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( Hyeon Jeong Goong ),( Jong Ho Moon ),( Yun Nah Lee ),( Hyun Jong Choi ),( Seo-youn Choi ),( Moon Han Choi ),( Min Jin Kim ),( Tae Hoon Lee ),( Sang-heum Park ),( Hae Kyung Lee ) 대한간학회 2017 Gut and Liver Vol.11 No.3
Background/Aims: Treatment for cholangitis without common bile duct (CBD) stones has not been established in patients with gallstones. We investigated the usefulness of endoscopic biliary drainage (EBD) without endoscopic sphincterotomy (EST) in patients diagnosed with gallstones and cholangitis without CBD stones by endoscopic retrograde cholangiopancreatography (ERCP) and intraductal ultrasonography (IDUS). Methods: EBD using 5F plastic stents without EST was performed prospectively in patients with gallstones and cholangitis if CBD stones were not diagnosed by ERCP and IDUS. After ERCP, all patients underwent laparoscopic cholecystectomy. The primary outcomes were clinical and technical success. The secondary outcomes were recurrence rate of biliary events and procedure-related adverse events. Results: Among 187 patients with gallstones and cholangitis, 27 patients without CBD stones according to ERCP and IDUS received EBD using 5F plastic stents without EST. The stents were maintained in all patients until laparoscopic cholecystectomy, and recurrence of cholangitis was not observed. After cholecystectomy, the stents were removed spontaneously in 12 patients and endoscopically in 15 patients. Recurrence of CBD stones was not detected during the follow-up period (median, 421 days). Conclusions: EBD using 5F plastic stents without EST may be safe and effective for the management of cholangitis accompanied by gallstones in patients without CBD stones according to ERCP and IDUS. (Gut Liver 2017;11:434-439)
( Jeong-ju Yoo ),( Hyeon Jeong Goong ),( Sang Gyune Kim ),( Young Seok Kim ),( Soung Won Jeong ),( Jae Young Jang ),( Sae Hwan Lee ),( Hong Soo Kim ),( Baek Gyu Jun ),( Young Don Kim ),( Gab Jin Cheon 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The indiscriminate use of sedative drug during endoscopy can pose a risk of minimal hepatic encephalopathy (MHE) in patient with liver cirrhosis, . However, it has not been studied yet which drugs are safest and most inviting on these patients. The aim of this study is to evaluate which one among midazolam, propofol, or combination therapy, was the least likely to cause complications including MHE by using Stroop application in cirrhotic patients. Methods: This randomized prospective study included consecutive 32 patients who underwent upper GI endoscopy at tertiary hospitals in Korea. Patients were randomly assigned to one of three groups, midazolam, propofol, or combination group, and underwent Stroop test before endoscopy, and 2 hours after the completion of endoscopy. The vital signs was checked before and after the drug administration and the patient / physician / nurse satisfaction was scored after endoscopy. Results: Mean age of the patients was 54.0 ± 9.30 years and 81.3% were male. Fifteen patients (46.9%) were child-pugh class A, and 17 (53.1%) were child-pugh class B or C. Alcohol was the most common etiology (21, 65.6%). Patients did not show significant changes in Ontime, Offtime on Stroop test before and after drug administration, and there was no significant difference between the three treatment groups. Also, there was no significant vital sign changes after drug use in all groups. However, with respect to subjective indicators, the satisfaction scores of patient and nursing staff was higher in the combined group than in the other two groups, and time to recovery was shorter in propofol than other groups. Conclusions: In patients with cirrhosis, sedative endoscopy using midazolam, propofol, or combination therapy is relatively safe, and was not associated with increased risk of MHE. However, since there is subjective satisfaction or recovery time difference among sedative agents, it should be considered according to each individual patient.
