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김재환 ( Jaihwan Kim ),박은택 ( Eun Taek Park ),손병관 ( Byoung Kwan Son ),최은광 ( Eun Kwang Choi ),김국현 ( Kook Hyun Kim ),김효정 ( Hyo Jung Kim ),박상욱 ( Sang Wook Park ),송태준 ( Tae Jun Song ),안동원 ( Dong-won Ahn ),윤재훈 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.1
내시경역행담췌관조영술(ERCP)은 췌담도계 질환의 진단 및 치료에 필수적인 내시경 술기이다. 비록 자기 공명 담췌관 조영술이나 초음파 내시경과 같은 비침습적인 검사들로 인해 서 ERCP의 진단적인 역할은 감소하고 있으나 여전히 ERCP 는 췌담도계 질환의 치료에서 매우 중요하다. 그러나 한국에 서는 시술이 많은 일부 병원으로의 ERCP 집중, 시술 후 합병증의 높은 위험 그리고 긴 수련과정과 같은 이유로 전임의들 이 ERCP를 배우고자 하는데 주저함이 있다. 이와 같은 배경 에서 대한췌담도학회 교육위원회는 한국에서 수련받고 있는 전임의들을 위해 ERCP 교육 가이드라인을 준비해왔다. 대한 췌담도학회 교육위원회는 가이드라인이 현재 수련 중인 전임 의들에게 도움이 될 것을 기대한다. Endoscopic Retrograde Cholangiopancreatography (ERCP) is an essential endoscopic technique in diagnosis and treatment of pancreatobiliary diseases. Although its diagnostic role is decreasing because of less invasive modalities such as magnetic resonance cholangiopancreatography or endoscopic ultrasound, it is still very important in treatment of pancreatobiliary diseases. However, there is a trend of hesitation to learn ERCP by the fellows in Korea because of following reasons; concentration of ERCP in a few high volume centers, high risk of post-procedural complications, and long training courses. In this background, the education committee of Korean Pancreatobiliary Association has prepared for ERCP educational guidelines for fellows in Korea. This guideline should be helpful to fellows who are currently under the training.
S-16 ERCP in EST-naive Patients with Advanced Liver Cirrhosis
( Joo Seong Kim ),( Jong-chan Lee ),( Hyoung Woo Kim ),( Jongchan Lee ),( Eun Sun Jang ),( Jin-hyeok Hwang ),( Jin-wook Kim ),( Sook-hyang Jeong ),( Jaihwan Kim ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Background: Although endoscopic retrograde cholangiopancreatography (ERCP) is not contraindicated in patients with decompensated liver cirrhosis, coagulopathy is a practically common obstacle. This study aims to assess the results of ERCP in endoscopic sphincterotmy (EST)-naive patients with decompensated cirrhosis. Methods: In a single tertiary teaching hospital, total 146 EST-naive patients with cirrhosis who had undergone ERCP were identified between 2005 and 2016. Decompensated and compensated liver cirrhosis were defined as Child-Turcotte-Pugh classification (CTP) C and CTP A or B. Results: There were 125 compensated, 21 decompensated liver cirrhosis patients. Male were 106 (72.6%) and median age was 64.6 years. Indications of ERCP were common bile duct stone (50.7%), malignant biliary obstruction (26.0%), and others (23.3%). Among baseline characteristics, mean prothrombin time (1.2 and 1.5 international normalized ratio, p<0.001) and amount of transfusion of fresh frozen plasma (13.6% and 42.9%, p=0.001) were significantly different between 2 groups. Compared with clinical success rate of patients with compensated cirrhosis (92.8%), that of patients with decompensated cirrhosis (71.4%) was significantly lower (p=0.003). However, there were no significant differences in cannulation (97.6% and 90.5%, p=0.097) and technical success rates (93.6% and 90.5%, p=0.600) between compensated and decompensated cirrhosis. About 6 cases with clinical failures, there were 4 patients with compensated cirrhosis and 2 patients with decompensated cirrhosis. Causes of clinical failure were 5 patients with persistent jaundice and 1 patient with persistent cholangitis. There were no significant differences in complication rate (25.6% and 42.9%, p=0.103) and median post-ERCP hospital days (8 days and 9 days, p=0.231) between compensated and decompensated cirrhosis. Conclusions: Although there were no difference of cannulation success rate, technical success rate, and complication rate, there was a significant difference of clinical success rate between patients with decompensated and compensated liver cirrhosis. More attention is needed in patients with decompensated cirrhosis after ERCP.
