전이성 췌장암 환자에서 Gemcitabine과 Nanoparticle Albumin Bound (nab)-Paclitaxel로 인한 허혈성 심독성 발생 1례

박세우,김미강,Se Woo Park,Mi Kang Kim 대한소화기암연구학회 2017 Journal of digestive cancer reports Vol.5 No.1

Pancreatic cancer is an aggressive disease and despite the efforts of the past few decades, the 5-year overall survival (OS) rate remains disappointing and does not exceed 10% in Korea. Especially, only 15-20% of patients are candidates for surgical resection because most patients are diagnosed with locally advanced or metastatic disease, and their only treatment approach is palliative chemotherapy. Since the first chemo-regimen of Gemcitabine and Nanoparticle albumin bound (nab) - paclitaxel was brought to clinical practice in 2013, the improvement in overall survival, progression-free survival, and response rate was achieved in patients with metastatic pancreatic adenocarcinoma. We report the case of a young patient with cardiogenic shock accompanied by multi-organ failure after 4^th cycle Gemcitabine and nab-paclitaxel chemotherapy with partial response.

원발 담관 간경변

박세우 ( Se Woo Park ),이항락 ( Hang Lak Lee ),최호순 ( Ho Soon Choi ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6

개량형 유두괄약근절개도와 외국산 유두괄약근절개도를 이용한 내시경괄약근절개술의 유용성 및 안전성 검증을 위한 공개, 무작위, 다기관, 전향적 비교 연구

박세우 ( Se Woo Park ),장성일 ( Sung Ill Jang ),정문재 ( Moon Jae Chung ),조재희 ( Jae Hee Cho ),방승민 ( Seungmin Bang ) 대한소화기학회 2022 대한소화기학회지 Vol.79 No.1

목적: 전적으로 수입에 의존한 기존 유두절개도의 단점을 보완한 새로운 국산 제품(Optimos™, Taewoong, Goyang, Korea)을 개발하여 기존 절개도와 조작성, 편리성 및 안전성을 비교 평가하였다. 대상 및 방법: 2021년 4월부터 2021년 7월까지 세 개 기관에서 췌관담관 질환의 진단 및 치료를 위해 내시경적 역행성 담췌관조영술(ERCP)을 시행한 환자를 대상으로 연구를 진행하였다. 총 104명의 환자를 전향적으로 모집하여 Optimos™ 및 CleverCut™ 절개도 각 군 당 52명의 환자를 무작위 배정하였다. 연구의 일차 목표는 ERCP 후 발생할 수 있는 모든 급성 합병증(출혈, 천공, 감염 및 췌장염)의 발생 빈도와 중증도의 절개도 간 차이이고, 이차 목표는 담관의 선택적 삽관 성공률과 용이성 비교 평가이다. 결과: CleverCut™군은 최종 51명, Optimos™군은 최종 53명이 연구에 포함되었다. BMI를 제외한 모든 인구학적 항목에서 두 군 간 유의한 차이는 보이지 않았다. 최종 선택적 삽관 성공률은 CleverCut™군 50예(98.0%) 및 Optimos™군에서 49명(92.5%)이었다. 평균 삽관 시도 횟수는 CleverCut™군 1.6±1.3, Optimos™군 2.4±2.7로 두 군 간 유의한 차이는 없었으며, 평균 삽관 시간도 CleverCut™군 2.5±2.3, Optimos™군 3.4±3.0분으로 두 군 간 차이는 없었다. 유두절개술 후 경미한 출혈은 각각 7예(14.3%)와 6예(11.8%) 발생하였다. 췌장염은 Optimos™군에서만 2예(3.8%) 발생하였으며 경증 1예, 중등도 1예였다. 전반적인 시술자 만족도와 기구 조작성은 CleverCut™군이 Optimos™군에 비하여 우월한 결과를 보여 주었다. 결론: 국내에서 개발 및 제조한 Optimos™ 절개도는 CleverCut™ 절개도와 비교하여 임상적으로 안전하면서 효율적으로 선택적 삽관 및 유두 절개를 시행할 수 있음을 확인하였다. 그러나 추가적인 개선을 통해 사용자 편의성을 높일 수 있는 추가적인 노력이 필요하다. Background/Aims: Sphincterotomes are essential for endoscopic sphincterotomy (EST) and can also be used for cannulation in ERCP. A domestic new pull-type sphincterotome (Optimos™, Taewoong, Goyang, Korea) provides acceptable technical feasibility and safety, but there are no comparison results. Thus, this study compared the clinical performance and safety of Optimos™ sphincterotome to a conventional sphincterotome (CleverCut3™, Olympus, Tokyo, Japan) in patients who underwent ERCP. Methods: From April 2021 to July 2021, a randomized prospective comparative study was conducted on 104 consecutive patients who underwent ERCP in three medical centers. The primary endpoint was the clinical performance and safety of sphincterotomes during ERCP. Results: One hundred and four patients were assigned randomly to the Optimos™ group (n=51) or CleverCut3™ group (n=53). All demographic characteristics did not differ between the groups except the BMI. The technical success rate for cannulation, performance of EST, and total procedure time were similar in the two groups. The adverse events did not differ, even though two cases of post-ERCP pancreatitis occurred in CleverCut3™. On the other hand, in questionnaire analysis, CleverCut™ showed a better user’s convenience (median [interquartile range] 4.0 [3.0-4.0] vs. 3.0 [3.0-4.0], p=0.013) and manipulability (median [interquartile range], 4.0 [3.0-4.0] vs. 3.0 [3.0-4.0], p=0.039) than Optimos™, even though the other profiles did not reveal any differences. Conclusions: New domestic pull-type sphincterotome can offer comparable clinical performance and safety profiles to conventional sphincterotome, but it needs refinements to increase the user’s convenience and manipulability. Further improvement and innovation will be required to advance domestic medical devices. (Korean J Gastroenterol 2022;79:22-30)

