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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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Fucoidan protects hepatocytes from apoptosis and inhibits invasion of hepatocellular carcinoma by up-regulating p42/44 MAPK-dependent NDRG-1/CAP43

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Acta Pharmaceutica Sinica B 2015年第6期5卷 544-553页

作者： Yuri Cho Jung-Hwan Yoon Jeong-ju Yoo Minjong Lee Dong Hyeon Lee Eun Ju Cho Jeong-Hoon Lee Su Jong Yu Yoon Jun Kim Chung Yong Kim Department of internal medicine and liver research institute Seoul National University College of Medicine

Fucoidan is a traditional Chinese medicine suggested to possess anti-tumor *** this study the anti-metastatic effects of fucoidan were investigated in vitro in human hepatocellular carcinoma(HCC) cells(Huh-7 and SNU-761) under normoxic and hypoxic conditions and in vivo using a distant liver metastasis model involving injection of MH134 cells into spleen via the portal *** ability to protect hepatocytes against bile acid(BA)-induced apoptosis was investigated in primary *** was found to suppress the invasion of HCC cells through up-regulation of p42/44 MAPKdependent NDRG-1/CAP43 and partly,under normoxic conditions,through up-regulation of p42/44MAPK-dependent VMP-1 *** also significantly decreased liver metastasis in *** regards its hepatoprotective effect,fucoidan decreased BA-induced hepatocyte apoptosis as shown by the attenuation of caspase-8,and-7 cleavages and suppression of the mobilization of caspase-8 and Fas associated death domain(FADD) into the death-inducing signaling *** summary,fucoidandisplays inhibitory effects on proliferation of HCC cells and protective effects on *** results suggest fucoidan is a potent suppressor of tumor invasion with hepatoprotective effects.

关键词： Fucoidan Hepatocellular carcinoma Invasion Hypoxia Hepatoprotective Cultured hepatocyte NDRG-1/CAP43 VMP-1

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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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New approaches to gastric cancer staging:Beyond endoscopic ultrasound,computed tomography and positron emission tomography

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World Journal of Gastroenterology 2014年第38期20卷 13783-13790页

作者： Hyuk Yoon Dong Ho Lee Department of internal medicine Seoul National University Bundang Hospital Department of internal medicine and liver research institute Seoul National University College of Medicine

Currently, there is no single gold standard modality for staging of gastric cancer and several methods have been used complementarily in the each clinical situation. To make up for the shortcomings of conventional modalities such as endoscopic ultrasound, computed tomography and 18F-fluoro-2-deoxyglucose positron emission tomography, numerous attempts with new approaches have been made for gastric cancer staging. For T staging, magnifying endoscopy with narrow-band was evaluated to differentiate mucosal cancer from submucosal cancer. Single/double contrast-enhanced ultrasound and diffusion-weighted magnetic resonance imaging were also tried to improve diagnostic accuracy of gastric cancer. For intraoperative staging with sentinel node mapping, indocyanine green infrared and fluorescence imaging was introduced. In addition, to detect micrometastasis, real-time reverse transcription-polymerase chain reaction system with multiple markers was studied. Staging laparoscopy using 5-aminolevulinic acid-mediated photodynamic diagnosis and percutaneous diagnostic peritoneal lavage were also evaluated. However, most studies reporting new staging methods is preliminary and further studies for validation in clinical practice are needed. In this mini-review, we discuss new progress in gastric cancer staging. Especially, we focus on new diagnostic approach to gastric cancer staging beyond the conventional modalities and briefly review the remarkable clinical results of the studies published over the past three years.

关键词： Gastric cancer Neoplasm staging Diagnostic accuracy New methods New approaches

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Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives

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World Journal of Gastroenterology 2013年第12期19卷 1890-1900页

作者： Beom Kyung Kim James Fung Man-Fung Yuen Seung Up Kim Department of internal medicine Institute of Gastroenterology Yonsei University College of Medicine liver Cirrhosis Clinical research Center Department of medicine State Key Laboratory for Liver Research the University of Hong Kong

Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the "gold standard" for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/ inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE),as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.

关键词： liver stiffness Transient elastography Fibroscan Fibrosis Longitudinal Outcome

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Is endoscopic ultrasonography still the modality of choice in preoperative staging of gastric cancer?

