National Survey Regarding the Management of Difficult Bile Duct Stones in South Korea

Lee Yoon Suk,Jeon Tae Joo,Paik Woo Hyun,Ahn Dong-Won,Chung Kwang Hyun,Son Byoung Kwan,Song Tae Jun,Moon Sung-Hoon,Lee Eaum Seok,Lee Jae Min,Yoon Seung Bae,Paik Chang Nyol,Lee Yun Nah,Park Jin-Seok,Lee 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.3

Background/Aims: This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea. Methods: The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021. Results: The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the doubleguidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively. Conclusions: Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones.

Growth Differentiation Factor 15 Predicts Chronic Liver Disease Severity

( Eaum Seok Lee ),( Seok Hyun Kim ),( Hyun Jin Kim ),( Kyung Hee Kim ),( Byung Seok Lee ),( Bon Jeong Ku ) 대한간학회 2017 Gut and Liver Vol.11 No.2

Background/Aims: Growth differentiation factor 15 (GDF-15) belongs to the transforming growth factor-β superfamily. GDF-15 is emerging as a biomarker for several diseases. The aim of this study was to determine the clinical performances of GDF-15 for the prediction of liver fibrosis and severity in chronic liver disease. Methods: The serum GDF-15 levels were examined via enzyme immunoassay in 145 patients with chronic liver disease and 101 healthy individuals. The patients with chronic liver disease consisted of 54 patients with chronic hepatitis, 44 patients with compensated liver cirrhosis, and 47 patients with decompensated liver cirrhosis. Results: Of the patients with chronic liver diseases, the decompensated liver cirrhosis patients had an increased serum GDF-15 (3,483 ng/L) level compared with the patients with compensated liver cirrhosis (1,861 ng/L) and chronic hepatitis (1,232 ng/L). The overall diagnostic accuracies of GDF-15, as determined by the area under the receiver operating characteristic curves, were as follows: chronic hepatitis= 0.656 (>574 ng/L, sensitivity, 53.7%; specificity, 79.2%), compensated liver cirrhosis=0.886 (>760 ng/L, sensitivity, 75.6%; specificity, 92.1%), and decompensated liver cirrhosis= 0.984 (>869 ng/L, sensitivity, 97.9%; specificity, 94.1%). Conclusions: This investigation represents the first study to demonstrate the availability of GDF-15 in chronic liver disease. GDF-15 comprised a useful biomarker for the prediction of liver fibrosis and severity in chronic liver disease. (Gut Liver 2017;11:276-282)

Atypical onset of liver injury case occurred by bicalutamide

( Seok Won Kim ),( Sung Hoon Kang ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Byung Seok Lee ),( Heon Young Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Androgen deprivation therapy has been the mainstay of treatment for metastatic prostate cancer and used for neoadjuvant or adjuvant treatment. It can cause gynecomastia, fatigue, and decreased libido through competitive androgen receptor blockade. Although not as common, drug-induced liver injury is possible with bicalutamide therapy. Typically bicalutamide induced hepatotoxicity occurred in a few days. Butin this case, hepatic injury occurred after 3 month later. An 62-year-old South Korean male with prostate cancer presented with jaundice started few days ago. He was took bicalutamide 100mg orally every day for 19 weeks prior to presentation of jaundice. Blood test revealed deranged liver function. Other etiologies of hepatitis were ruled out. Modified RUCAM scale score was 8. Abdomen CT finding was non-specific. Results of liver biopsy were acute intrahepatic cholestasis in zone 3 and sinusoidal dilation with moderate lobular inflammation. These mean that liver injury occurred by androgen, estrogen or glucocorticoid. Bicalutamide was discontinued right away and patient was managed with supportive care. He showed improvement of clinical and laboratory abnormalities within few weeks. While rare, clinically significant and potentially life-threatening liver injury can result from use of bicalutamide. Prompt recognition and discontinuation of bicalutamide is necessary to avoid serious complications. And regular liver function test should be checked during bicalutamide treatment not only in a few days but also after 3 month later.