Hyeon Jeong Goong,Sang Gyune Kim,Seung Sik Park,Youn Hee Cho,Young Seok Kim,Boo Sung Kim 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.1
Hepatic hydrothorax is defined as the presence of pleural fluid (>500 mL) in the absence of primary cardiac or pulmonary disease. Initial treatments consist of a low salt diet, diuretics, and thoracentesis. If these are not effective, other modalities should be considered. The transjugular intrahepatic portosystemic shunt (TIPS) placement is one of the modalities for treatment of hepatic hydrothorax. However, the effects of TIPS placement have been contradictory. A 42-year-old man was diagnosed hepatic hydrothorax with liver cirrhosis. He was managed with medical therapy, but it was not effective to control hepatic hydrothorax. This case is reported with a review of relevant literature.
( Soo-kyung Park ),( Hyeon Jeong Goong ),( Bong Min Ko ),( Haewon Kim ),( Hyo Sun Seok ),( Moon Sung Lee ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.5
Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD. Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed. Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the low- risk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group. Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.
Survey-Based Analysis of the Clinical Treatment Status of Irritable Bowel Syndrome in Korea
Koo Hoon Sup,Son Hui Chang,이홍섭,Goong Hyeon Jeong,김주석,김기배,Kwon Yong Hwan,김재학,신현덕,Shin Ji Eun,지삼룡 대한의학회 2023 Journal of Korean medical science Vol.38 No.16
Background: The quality-of-life of patients with irritable bowel syndrome is low; incorrect diagnosis/treatment causes economic burden and inappropriate consumption of medical resources. This survey-based study aimed to analyze the current status of irritable bowel syndrome treatment to examine differences in doctors’ perceptions of the disease, and treatment patterns. Methods: From October 2019 to February 2020, the irritable bowel syndrome and Intestinal Function Research Study Group of the Korean Society of Neurogastroenterology and Motility conducted a survey on doctors working in primary, secondary, and tertiary healthcare institutions. The questionnaire included 37 items and was completed anonymously using the NAVER platform (a web-based platform), e-mails, and written forms. Results: A total of 272 doctors responded; respondents reported using the Rome IV diagnostic criteria (amended in 2016) for diagnosing and treating irritable bowel syndrome. Several differences were noted between the primary, secondary, and tertiary physicians’ groups. The rate of colonoscopy was high in tertiary healthcare institutions. During a colonoscopy, the necessity of random biopsy was higher among physicians who worked at tertiary institutions. ‘The patient did not adhere to the diet’ as a reason for ineffectiveness using low-fermentable oligo-, di-, and mono-saccharides, and polyols diet treatment was higher among physicians in primary/secondary institutions, and ‘There are individual differences in terms of effectiveness’ was higher among physicians in tertiary institutions. In irritable bowel syndrome constipation predominant subtype, the use of serotonin type 3 receptor antagonist (ramosetron) and probiotics was higher in primary/secondary institutions, while serotonin type 4 receptor agonist was used more in tertiary institutions. In irritable bowel syndrome diarrhea predominant subtype, the use of antispasmodics was higher in primary/secondary institutions, while the use of serotonin type 3 receptor antagonist (ramosetron) was higher in tertiary institutions. Conclusion: Notable differences were observed between physicians in primary/secondary and tertiary institiutions regarding the rate of colonoscopy, necessity of random biopsy, the reason for the ineffectiveness of low-fermentable oligo-, di-, and mono-saccharides, and polyols diet, and use of drug therapy in irritable bowel syndrome. In South Korea, irritable bowel syndrome is diagnosed and treated according to the Rome IV diagnostic criteria, revised in 2016.