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World Journal of Gastroenterology 2014年第38期20卷 13775-13782页

作者： Sung Wook Hwang Dong Ho Lee Department of internal medicine and liver research institute Seoul National University College of Medicine Department of internal medicine Seoul National University Bundang HospitalSeongnam

The treatment option for gastric cancer is usually based on preoperative staging by imaging modalities. Endoscopic ultrasonography (EUS) and computed tomography (CT) have been used as the diagnostic modality of choice in preoperative staging of gastric cancer. Magnetic resonance imaging (MRI) has been employed in several studies, and (18F) 2-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) has emerged as a new promising imaging modality. The purpose of this article is to provide summarized information on preoperative staging using EUS, multi-detector row CT (MDCT), MRI and PET for gastric cancer. In T staging, both EUS and MDCT show high accuracy. MRI seemed to have better performance, but the number of MRI studies is limited. FDG-PET is not able to properly evaluate the depth of invasion. In N staging, the diagnostic accuracy of EUS, MDCT and MRI is not sufficient. In preoperative M staging, MDCT and FDG-PET showed similar diagnostic accuracies. FDG-PET/CT fusion could be expected to show better performance in the future. Physicians should keep in mind that each diagnostic modality has advantages and limitations and choose an appropriate diagnostic strategy tailored for each patient.

关键词： Gastric cancer Endoscopic ultrasonography Computed tomography Magnetic resonance imaging Positron emission tomography

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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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Hepatitis B viral load affects prognosis of hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第34期20卷 12039-12044页

作者： Su Jong Yu Yoon Jun Kim Department of internal medicine and liver research institute Seoul National University College of MedicineSeoul 110-744South Korea

Hepatocellular carcinoma(HCC)is a complex disease that is dually challenging to treat due to underlying chronic liver disease in addition to the cancer *** prognosis of patients with HCC is determined by intrahepatic tumor status and reserved hepatic *** B virus(HBV)is an established major risk factor of HCC development,and HBV viral load is being increasingly recognized as a prognostic factor in the presence of established *** HBV viral load may affect the prognosis of HBV-related HCC patients in several ***,it is associated with more frequent recurrence of HBV-related HCC after ***,it is associated with more occurrence and severity of potentially life-threatening HBV ***,it is associated with more worsened liver function,which limits the therapeutic options for HBV-related ***,directly or indirectly,can induce *** patients with a high HBV DNA level and subsequent active hepatitis,adhesion molecules expressed on the sinusoidal cells are up-regulated and may increase intrahepatic *** progression after treatment can lead to a poor prognosis by reducing number of normal functioning ***,high HBV viral load can affect the prognosis of patientswith HCC by frequent recurrence after treatment for HCC and deterioration of hepatic function associated with HCC *** meta-analysis showed that antiviral treatment reduces HCC recurrence and liver-related mortality after curative therapy of *** the strong relationship between high HBV DNA load and poor survival outcome of HCC patients due to cancer progression,it is expected that long-term antiviral therapy results in the sustained HBV suppression,control of inflammation,reduction in HCC progression,and eventually in improved overall survival.

关键词： Hepatitis B virus DNA Hepatocellular carcinoma Progression Prognosis

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Effective treatment strategies other than sorafenib for the patients with advanced hepatocellular carcinoma invading portal vein

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World Journal of Hepatology 2015年第11期7卷 1553-1561页

作者： Su Jong Yu Yoon Jun Kim Department of internal medicine and liver research institute Seoul National University College of Medicine

Patients with hepatocellular carcinoma(HCC) accompanying portal vein tumor thrombosis(PVTT) have relatively few therapeutic options and an extremely poor prognosis. These patients are classified into barcelonaclinic liver cancer stage C and sorafenib is suggested as the standard therapy of care. However, overall survival(OS) gain from sorafenib is unsatisfactory and better treatment modalities are urgently required. Therefore, we critically appraised recent data for the various treatment strategies for patients with HCC accompanying PVTT. In suitable patients, even surgical resection can be considered a potentially curative strategy. Transarterial chemoembolization(TACE) can be performed effectively and safely in a carefully chosen population of patients with reserved liver function and sufficient collateral blood flow nearby the blocked portal vein. A recent metaanalysis demonstrated that TACE achieved a substantial improvement of OS in HCC patients accompanying PVTT compared with best supportive care. In addition, transarterial radioembolization(TARE) using yttrium-90 microspheres achieves quality-of-life advantages and is as effective as TACE. A large proportion of HCC patients accompanying PVTT are considered to be proper for TARE. Moreover, TACE or TARE achieved comparable outcomes to sorafenib in recent studies and it was also reported that the combination of radiotherapy with TACE achieved a survival gain compared to sorafenib in HCC patients accompanying PVTT. Surgical resectionbased multimodal treatments, transarterial approaches including TACE and TARE, and TACE-based appropriate combination strategies may improve OS of HCC patients accompanying PVTT.

关键词： Sorafenib Hepatocellular carcinoma Portalvein Thrombosis

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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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