ZLITHAMACR

( Byung Seok Lee ),( Seok Hyun Kim ),( Eaum Seok Lee ),( Ju Seok Kim ),( Jong Seok Joo ),( Hae Jin Shin ),( Hyuk Soo Eun ),( Woo Sub Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: To alert all the people to recklessly consuming herb medicines. Herbs are widely used in oriental medicine to treat various symptoms in South Korea. But, very few toxic effects have been described. Zizania latifolia, known as Manchurian wildrice is a plant easily accessible in rural areas in South Korea. It is believed that Zizania latifolia has beneficial effects for immunity, detoxification function, diabetes mellitus, arthritis as a folk remedy. Medicinal herb-induced liver injury reported on the literature ranges from mild elevation of liver enzymes to fulminant liver failure and liver cirrhosis. However, the toxicity of Zizania latifolia has not yet been described in the literature. A 57-year old woman was admitted to our hospital with the presentation of nausea, jaundice, generalized weakness, proximal muscle weakness that started from 1 to 2 weeks after consuming boiled wild rice. Laboratory investigations, imaging study, muscle biopsy were performed. The overall history, clinical manifestations and results of laboratory findings, histological findings, imaging study all are indicative of the diagnosis of Zizania latifolia-induced toxic hepatitis and symmetrical myopathy. She revealed fairly elevated aspartate aminotransferase: 1266U/L, alanine aminotransferase: 630U/L, total bilirubin: 11.1mg/dL, alkaline phosphphatase: 218U/L, lactate dehydrogenase: 2674U/L, creatine kinase: >15000U/L levels at peak hours. The recovery of her symptoms and elevated laboratory findings to some degree took approximately 2 weeks. She got discharged after 2 weeks of hospitalization with remaining mild muscle weakness and laboratory results of aspartate aminotransferase: 136U/L, alanine aminotransferase: 22U/L, total bilirubin: 5.5mg/dL, alkaline phosphphatase: 188U/L, lactate dehydrogenase: 673U/L, creatine kinase: 107U/L. Her follow-up 10 days after discharge showed remaining mild muscle weakness and still elevated laboratory findings. She has still been followed up. Here we report a rare case of Zizania latifolia-induced toxic hepatitis and myopathy to alert all the people to recklessly consuming herb medicines.

HCV, Acute, LT : 5 Cases of Klebsiella Pneumoniae Liver Abscess Associated with Endogenous Endophthalmitis

( Jong Seok Ju ),( Dae Hyun Tak ),( Dae Hwa Park ),( Hae Jin Shin ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Heon Young Lee ),( Byung Seok Lee* ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: Endogenous endophthalmitis is a rare but potentially devastating disease with a prevalence of approximately 2.15% of all cases of endophthalmitis. We report 5 patients with Klebsiella pneumoniae liver abscess associated with endogenous ophthalmitis. Case: 4 of 5 patients was non-diabetic. All patient was treated initially with systemic and subconjunctival antibiotics, followed intravitreal antibiotics. Despite of aggressive treatment, liver abscess was resolved in all patients, but only 1 patient was improved ocular discomfort, 4 patients developed permanent loss of visual acuity and 1 of them who had diagnosed diabetes mellitus was received evisceration. Conclusions: 4 of 5 patients with K. pneumoniae liver abscess and endophthalmitis had extremely poor opthalmologic outcome. When the patient with klebsiella pneumoniae liver abscess complain ocular symptom, endogenous ophthalmitis shoud be considered as well as prompt full ophthalmologic examination and management shoud be performed.

Poster Session:PS 1117 ; Gastroenterology (Liver) : Treatment Effi cacy of Tenofovir in Korean Patients with Chronic Hepatitis B After Twelve Months of Treatment

( Jong Seok Ju ),( Sung Hoon Kang ),( Seok Won Kim ),( Hae Jin Shin ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Heon Young Lee ),( Byung Seok Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Tenofovir was licensed in 2008 for the treatment of HBV infections in Europe and the United States and has been available in Korea since 2012. It has shown potent antiviral effi cacy and safety against HBV infections. The aim of this study was to evaluate the biochemical response and virological response to tenofovir in HBV patients at six months after treatment with tenofovir. Methods: One hundred and twenty-two chronic hepatitis B patients who took tenofovir for at least twelve months were enrolled. We investigated virological response( VR) and biochemical response(BR) by retrospectively reviewing medical records. We measured ALT levels, HBeAg, anti-HBe, HBV DNA, serum creatinine and phosphorous at six and twelve months after treatment with tenofovir. Results: The BR rate at six and twelve months after treatment with tenofovir in naive patients were 75. 0% and 85. 4%, respectively. The VR rate at six and twelve months after treatment with tenofovir in naive patients were 27. 1% and 41. 7%, respectively. High VR rate at six and twelve months after treatment were associated with initial low HBV DNA titer and initial negative HBeAg status. In this study nephrotoxicity due to tenofovir was not reported. Conclusions: Tenofovir induced good biochemical and virological responses at six and twelve months after treatment in Korean patients with chronic hepatitis B.