급성 충수돌기염 소견을 보인 충수돌기 결핵 1예

박세우 ( Se Woo Park ),이항락 ( Hang Lak Lee ),이오영 ( Oh Young Lee ),전용철 ( Yong Chul Jeon ),한동수 ( Dong Soo Han ),윤병철 ( Byung Chul Youn ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ) 대한소화기학회 2007 대한소화기학회지 Vol.50 No.6

Tuberculosis may affect primarily all organs and tissues of the body, although some of these show high immunity against the infection. The most common forms of non-pulmonary tuberculosis are tuberculosis of bones and joints (30%), urinary system (24%), lymph nodes (13%), sexual organs (8%), cerebrospinal meninges (4%), and alimentary system (3%). Especially, the commonest presentation of abdominal tuberculosis is ileocecal disease, but isolated appendicular involvement is also rarely seen, occuring in only 1.5% to 3% of cases in the absence of pulmonary or other abdominal involvement. The appendix may either be involoved secondary to ileocecal tuberculosis, or to tuberculosis at another site within the abdomen, or may occur in the even, rarer "isolated" form, without the evidence of disease elsewhere. We report a case of acute appendicitis underwent appendectomy and histopathologic examination of appendix revealed appendicular tuberculosis. (Korean J Gastroenterol 2007;50: 388-392)

타카야수 동맥염의 진단과 치료 과정에서 Positron-Emission Tomography의 역할

박세우 ( Se Woo Park ),이창화 ( Chang Hwa Lee ),김근호 ( Gheun Ho Kim ),정명호 ( Myung Ho Jeong ),박수역 ( Soo Yuck Park ),송순영 ( Soon Yeong Song ),최윤영 ( Yun Young Choi ),강종명 ( Chong Myung Kang ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1

Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause that results in occlusive obliteration and less commonly aneurysmal degeneration of large and medium-sized elastic arteries. The diagnosis of Takayasu arteritis and the assessment of its progression and extent remain challenging, especially in patients presenting with a constellation of non-specific symptoms and laboratory tests. The standard diagnostic procedures include biopsy, arteriography, sonography, and magnetic resonance angiography. However, these procedures are invasive or largely operator-dependent, and document only morphological changes such as stenosis, occlusion and aneurysmal transformation which mainly occur in late stages of the disease. On the other hand, Positron-emission tomography is an operator-independent, non-invasive metabolic imaging modality which plays a major role in diagnosis of nonspecific inflammatory diseases. We report a case in which Positron-emission tomography was applied to the detection of Takayasu arteritis and assessment of its disease progression.