( Seong Ran Jeon ),( Jin-oh Kim ),( Jeong-sik Byeon ),( Dong-hoon Yang ),( Bong Min Ko ),( Hyeon Jeong Goong ),( Hyun Joo Jang ),( Soo Jung Park ),( Eun Ran Kim ),( Sung Noh Hong ),( Jong Pil Im ),( S 대한간학회 2021 Gut and Liver Vol.15 No.3
Background/Aims: Although balloon-assisted enteroscopy (BAE) enables endoscopic visualization of small bowel (SB) involvement in Crohn’s disease (CD), there is no data on the changes in outcomes over time. We therefore investigated the changes in BAE use on CD patients over different time periods in terms of its role and clinical outcomes. Methods: We used a multicenter enteroscopy database to identify CD patients with SB involvement who underwent BAE (131 procedures, 116 patients). We compared BAE-related factors and outcomes between the first period (70 procedures, 60 patients) and the second period (61 procedures, 56 patients). The specific cutoff point for dividing the two periods was 2007, when BAE guidelines were introduced. Results: Initial diagnosis of SB involvement in CD was the most common indication for BAE during each period (50.0% vs 31.1%, p=0.034). The largest change was in the number of BAE uses for stricture evaluation and/or treatment, which increased significantly in the latter period (2.9% vs 21.3%, p=0.002). The diagnostic yield in patients with suspected CD was 90.7% in the first period and 95.0% in the second (p=0.695). More endoscopic interventions were performed in the second period than in the first (5.1% vs 17.6%, p=0.041). Enteroscopic success rates were high throughout (100% in the first period vs 80.0% in the second period, p>0.999). In the first and second periods, therapeutic plans were adjusted in 62.7% and 61.4% of patients, respectively. Conclusions: The overall clinical indications, outcomes, and effectiveness of BAE were constant over time in CD patients with SB involvement, with the exception that the frequency of enteroscopic intervention increased remarkably. (Gut Liver 2021;15:375-382)
국내에서 발생한 중추신경계 합병증을 동반한 삼일열 말라리아
권순하 ( Soon Ha Kwon ),궁현정 ( Hyeon Jeong Goong ),이은정 ( Eun Jung Lee ),전민혁 ( Min Hyok Jeon ),김태형 ( Tae Hyong Kim ),박선아 ( Sun A Park ),추은주 ( Eun Ju Choo ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3
A 51-year-old man diagnosed with Plasmodium vivax malaria was transferred to our clinic with newly developed drowsy mentality and myoclonus after the initiation of hydroxychloroquine therapy. Following therapy to treat the vivax malaria and supportive care, the patient recovered completely with no sequelae. Cerebral complications caused by vivax malaria are very rare worldwide, and only two cases have been reported in Korea. Here, we report the third published case of P. vivax infection with cerebral complications in Korea. (Korean J Med 2012;82:382-385)
Cancer risk in patients with Peutz-Jeghers syndrome in Korea: a retrospective multi-center study
( Su Hwan Kim ),( Eun Ran Kim ),( Jae Jun Park ),( Eun Sun Kim ),( Hyeon Jeong Goong ),( Kyeong Ok Kim ),( Ji Hyung Nam ),( Yehyun Park ),( Sang Pyo Lee ),( Hyun Joo Jang ) 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.2
Background/Aims: There have been little research on the cancer risks of patients with Peutz-Jeghers syndrome (PJS) in Korea. We aimed to investigate the clinical features of PJS patients and their cancer incidence rate. Methods: Patients with PJS from nine medical centers were enrolled. In those patients diagnosed with cancer, data obtained included the date of cancer diagnosis, the tumor location, and the cancer stage. The cumulative risks of gastrointestinal cancers and extra-gastrointestinal cancers were calculated using the Kaplan-Meier method. Results: A total of 96 PJS patients were included. The median age at diagnosis of PJS was 23.4 years. Cancer developed in 21 of the 96 patients (21.9%). The age of PJS diagnosis was widely distributed (0.9 to 72.4 years). The most common cancers were gastrointestinal cancer (n = 12) followed by breast cancer (n = 6). The cumulative lifetime cancer risk was calculated to be 62.1% at age 60. The cumulative lifetime gastrointestinal cancer risk was 47.1% at age 70. The cumulative lifetime extra- gastrointestinal cancer risk was 40.3% at age 60. Conclusions: PJS onset may occur at any age and the risks of gastrointestinal and extra-gastrointestinal cancer are high. Thorough surveillance of PJS patients for malignancies is vital.