Poster Session:PS 1121 ; Gastroenterology (Liver) : 5 Cases of Klebsiella Pneumoniae Liver Abscess Complicated with Endogenous Endophthalmitis

( Jong Seok Ju ),( Sung Hoon Kang ),( Seok Won Kim ),( Hae Jin Shin ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Heon Young Lee ),( Byung Seok Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Endogenous endophthalmitis is a rare but potentially devastating disease with a prevalence of approximately 2. 15% of all cases of endophthalmitis. We report 5 patients with Klebsiella pneumoniae liver abscess associated with endogenous ophthalmitis. Case: 4 of 5 patients was non-diabetic. All patient was treated initially with systemic and subconjunctival antibiotics, followed intravitreal antibiotics. Despite of aggressive treatment, liver abscess was resolved in all patients, but only 1 patient was improved ocular discomfort, 4 patients developed permanent loss of visual acuity and 1 of them who had diagnosed diabetes mellitus was received evisceration. Conclusions: 4 of 5 patients with K. pneumoniae liver abscess and endophthalmitis had extremely poor opthalmologic outcome. When the patient with klebsiella pneumoniae liver abscess complain ocular symptom, endogenous ophthalmitis shoud be considered as well as prompt full ophthalmologic examination and management shoud be performed.

Real-World Single Center Experience with Grazoprevir- Elbasvir for Chronic HCV Genotype 1b Infection

( Ju Ho Lee ),( Hee Sung Lee ),( Hwan Hee Park ),( Woo Sun Rou ),( Hyuk Soo Eun ),( Jong Seok Joo ),( Eaum Seok Lee ),( Byung Seok Lee ),( Seok Hyun Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Grazoprevir-elbasvir is direct-acting antiviral agents (DAA) with an FDA-approved indication for the treatment of chronic HCV genotype 1 and 4 in adults. Grazoprevir-elbasvir showed high efficacy for patients of chronic HCV infection and sustained virological response 12 weeks post treatment (SVR12) was observed in 95% of the randomized control trial. This study aimed to evaluate the clinical effects of grazoprevirelbasvir in the real world single center setting for the treatment of chronic HCV genotype 1b. Methods: The medical records of patients treated for HCV genotype 1b with grazoprevir-elbasvir in the Chungnam National University, Korea from June 2017 to april 2018 were reviewed retrospectively. We assessed the SVR12 and SVR24 of the treatment of grazoprevir-elbasvir. Results: A total of 25 patients with HCV genotype 1b were treated with grazoprevir-elbasvir for 12 weeks. All of them were HCV treatment naiive and 20% had cirrhosis. SVR12 rate were 92% (23/25) with 1 relapse and 1 null response. SVR24 rate were 66% (2/3) and 1 relapse case was observed with HCV N55A mutation (Y93H). Conclusions: In the real-world setting, grazoprevir-elbasvir had similar effects to HCV genotype 1b compared with the results of the randomized control trials. Since relapse case occurred in SVR24, it seems necessary to continue serial assessments after the treatment followed by at least until 24weeks even after achieving SVR12 rates.

Case Report : A case of concomitant Gilbert`s syndrome and hereditary spherocytosis

( Hee Jung Lee ),( Hee Seok Moon ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Jae Kyu Sung ),( Byung Seok Lee ),( Hyun Yong Jeong ),( Heon Young Lee ),( Young Jae Eu ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3

We describe moderate hyperbilirubinemia in a 28-year-old man who suffered from gallstones and splenomegaly, with combined disorders of hereditary spherocytosis (HS) and Gilbert`s syndrome (GS). Since it is difficult to diagnose HS in the absence of signs of anemia, we evaluated both the genetic mutation in the UGT1A1 gene and abnormalities in the erythrocyte membrane protein; the former was heterozygous for a UGT1A1 allele with three mutations and the latter was partially deficient in ankyrin expression. This is the first report of the concomitance of HS and GS with three heterozygous mutations [T-3279G, A (TA)7TAA, and G211A] in the UGT1A1 gene. (Korean J Hepatol 2010;16:321-324)

경피 내시경하 위루술 후 발생한 상장간막 동맥 손상 1예

이서희 ( Seo Hee Lee ),문희석 ( Hee Seok Moon ),박재호 ( Jae Ho Park ),김주석 ( Ju Seok Kim ),강선형 ( Sun Hyung Kang ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),성재규 ( Jae Kyu Sung ),이병석 ( Byung Seok Lee ),정현용 ( H 대한소화기학회 2018 대한소화기학회지 Vol.72 No.6

Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure. (Korean J Gastroenterol 2018;72:308-312)