췌장고형종양의 초음파 내시경 유도하 조직 검사 임상 진료지침: 대한소화기내시경학회

정문재 ( Moon Jae Chung ),박세우 ( Se Woo Park ),김성훈 ( Seong-hun Kim ),조창민 ( Chang Min Cho ),최준호 ( Jun-ho Choi ),최은광 ( Eun Kwang Choi ),이태훈 ( Tae Hoon Lee ),조은애 ( Eunae Cho ),이준규 ( Jun Kyu Lee ),송태준 ( Tae J 대한소화기학회 2021 대한소화기학회지 Vol.78 No.2

췌장고형종양의 초음파 내시경(endoscopic ultrasound, EUS) 유도하 조직 검사는 기술적 난이도가 높고 침습적이기 때문에 임상에서의 적절한 사용을 위해 엄격한 권고안을 필요로 한다. 이에 대한소화기내시경학회에서는 췌장고형종양의 초음파 내시경 유도하 조직 검사를 위한 임상진료지침을 개발하기 위해 진료지침 개발위원회를 발족하였다. 권고안의 등급과 개별 권고안의 근거 수준은 2014년 출판된 임상진료지침 개발을 위한 Minds Handbook에서 제시된 체계에 기반하여 평가하였다. 본 진료지침 개발위원회는 초음파 내시경 분야의 전문가 16인과 임상진료지침 개발방법론 전문가 1인으로 구성되었으며, 8개 분야에 걸쳐 총 12건의 근거 기반 권고안을 개발하여 췌장고형종양 진단 시 임상의들이 근거에 기반한 임상적 판단을 할 수 있도록 돕고자 하였다. 본 임상 진료지침은 췌장고형종양에서 초음파 내시경 유도하 조직 검사에 대해 다루고 있으며, 권고안에서는 해당 검사의 적응증, 진단 정확도를 최대화하기 위한 기술적 방법론(예: 바늘의 종류 및 직경의 적절한 선택, 충분한 바늘천자횟수, 조직 획득 기술적 방법론, 검체 처리 방법), 시술 관련 합병증, 그리고 숙련도와 교육에 관련된 문제들에 대해 다루고 있다. 본 진료지침은 외부 전문가의 검토를 거쳤으며, 원고 작성 시점까지 보고된 가능한 모든 최신 근거들에 기반하여 최선의 진료 방법을 권고하고 있다. 그러나 모든 임상 상황에 본 진료지침을 일괄적으로 적용할 수는 없으며, 기관의 법적/행정적 상황 및 환자의 개별 임상적 상황과 해당 자원의 가용성 등을 고려하여야 한다. 추후 내시경적 기술의 발전과 이로 인한 변화, 임상에서의 최신 근거를 토대로 본 진료지침이 개정될 수 있다. Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence- based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice. (Korean J Gastroenterol 2021;78:73-93)

췌장고형종양의 초음파 내시경 유도하 조직 검사 임상 진료지침: 대한소화기내시경학회

정문재 ( Moon Jae Chung ),박세우 ( Se Woo Park ),김성훈 ( Seong-Hun Kim ),조창민 ( Chang Min Cho ),최준호 ( Jun-ho Choi ),최은광 ( Eun Kwang Choi ),이태훈 ( Tae Hoon Lee ),조은애 ( Eunae Cho ),이준규 ( Jun Kyu Lee ),송태준 ( Tae J 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.3

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice. Korean J Pancreas Biliary Tract 2021;26(3):125-147

