Recent developments in endoscopic ultrasound-guided ablation treatment

Hoonsub So,Dongwook Oh,Dong-Wan Seo 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.4

Endoscopic ultrasound (EUS)-guided fine-needle aspiration was introduced in the early 1990s. EUS has evolved from a diagnostic modality to a therapeutic tool for patients with various pancreatic neoplasms. Recent advances in EUS-guided interventions include drainage and ablation. EUSguided treatment provides a minimally invasive option for patients with pancreatic neoplasms instead of surgery or the percutaneous approach. This review aimed to provide an overview of the current EUS-guided ablation treatments, such as ethanol ablation and radiofrequency ablation, for treating various pancreatic tumors.

LETTERS TO THE EDITOR : Author`s Reply

( Hoonsub So ),( Seungbong Han ),( Dong Hoon Yang ) 대한장연구학회 2015 Intestinal Research Vol.13 No.4

Patient Descriptions of Rectal Effluents May Help to Predict the Quality of Bowel Preparation With Photographic Examples

( Hoonsub So ),( Sun Jin Boo ),( Hyungil Seo ),( Ho Su Lee ),( Hyojeong Lee ),( Sang Hyoung Park ),( Kyung Jo Kim ),( Byong Duk Ye ),( Jeong Sik Byeon ),( Seung Jae Myung ),( Suk Kyun Yang ),( Jin Ho 대한장연구학회 2015 Intestinal Research Vol.13 No.2

Background/Aims: Previous studies have suggested a weak correlation between self-reported rectal effluent status and bowel preparation quality. We aim to evaluate whether photographic examples of rectal effluents could improve the correlation between patient descriptions of rectal effluents and bowel preparation quality. Methods: Before colonoscopy, patients were asked to describe the nature of their last three rectal effluents. Photographic examples of rectal effluents were provided as a reference for scoring. Bowel preparation was subsequently assessed by a single endoscopist using a global preparation assessment scale. Preparation outcomes were grouped into two levels (excellent to good vs. fair to inadequate). Both univariate and multivariate logistic regression models were used to find any association between bowel preparation quality and patient characteristics. Results: A total of 138 patients completed the questionnaires. The mean age was 56.5±10.4 years. The mean sum of the last three rectal effluent scores was 5.9±2.0. Higher rectal effluent scores (odds ratio [OR], 0.82; P=0.043) and the presence of diverticula (OR, 0.16; P<0.001) were risk factors for suboptimal preparation. Conclusions: Photographic example-guided patient descriptions of rectal effluents showed a statistically significant association with bowel preparation quality. However, clinical significance seemed to be low. The presence of diverticula was an independent predictive factor for suboptimal bowel preparation quality. (Intest Res 2015;13:153-159)

Gastric lesions in patients with Crohn`s disease in Korea: a multicenter study

( So Hoonsub ),( Byong Duk Ye ),( Young Soo Park ),( Jihun Kim ),( Joo Sung Kim ),( Won Moon ),( Kang-Moon Lee ),( You Sun Kim ),( Bora Keum ),( Seong-Eun Kim ),( Kyeong Ok Kim ),( Eun Soo Kim ),( Cha 대한장연구학회 2016 Intestinal Research Vol.14 No.1

Gastric pathology and Helicobacter pylori (H. pylori) infection among Asian patients with Crohn’s disease (CD) are still unclear. We evaluated gastric histologic features and frequency of H. pylori infection in Korean patients with CD. Methods: Among 492 patients with CD receiving upper gastrointestinal (GI) endoscopic evaluation in 19 Korean hospitals, we evaluated the endoscopic findings and gastric histopathologic features of 47 patients for our study. Histopathologic classification was performed using gastric biopsy tissues, and H. pylori infection was determined using the rapid urease test and histology. Results: There were 36 men (76.6%), and the median age of patients at the time of upper GI endoscopy was 23.8 years (range, 14.2.60.5). For CD phenotype, ileocolonic disease was observed in 38 patients (80.9%), and non-stricturing, nonpenetrating disease in 31 patients (66.0%). Twenty-eight patients (59.6%) complained of upper GI symptoms. Erosive gastritis was the most common gross gastric feature (66.0%). Histopathologically, H. pylori -negative chronic active gastritis (38.3%) was the most frequent finding. H. pylori testing was positive in 11 patients (23.4%), and gastric noncaseating granulomata were detected in 4 patients (8.5%). Gastric noncaseating granuloma showed a statistically significant association with perianal abscess/ fistula (P =0.0496). Conclusions: H. pylori -negative chronic active gastritis appears to be frequent among Korean patients with CD. The frequency of H. pylori infection was comparable with previous studies. An association with perianal complications suggests a prognostic value for gastric noncaseating granuloma in patients with CD. (Intest Res 2016;14:60-68)

Recent developments in endoscopic ultrasound-guided ablation treatment

Hoonsub So,Dongwook Oh,Dong-Wan Seo 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.4

Endoscopic ultrasound (EUS)-guided fine-needle aspiration was introduced in the early 1990s. EUS has evolved from a diagnostic modality to a therapeutic tool for patients with various pancreatic neoplasms. Recent advances in EUS-guided interventions include drainage and ablation. EUSguided treatment provides a minimally invasive option for patients with pancreatic neoplasms instead of surgery or the percutaneous approach. This review aimed to provide an overview of the current EUS-guided ablation treatments, such as ethanol ablation and radiofrequency ablation, for treating various pancreatic tumors.

