae Yoon Mong Cho Byeong Jun Song Department of Internal Medicine Pusan National University School of Medicine Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital Yangsan-si Gyeongsangnam-do 626-770South Korea

AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy ***:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is *** used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing *** technique was performed in nine patients between August 2010 and June *** as described above was *** sphincterotomy,successful stone removal,and complications were investigated ***:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine *** started towards the 4-5 o’clock direction and continued to the upper margin of the papillary *** stone removal in one session was achieved in all *** were no procedure related complications,such as bleeding,pancreatitis,or ***:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.

关键词： Billroth Ⅱ gastrectomy Endoscopic sphincterotomy Forward-viewing endoscopy Guide wire Triple lumen needle knife

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

Rectal tonsil:A case report and literature review

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World Journal of Gastroenterology 2015年第8期21卷 2563-2567页

作者： Joung Boom Hong Hyung Wook Kim Dae Hwan Kang cheol woong choi Su Bum Park Dong Jun Kim Byoung Hoon Ji Kyung Won Koh Department of Internal Medicine Pusan National University School of Medicine Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital

The rectal tonsil,a reactive proliferation of lymphoidtissue located in the rectum,is ***,benign lymphoid hyperplasia of the rectum is usuallycharacterized by large lymphoid follicles with activegerminal centers and a narrow surrounding mantlezone and marginal *** lesion is benign,but must be differentiated from the polypoid type of mucosaassociated lymphoid tissue *** the current paper,we present a case of rectal tonsil in a 59-yearold *** describe the endoscopic ultrasound imaging findings with literature review.

关键词： Rectum Tonsil Lymphoid hyperplasia Rectal tonsil L

Limited endoscopic sphincterotomy plus large balloon dilation for choledocholithiasis with periampullary diverticula

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World Journal of Gastroenterology 2010年第34期16卷 4335-4340页

作者： Hyung Wook Kim Dae Hwan Kang cheol woong choi Jong Hwan Park Jin Ho Lee Min Dae Kim Il Doo Kim Ki Tae Yoon Mong Cho Ung Bae Jeon Suk Kim Chang Won Kim Jun Woo Lee Department of Internal Medicine Pusan National University School of Medicine and Medical Research Institute Pusan National University Yangsan Hospital Department of Radiology Pusan National University School of Medicine and Medical Research Institute Pusan National University Hospital

AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047). CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.

关键词： Endoscopic sphincterotomy Large balloon dilation Choledocholithiasis Periampullary diverticula

Second-look endoscopy and factors associated with delayedbleeding after endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2016年第3期8卷 173-179页

作者： Su-Jin Kim cheol-woong choi Dae-Hwan Kang Hyung-Wook Kim Su-Bum Park Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsan 626-770South Korea

Endoscopic submucosal dissection(ESD) is a widely used procedure as curative treatment for superficial gastric neoplasms, including early gastric cancer without lymph node metastasis. However, ESD requires advanced endoscopic skill and there is a major concern regarding complications from bleeding. So far, extensive efforts have been made to develop strategies to reduce post-ESD bleeding. Use of proton pump inhibitors and coagulating exposed vessels on the ulcer floor after ESD are strategies known to reduce the risk of delayed bleeding. Second-look endoscopy(SLE) is also carried out to reduce delayed bleeding following ESD in many institutions. However, the incidence of bleeding still remains around 5%, and further measures are needed to reduce delayed bleeding after gastric ESD. Recently, three randomized studies indicated that routine SLE was unnecessary. Although routine SLE may not be recommended for all patients after gastric ESD, SLE might be an important tool for the prevention of the delayed bleeding in selected high-risk patients. Thus, the identification of the risk factors, such as large size of resected specimen and treatment with multiple antiplatelet medications, may help to further guide clinicians in deciding whether to perform SLE. Studies carried out on larger cohorts are necessary to clarify the efficacy of SLE after ESD in the prevention of post-ESD bleeding in potentially high-risk patients.

关键词： Endoscopic submucosal dissection Secondlookendoscopy Early gastric cancer