췌장고형종양의 초음파 내시경 유도하 조직 검사 임상 진료지침: 대한소화기내시경학회

정문재 ( Moon Jae Chung ),박세우 ( Se Woo Park ),김성훈 ( Seong-Hun Kim ),조창민 ( Chang Min Cho ),최준호 ( Jun-ho Choi ),최은광 ( Eun Kwang Choi ),이태훈 ( Tae Hoon Lee ),조은애 ( Eunae Cho ),이준규 ( Jun Kyu Lee ),송태준 ( Tae J 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.4

Hep3B 세포내 PPARγ/PGC-1α/HNF-4α 연쇄작용을 통한 Atorvastin의 FXR과 CYP1A1 활성화 유도

이진 ( Jin Lee ),홍은미 ( Eun Mi Hong ),정장한 ( Jang Han Jung ),박세우 ( Se Woo Park ),이상표 ( Sang Pyo Lee ),고동희 ( Dong Hee Koh ),장현주 ( Hyun Joo Jang ),계세협 ( Sea Hyub Kae ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.3

Background/Aims: PPARγ, farnesoid X receptor (FXR) and CYP7A1 are associated with solubility of bile. This study was performed to understand a mechanism and interactions of statin-induced PPARγ, PGC-1α and HNF-4α related to the statin-induced activation of FXR and CYP7A1, and verify whether the mevalonate pathway is involved in the mechanism. Methods: MTT assays were performed using cultured human Hep3B cells to determine the effect of atorvastatin on the cell proliferation. Expression levels of indicated proteins were measured using Western blotting assays by inhibiting the protein expression or not. Results: Atorvastatin increased expression of PPARγ, PGC-1α, HNF-4α, FXR, and CYP7A1 in Hep3B cells. PPARγ ligand of troglitazone upregulated the expression of PGC-1α, HNF-4α, FXR, and CYP7A1 in Hep3B cells. Silencing of PPARγ, PGC1α, and HNF4α using respective siRNA demonstrated that atorvastatin-induced FXR and CYP7A1 activation required sequential action of PPARγ/PGC-1α/HNF-4α. The silencing of PPARγ completely inhibited atorvastatin-induced PGC-1α expression, and the PGC1α silencing partially inhibited atorvastatin-induced PPARγ expression. The inhibition of HNF4α did not affect atorvastatin-induced PPARγ expression, but partially inhibited atorvastatin-induced PGC-1α expression. Besides, mevalonate completely reversed the effect of atorvastatin on PPARγ, PGC-1α, HNF-4α, FXR, and CYP7A1. Conclusions: Atorvastatin induces FXR and CYP7A1 activation as a result of sequential action of PPARγ/PGC-1α/HNF-4α in human hepatocytes. We propose that atorvastatin enhances solubility of cholesterol in bile by simultaneously activating of FXR and CYP7A1. (Korean J Gastroenterol 2021;77:123-131)

복부 종괴로 발현된 다발성 침윤 장 자궁내막증 1예

조현석 ( Hyun Seok Cho ),한동수 ( Dong Soo Han ),박세우 ( Se Woo Park ),변태준 ( Tae Jun Byun ),김태엽 ( Tae Yeob Kim ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),손주현 ( Joo Hyun Sohn ) 대한장연구학회 2007 Intestinal Research Vol.5 No.1

Endometriosis is one of the most common benign gynecologic conditions in women of childbearing age. Endometriosis involving the gastrointestinal tract occurs in 5.3-12% of women and the most commonly affected site is the rectum and the sigmoid colon. The reports of intestinal endometriosis in Korea are too few to obtain a rate of occurence, and in these cases, the depth of invasion was limited to the serosa, resulting in no significant symptoms or signs. Intestinal endometriosis can show up as a mass suggestive of malignant neoplasm on imaging studies, which can result in serious errors in diagnosis and treatment. In Korean studies, the masses were solitary, and there was no reported case of multiple endometriosis in the sigmoid colon, ascending and descending colon. We report a case of multiple deep infiltrating intestinal endometriosis presenting as an abdominal mass. (Intest Res 2007; 5:87-91