급성 췌장염의 치료: 영양과 항생제

소훈섭 ( Hoonsub So ),이혜경 ( Hye Kyung Lee ),송태준 ( Tae Jun Song ) 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.3

급성 췌장염은 담석, 음주 등의 원인으로 발생하는 급성염증성 질환이다. 약 80%에서는 췌장에만 염증이 생기는 경증췌장염으로 그치나, 약 20%의 환자에서는 증증 괴사성 췌장염으로 발전하고, 보고에 따라 사망률이 43%에 이른다. 이에 따라 초기의 집중적인 치료는 매우 중요하다. 본고에서는 급성 췌장염의 치료 중 영양과 항생제의 사용에 대해 살펴보고자 하였다. 전통적으로 급성 췌장염은 금식으로 췌장을 쉬게 한다는 개념으로 한 치료가 강조되었고, 이와 함께 대량 수액 공급, 통증 조절, 영양 공급, 적절한 항생제 치료가 주로 이루어졌다. 그러나 최근 조기에 경장 영양을 시작하는 것이 입원 기간 단축, 다발성 장기 부전, 전신 감염, 수술적 치료필요성을 개선시키고 사망률을 개선시킨다는 것이 여러 연구들을 통해 입증되었다. 따라서 금기사항만 없다면 가급적 조기에 경장 영양을 시키는 것이 장려된다. 또한 무작위 대조군 연구들에 따르면 예방적 항생제가 감염을 예방하거나 사망률을 감소시키는 것에 도움이 되지 않고 오히려 항생제 내성을 유발하고 의료비 지출이 높아지므로 예방적 항생제 사용을 권장하지 않고 있다. 하지만 중증 급성 췌장염에서는 예방적 항생제를 쓰는 것에 대해 여전히 논란이 되고 있고 감염이 의심될 때에는 광범위 항생제를 조기에 쓰는 것이 필요하다. 결론적으로 급성 췌장염의 치료에 있어 전통적으로 행해 왔던 금식보다는 조기에 경장 영양을 시작하고 항생제는 적절히 사용하는 것이 중요하다. Acute pancreatitis is a sudden inflammatory disease that could be developed into a fatal condition. Traditional dogma was to rest the pancreas by fasting. However, evidence shows the benefits of early enteral feeding resulting in a shorter hospital stay, improved mortality, multi-organ failure, systemic infections, and the need for operative interventions. Clinicians should encourage enteral feeding as soon as possible even in severe acute pancreatitis if there are no contraindications. An immediate solid diet could be attempted. Regarding tube feeding, the nasojejunal tube did not show superiority to the nasogastric tube. Different formulas and probiotics need more investigation. Guidelines are against using prophylactic antibiotics, but Korean centers still report overuse of antibiotics. However, there is still a debate about using prophylactic antibiotics in severe acute pancreatitis. Broad-spectrum antibiotics should be initiated when an infection is suspected. In conclusion, enteral nutritional support and optimal use of antibiotics are the keys to the management of acute pancreatitis. Korean J Pancreas Biliary Tract 2021;26(3):176-180

성인에서 부비장 경색으로 인해 발생한 급성 복통 1예

왕호영 ( Hoyoung Wang ),소훈섭 ( Hoonsub So ),나양원 ( Yang Won Nah ),김미성 ( Misung Kim ),이태영 ( Tae Young Lee ),서민정 ( Minjung Seo ),방성조 ( Sung-Jo Bang ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.3

Accessory spleens are common congenital anatomic variations that are usually asymptomatic. On the other hand, they can be clinically significant if complicated by hemorrhage, torsion, or infarction. This paper describes a case of an infarcted accessory spleen in a 30-year-old male who presented with abdominal pain. Abdominal CT and MRI revealed an isolated mass, 4.5 cm in size, in the perisplenic area. An infarcted accessory spleen was suspected. The patient underwent laparoscopic accessory splenectomy. Histopathology identified the mass as splenic tissue that had undergone ischemic necrosis. A definitive diagnosis of an infarcted accessory spleen was made, and the patient was discharged on day 5 after surgery symptom-free. (Korean J Gastroenterol 2021;78:183-187)

간절제술 시행 후 발생한 담관-대장 누공을 대장내시경을 통하여 봉합 치료한 1예

노수민 ( Soo Min Noh ),소훈섭 ( Hoonsub So ),신승환 ( Seung Whan Shin ),양동훈 ( Dong-hoon Yang ),박도현 ( Do Hyun Park ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.1

