http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
Chon Hyung Ku,Song Tae Jun,Yoo Kyoung-Hoon,Hwang Jun Seong,Kim Myung-Hwan,Choi Eun Kwang,Kim Tae Hyeon 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.6
Background/Aims: Most guidelines recommend surgical resection of all main duct (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMNs) in suitable patients. However, there is little evidence regarding the malignancy risk of enhancing mural nodules (EMNs) that are present only in the main pancreatic duct (MPD) in patients with MD- and MT-IPMNs. Therefore, this study aimed to identify the clinical and morphological features associated with malignancy in MD- and MT-IPMNs with EMNs only in the MPD. Methods: We retrospectively enrolled 50 patients with MD- and MT-IPMNs with EMNs only in the MPD on contrast-enhanced magnetic resonance imaging. We evaluated the clinical characteristics and preoperative radiologic imaging results of MPD morphology and EMN size and analyzed the risk factors associated with malignancy. Results: Histological findings of EMNs were low-grade dysplasia (38%), malignant lesions (62%), high-grade dysplasia (34%), and invasive carcinoma (28%). On the receiver operating characteristic curve, the cutoff value of EMN size on magnetic resonance imaging for best predicting malignancy was 5 mm (sensitivity, 93.5%; specificity, 52.6%; area under the curve, 0.753). Multivariate analysis showed that only EMN >5 mm (odds ratio, 27.69; confidence interval, 2.75 to 278.73; p=0.050) was an independent risk factor for malignancy. Conclusions: EMNs of >5 mm are associated with malignancy in patients with MD- and MT-IPMNs with EMNs that are present only in the MPD, in accordance with the international consensus guidelines.
Endoscopic ultrasound-guided drainage for local complications related to pancreatitis
Hyung Ku Chon,Seong-Hun Kim 소화기인터벤션의학회 2023 International journal of gastrointestinal interven Vol.12 No.1
Despite many advances in the treatment of acute pancreatitis, the mortality rate in severe cases is as high as 30%. Therefore, it is very important to treat the local complications of acute pancreatitis. Pancreatic fluid collections (PFCs) are among the most important local complications of acute pancreatitis. According to the Atlanta classification of acute pancreatitis in 2012, PFCs are categorized as acute peripancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. In principle, PFCs with complications require an intervention such as drainage. With the recent development of endoscopic ultrasound (EUS)-guided interventions, EUS-guided drainage or necrosectomy has emerged as an important standard treatment for PFCs. In this article, we present recent advances in EUS-guided drainage and necrosectomy for PFCs in acute pancreatitis, along with a literature review.
( Hyung Ku Chon ),( Keum Ha Choi ),( Sang Hyun Seo ),( Tae Hyeon Kim ) 대한소화기학회 2022 Gut and Liver Vol.16 No.1
Background/Aims: Percutaneous transhepatic cholangioscopy (PTCS) is used for the diagnosis and treatment of biliary diseases in patients with failed endoscopic retrograde cholangiopancreatography, particularly those with surgically altered anatomy. However, few studies are available on the clinical use of Spyglass DS direct visualization system (SpyDS)-assisted PTCS. This study aimed to assess the efficacy and safety of SpyDS-assisted PTCS in patients with surgically altered anatomy, particularly those with a Roux-en-Y reconstruction. Methods: Thirteen patients (six women, median age 71.4 years [range, 53 to 83 years]) with surgically altered anatomy (four Roux-en-Y choledochojejunostomies, seven Roux-en-Y hepaticojejunostomies, and two Roux-en-Y esophagojejunostomies) who underwent SpyDS-assisted PTCS between January 2019 and August 2020 were included and the data was acquired by retrospectively reviewing electronic medical record. Results: A total of 19 SpyDS-assisted PTCS procedures were performed in the 13 patients: eight had bile-duct stones, and five had biliary strictures. All SpyDS-assisted PTCS procedures were successfully performed. The total procedure time was 42.42±18.0 minutes (mean±standard deviation). Bile duct clearance was achieved in all bile duct stone cases after a median of 2 (range, 1 to 3) procedures. In the five biliary stricture cases, the results of SpyBite forceps-guided targeted biopsy were consistent with adenocarcinoma (100% accuracy). The median hospitalization duration was 20 days (range, 14 to 30 days). No procedure-related morbidity or mortality occurred. Conclusions: SpyDS-assisted PTCS may be a safe, feasible, and effective procedure for the diagnosis and treatment of biliary diseases in patients with surgically altered anatomy, particularly in those with the Roux-en-Y reconstruction requiring a percutaneous approach. However, our findings need to be validated in further studies. (Gut Liver 2022;16:111-117)
