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Hong Jun Park,Byung-Wook Kim,Jun Kyu Lee,Yehyun Park,Jin Myung Park,Jun Yong Bae,Seung Young Seo,Jae Min Lee,Jee Hyun Lee,Hyung Ku Chon,Jun-Won Chung,Hyun Ho Choi,Myung Ha Kim,Dong Ah Park,Jae Hung Ju 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2
Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriatesedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneousbreathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of themedical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonarycomplications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications,such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications bymeticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinicalpractice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using anadaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expertconsensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policymakers with information on how to perform endoscopic sedation with minimal risk.
Park, Yehyun,Cheon, Jae Hee,Park, Yi Lang,Ye, Byong Duk,Kim, You Sun,Han, Dong Soo,Kim, Joo Sung,Hong, Sung Noh,Kim, Young Ho,Jeon, Seong Ran,Kim, Won Ho Oxford University Press 2017 Inflammatory bowel diseases Vol.23 No.7
<P>Conclusions: This is the first validated surgery risk prediction model for Korean patients with CD; it provides accurate individualized estimates of the probability of surgery using clinical parameters collected at diagnosis. This model might guide appropriate patient selection for the early intensive treatment of CD.</P>
( Yehyun Park ),( Seung Up Kim ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang Hyub Han ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background: Noninvasive methods which can identify esophageal varices (EVs) accurately in patients with compensated cirrhosis are needed, because patients with a low risk of having EVs may safely avoid periodic upper gastrointestinal endoscopy. We evaluated whether liver stiffness (LS) measured using acoustic radiation force impulse (ARFI) elastography can predict the presence of EVs in patients with compensated cirrhosis. Methods: We retrospectively reviewed data of 143 patients with compensated cirrhosis who received upper gastrointestinal endoscopy and ARFI elastography on the same day between February 2010 and February 2013. For detection of EVs, univariate and multivariate analysis were performed to identify independent predictors of EVs. Results: The mean age of the study population (82 men and 61 women) was 54.7 years. The mean ARFI value was 1.81±0.67 m/s. All patients were diagnosed as having liver cirrhosis clinically or histologically. Child-Pugh Class A and B was observed in 123 (86.0 %), and 20 (14.0%), respectively. Patients with EVs (n=37, 25.9 %) had significantly higher ARFI values, LS values by TE, and spleen size and lower serum albumin, prothrombin time, and platelet count than those without EVs (all P<0.05). The area under the receiver operating characteristic (AUROC) of ARFI values to predict EVs were 0.769 (P<0.001; 95 % confi- dence interval [CI] 0.680-0.858). However, AUROC value increased up to 0.906 (P<0.001; 95% CI 0.852-0.961) when ARFI values were combined with platelet count and spleen size which were selected as independent predictor of the presence of EVs. Conclusions: The accuracy of ARFI elastography to predict the presence of EVs in patients with compensated liver cirrhosis was not satisfactory. However, when combined with platelet count and spleen size, the accuracy was significantly enhanced. However, external validation of our results should be warranted for clinical application.
Pandemic Influenza (H1N1) and Mycobacterium tuberculosis Co-infection
Park, Yehyun,Chin, Bum Sik,Han, Sang Hoon,Yun, Yujung,Kim, Young Ju,Choi, Jun Yong,Kim, Chang Oh,Song, Young Goo,Kim, June Myung The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.76 No.2
We hereby observe four co-infection cases of pandemic influenza H1N1 and Mycobacterium tuberculosis with various clinical presentations. It may be prudent to consider M. tuberculosis co-infections when patients with pandemic influenza reveal unusual clinical features that do not improve despite appropriate treatments against the influenza, especially in Korea, in the endemic areas of M. tuberculosis.
Is fasting beneficial for hospitalized patients with inflammatory bowel diseases?