MicroRNA 141 Expression Is a Potential Prognostic Marker of Biliary Tract Cancers
( Jaihwan Kim ),( Ji Kon Ryu ),( Sang Hyub Lee ),( Yong-tae Kim ) 대한간학회 2016 Gut and Liver Vol.10 No.5
Background/Aims: In recent years, a large number of microribonucleic acids (miRNAs) have been identified as putative prognostic biomarkers for solid cancers because of their role in controlling the expression of oncogenes and tumor suppressor genes. The aim of this study was to verify the utility of miRNA 141 as a prognostic biomarker of biliary tract cancers. Methods: From June 2010 to June 2012, common bile duct cancer tissue samples and matched noncancerous tissues from the ampulla of Vater were obtained from patients with biliary tract cancer undergoing endoscopic retrograde cholangiopancreatography. Using quantitative real-time polymerase chain reaction assays, we measured the mean relative expression levels of miRNA 141 in both groups of tissues. Overexpression of miRNA 141 was defined as a greater than 2-fold increase in expression levels as determined by the 2<sup>-ΔΔCt</sup> method. Results: In a cohort of 38 patients with biliary tract cancers (seven gallbladder, 13 hilar, and 18 distal bile duct cancers), 26 patients (68.4%) were male, and the median age was 69.5 (52 to 85) years. Nineteen patients (50%) had undergone R0 resection procedures, including three Whipple operations, seven pylorus-preserving pancreaticoduodenectomies, six bile duct resections, and three extended lobectomies. Among the patients who had undergone R0 resection, the overexpression of miRNA 141 was significantly associated with shorter disease-free survival and a greater risk of angiolymphatic invasion. Among the patients who did not undergo R0 resection, miRNA 141 overexpression was significantly associated with reduced overall survival. Conclusions: Overexpression of miRNA 141 is an indicator of a poor prognosis in patients with biliary tract cancer, suggesting that miRNA 141 may be a valuable prognostic biomarker of this disease. (Gut Liver 2016;10:836-841)
김재환 ( Jaihwan Kim ) 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.3
많은 사람들이 복지 및 건강에 대한 관심이 증가하면서 한국에서 건강검진은 점점 더 많이 행해지고 있다. 하지만 건강검진의 유용성에 대해서는 논란이 있다. 종양 표지자는 건강 검진에서 흔히 행해지게 되는데 그 결과 많은 환자들이 우연히 발견된 종양 표지자의 상승으로 병원을 방문하게 된다. CA 19-9는 췌장암에서 예후를 예측하고 치료 과정을 추적하는데 유용한 종양 표지자지만 췌장암의 낮은 발생률로 인해 췌장암의 선별 검사로서는 유용성이 떨어진다. Health care screening is becoming more popular in Korea as more people are interested in well-being and health. However, there are controversies regarding usefulness of screening. Tumor markers are frequently measured in the health care screening. As a result, many patients end up visiting physicians because of incidentally found increased levels of tumor markers. Carbohydrate antigen (CA) 19-9 is the single most useful tumor marker for pancreatic cancer. Although CA 19-9 is useful for predicting prognosis and evaluating treatment response for pancreatic cancer, CA 19-9 is less useful for screening of pancreatic cancer because of low incidence of pancreatic cancer.
제왕절개 출산 후 발생한 특발성 중증 급성 췌장염 1예
김정 ( Jung Kim ),최진호 ( Jin Ho Choi ),신방섭 ( Bang Sup Shin ),남준열 ( Joon Yeul Nam ),강은애 ( Eun Ae Kang ),김주성 ( Joo Seong Kim ),황진혁 ( Jin Hyeok Hwang ),김재환 ( Jaihwan Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.3
Acute pancreatitis rarely occurs in the postpartum period. Furthermore, there are very few reports of it after cesarean section delivery. A 35-year-old woman presented with dyspnea and abdominal distension on the third day after cesarean section delivery. Under a suspicion of acute pancreatitis, she was initially managed with conservative treatment. However, she developed intra-abdominal fluid collections and gastric bleeding, which were managed with percutaneous drainage, endoscopic hemostasis, and angiographic embolization. She was discharged with good clinical recovery. Postpartum pancreatitis, especially after cesarean section, is rare; however, its management is not different from that for usual pancreatitis. (Korean J Gastroenterol 2016;68:161-165)
( Gi Hyun Kim ),( Jung Wha Chung ),( Jong Ho Lee ),( Kyeong Sam Ok ),( Eun Sun Jang ),( Jaihwan Kim ),( Cheol Min Shin ),( Young Soo Park ),( Jin Hyeok Hwang ),( Sook Hyang Jeong ),( Nayoung Kim ),( D 대한간학회 2015 Clinical and Molecular Hepatology(대한간학회지) Vol.21 No.4
Background/Aims: Vitamin E improves the biochemical profiles and liver histology in nonalcoholic steatohepatitis, but the role of vitamin E is not clearly defined in the management of nonalcoholic fatty liver disease (NAFLD) which includes both simple steatosis and steatohepatitis. Co-morbid metabolic syndrome increases the probability of steatohepatitis in NAFLD. In this study, we aimed to determine the short-term effects of vitamin E and off-treatment durability of response in a propensity-score matched cohort of NAFLD patients with metabolic syndrome. Methods: A retrospective cohort was constructed by retrieving 526 consecutive NAFLD patients from the electronic medical record data warehouse of a tertiary referral hospital in South Korea. Among them, 335 patients (63.7%) had metabolic syndrome and were eligible for vitamin E therapy. In order to assess the effect of vitamin E, propensity score matching was used by matching covariates between control patients (n=250) and patients who received vitamin E (n=85). Results: The PS-matched vitamin E group (n=58) and control group (n=58) exhibited similar baseline metabolic profiles. After 6 months of vitamin E therapy, the mean ALT levels decreased significantly compared to PS-matched control (P<0.01). The changes in metabolic profiles (body weight, lipid and glucose levels) did not differ between control and vitamin E groups during the study period. Conclusions: Short-term vitamin E treatment significantly reduces ALT levels in NAFLD patients with metabolic syndrome, but metabolic profiles are not affected by vitamin E. (Clin Mol Hepatol 2015;21:379-386)