( Hyung Ku Chon ),( Ik Sang Shin ),( Sang Wook Kim ),( Soo Teik Lee ) 대한장연구학회 2016 Intestinal Research Vol.14 No.3
Endoscopic treatments have emerged as an alternative to surgery, in the treatment of benign colorectal stricture. Unlike endoscopic balloon dilatation, there is limited data on endoscopic electrocautery incision therapy for benign colorectal stricture, especially with regards to safety and long-term patency. We present a case of a 29-year-old female with Crohn’s disease who had difficulty in defecation and passing thin stools. A pelvic magnetic resonance imaging scan, gastrograffin enema, and sigmoidoscopy showed a high-grade anorectal stricture. An endoscopic insulated-tip knife incision was successfully performed to resolve the problem. From our experience, we suggest that endoscopic insulated-tip knife treatment may be a feasible and effective modality for patients with short-segment, very rigid, fibrotic anorectal stricture.
Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey
( Hyung Ku Chon ),( Sung Hoon Moon ),( Sang Wook Park ),( Woo Hyun Paik ),( Chang Nyol Paik ),( Byoung Kwan Son ),( Tae Jun Song ),( Dong Won Ahn ),( Eaum Seok Lee ),( Yun Nah Lee ),( Yoon Suk Lee ),( 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.1
Background/Aims: The study aimed to investigate the current practice patterns in the management of pancreatic cystic neoplasms in Korea. Methods: An electronic survey was systematically distributed by email to members of the Korean Pancreatobiliary Association from December 2019 to February 2020. Results: In total, 115 (110 gastroenterologists, five surgeons) completed the survey, 72.2% of whom worked in a tertiary/ academic medical center. Most (65.2%) followed the 2012/2017 International Association of Pancreatology guidelines for the management of pancreatic cystic neoplasms. A gadolinium-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography was the most common first-line diagnostic modality (42.1%), but a contrast-enhanced computed tomography scan was preferred as a subsequent surveillance tool (58.3%). Seventy-four percent of respondents routinely performed endoscopic ultrasound-guided fine needle aspiration for pancreatic cystic neoplasms with suspicious mural nodules. Endoscopic ultrasound-guided fine needle aspiration cytology (94.8%) and cystic fluid carcinoembryonic antigen (95.7%) were used for cystic fluid analysis. Most (94%) typically recommended surgery in patients with high-risk stigmata, but 18.3% also considered proceeding with surgery in patients with worrisome features. Most (96.5%) would continue surveillance of pancreatic cystic neoplasms for more than 5 years. Conclusions: According to this survey, there was variability in the management of pancreatic cystic neoplasms among the respondents. These results suggest that the development of evidence-based guidelines for pancreatic cystic neoplasms that fit the Korean practice is needed to create an optimal approach to the management of pancreatic cystic neoplasms.
Hyung Ku Chon,Chan Park,Tae Hyeon Kim 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Mirizzi syndrome is a rare complication of gallbladder disease that can be difficult to treat. In particular, endoscopic treatmentoften fails because of the inability to access or to capture the impacted cystic duct stone. We report a case of Mirizzi syndromegrade III that was successfully managed by digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy withendoscopic nasogallbladder drainage and interval laparoscopic cholecystectomy. Based on our experience, digital single-operatorperoral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage is a feasible minimally invasiveapproach for the management of high-grade Mirizzi syndrome.