( Yong Eun Park ),( Yehyun Park ),( Soo Jung Park ),( Tae Il Kim ),( Won Ho Kim ),( Jung Nam Kim ),( Na Rae Lee ),( Jae Hee Cheon ) 대한장연구학회 2020 Intestinal Research Vol.18 No.1
Background/Aims: Patients with inflammatory bowel disease (IBD) are usually hospitalized because of aggravated gastrointestinal symptoms. Many clinicians empirically advise these patients to fast once they are admitted. However, there has been no evidence that maintaining a complete bowel rest improves the disease course. Therefore, we aimed to investigate the effects of fasting on disease course in admitted patients with IBD or intestinal Behcet’s disease. Methods: A total of 222 patients with IBD or intestinal Behcet’s disease, who were admitted for disease-related symptoms, were retrospectively analyzed. We divided them into 2 groups: fasting group (allowed to take sips of water but no food at the time of admission) and dietary group (received liquid, soft, or general diet). Results: On admission, 124 patients (55.9%) started fasting and 98 patients (44.1%) started diet immediately. Among patients hospitalized through the emergency room, a significantly higher proportion underwent fasting (63.7% vs. 21.4%, P<0.001); however, 96.0% of the patients experienced dietary changes. Corticosteroid use (P<0.001; hazard ratio, 2.445; 95% confidence interval, 1.506-3.969) was significantly associated with a reduction in the disease activity score, although there was no significant difference between the fasting group and the dietary group in disease activity reduction (P=0.111) on multivariate analysis. Conclusions: In terms of disease activity reduction, there was no significant difference between the fasting and dietary groups in admitted patients with IBD, suggesting that imprudent fasting is not helpful in improving the disease course. Therefore, peroral diet should not be avoided unless not tolerated by the patient. (Intest Res 2020;18:85-95)
( Jung Won Park ),( Yehyun Park ),( Soo Jung Park ),( Tae Il Kim ),( Won Ho Kim ),( Jae Hee Cheon ) 대한소화기학회 2018 Gut and Liver Vol.12 No.6
Background/Aims: The cumulative surgery rate and postoperative relapse of intestinal Behcet’s disease (BD) have been reported to be high. This study aimed to establish a scoring system based on follow-up endoscopic findings that can predict intestinal BD recurrence after surgery. Methods: Fifty-four patients with intestinal BD who underwent surgery due to bowel complications and underwent follow-up colonoscopy were retrospectively investigated. Their clinical data, including colonoscopic findings, were retrieved. Classification and regression tree analysis was used to develop an appropriate endoscopic classification model that can explain the postsurgical recurrence of intestinal BD most accurately based on the following classification: e0, no lesions; e1, solitary ulcer <20 mm in size; e2, solitary ulcer ≥20 mm in size; and e3, multiple ulcers regardless of size. Results: Clinical relapse occurred in 37 patients (68.5%). Among 38 patients with colonoscopic recurrence, only 29 patients had clinically relapsed. Multivariate analysis identified higher disease activity index for intestinal BD at colonoscopy (hazard ratio [HR], 1.013; 95% confidence interval [CI], 1.005 to 1.021; p=0.002) and colonoscopic recurrence (HR, 2.829; 95% CI, 1.223 to 6.545; p=0.015) as independent risk factors for clinical relapse of intestinal BD. Endoscopic findings were classified into four groups, and multivariate analysis showed that the endoscopic score was an independent risk factor of clinical relapse (p=0.012). The risk of clinical relapse was higher in the e3 group compared to the e0 group (HR, 6.284; 95% CI, 2.036 to 19.391; p=0.001). Conclusions: This new endoscopic scoring system could predict clinical relapse in patients after surgical resection of intestinal BD. (Gut Liver 2018;12:674-681)
New sedatives and analgesic drugs for gastrointestinal endoscopic procedures
Jae Min Lee,Yehyun Park,Jin Myung Park,Hong Jun Park,Jun Yong Bae,Seung Young Seo,Jee Hyun Lee,Hyung Ku Chon,Jun-Won Chung,Hyun Ho Choi,Jun Kyu Lee,Byung-Wook Kim,Endoscopic Sedation Committee of the 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.5
Procedural sedation has become increasingly common in endoscopy. Sedatives and analgesics induce anxiolysis and amnesia. In addi- tion, an appropriate level of sedation is necessary for safe procedures including therapeutic endoscopy. Midazolam and propofol are the most commonly used drugs in sedative endoscopy. In recent years, the need to ascertain the safety and effectiveness of sedation has in- creased in practice. Therefore, new sedatives and analgesic drugs for optimal sedative endoscopy, have recently emerged. This article reviews the characteristics of sedatives and analgesics, and describes their clinical use in gastrointestinal endoscopy.
박홍준,Kim Byung-Wook,Lee Jun Kyu,Park Yehyun,Park Jin Myung,Bae Jun Yong,Seo Seung Young,Lee Jae Min,Lee Jee Hyun,Chon Hyung Ku,Chung Jun-Won,Choi Hyun Ho,Kim Myung Ha,Park Dong-ah,정재흥,Cho Joo Young 거트앤리버 소화기연관학회협의회 2022 Gut and Liver Vol.16 No.3
Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Such cardiopulmonary complications are usually temporary, and most patients recover without sequelae. However, these events may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.