간절제술 후 담관-대장 누공은 매우 드물게 나타나는 합병증으로 알려져 있다. 저자들은 73세 여성에서 간절제술을 시행한 후 발생한 담즙종에 대하여 반복적인 담도 배액술 치료 중 내시경적 역행성 췌담도 조영술을 통하여 우연히 담관-대장 누공을 발견하였고, 이를 내시경적으로 대장 클립 거치를 통하여 치료에 성공하였던 1예를 경험하였기에 문헌고찰과 함께 보고하고자 한다. Biliary-colonic fistula is a rare complication after hepatic resection. We present at a case of asymptomatic biliary-colonic fistula that developed 6 months after hepatectomy in a 73-year old female patient. She had been undergoing endoscopic treatment for a postoperative bile leakage, and the fistula was found by follow-up endoscopic retrograde cholangiopancreatography (ERCP). The fistula was formed between the right posterior segmental duct and the colon, and it was closed by colonoscopic clipping under fluoroscopic guidance. There was no recurrence at the 6-week follow-up ERCP. Korean J Pancreas Biliary Tract 2018;23(1):36-40

Development, validation, and application of a novel tool to measure disease-related knowledge in patients with inflammatory bowel disease

( Hyuk Yoon ),( Suk-kyun Yang ),( Hoonsub So ),( Ko Eun Lee ),( Sang Hyoung Park ),( Sung-ae Jung ),( Joong Haeng Choh ),( Cheol Min Shin ),( Young Soo Park ),( Nayoung Kim ),( Dong Ho Lee ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.1

Background/Aims: The Crohn’s and Colitis Knowledge (CCKNOW) score does not reflect updated knowledge relating to inflammatory bowel disease (IBD). The aim of this study was to develop, validate, and apply a novel tool to measure disease-related knowledge in IBD patients. Methods: A questionnaire composed of 24 items regarding knowledge of IBD was developed: Inflammatory Bowel Disease Knowledge (IBD-KNOW). Discriminate ability of IBD-KNOW was validated in three occupational groups (14 doctors, 20 nurses, and 19 clerks). The CCKNOW and IBD-KNOW were administered to IBD patients. Factors affecting the level of IBD-related knowledge were analyzed. Results: The median Inflammatory Bowel Disease Knowledge (IBD-KNOW) score was significantly different among the three groups for validation (22 doctors, 20 nurses, and five clerks; p < 0.001). The IBD-KNOW showed excellent internal consistency (Cronbach α = 0.952) and high correlation with CCKNOW (Spearman ρ = 0.827, p = 0.01). A total of 200 IBD patients (120 Crohn’s disease, 80 ulcerative colitis) completed questionnaires. Multivariate analysis showed that a higher IBD-KNOW score than the median was associated with hospitalization history (odds ratio [OR], 2.625; p = 0.003), high education level (OR, 2.498; p = 0.012), and information acquired from patient organization (OR, 3.305, p = 0.035). Conclusions: The IBD-KNOW demonstrated excellent test characteristics. Hospitalization history, education level, and information acquired from patient organization play an important role in correct IBD-related knowledge.

급성 췌장염으로 내원한 간세포양 암종 1예

신승환 ( Seung Whan Shin ),성유나 ( You Na Sung ),소훈섭 ( Hoonsub So ),송의연 ( Eyun Song ),오충렬 ( Chung Ryul Oh ),홍승모 ( Seung-mo Hong ),박도현 ( Do Hyun Park ) 대한내과학회 2018 대한내과학회지 Vol.93 No.4

췌장의 간세포양 암종은 전세계적으로 매우 드문 암종으로, 기존의 원발성 췌장암, 간세포암종의 췌장 전이와의 감별을 위해서 임상적, 영상학적, 병리학적 소견을 모두 검토하여 신중한 진단이 필요하다. 현재까지 확립된 치료 방법은 없는 상태로, 수술적 절제가 항암치료보다 우수한 경과를 보여 수술이 가능할 경우 수술적 치료가 필요하다. 수술이 불가능한 종양에 대한 치료법은 향후 추가적인 연구를 통하여 찾아야 하는 노력이 필요하다. Hepatoid carcinoma is extrahepatic neoplasm showing similar morphologic, immunohistochemical features with hepatocellular carcinoma. It’s a very rare disease and has been reported most frequently in the stomach. Herein, we report a case of hepatoid carcinoma of pancreas presented with acute pancreatitis. The hepatoid carcinoma was diagnosed by his needle biopsy specimen and it showed pleomorphic nuclei and predominantly eosinophilic and occasionally clear cytoplasm in hematoxylin and eosin staining, and positive for HepPar-1 and cytokeratin 19 in immunohistochemical staining. Surgical treatment seems to be the best choice, if possible. However, there is no standard regimen for palliative chemotherapy. In our case, the patient was treated with 5-Fluorouracil (5-FU), folinic acid, irinotecan, oxaliplatin (FOLFIRINOX). The response was stable disease up to 4 month of follow up. (Korean J Med 2018;93:387-392)