내시경 초음파 중재시술을 위한 스텐트

허건 ( Gunn Huh ),송태준 ( Tae Jun Song ) 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.4

췌담도 질환에서 내시경 초음파 유도하 경벽 배액술은 췌장주위 액체고임과 담낭, 담도, 췌관 등의 배액이 필요한 다양한 상황에서 기존의 침습적인 치료를 대체할 수 있는 효과적인 치료로서 적응증을 넓혀가고 있다. 최근 내시경 초음파 유도하 경벽 배액술에 특화된 다양한 스텐트가 개발되면서 보다 효과적이고 안전한 시술이 가능해졌다. 본고에서는 내시경 초음파 유도하 경벽 배액술을 위해 개발된 다양한 스텐트들의 특징과 치료 성적에 대해 고찰하였다. Endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collection, gallbladder, bile duct, or pancreatic duct has emerged as a therapeutic option in patients with pancreatobiliary diseases. Recently, dedicated stents for EUSguided interventions, which include lumen-apposing metal stents and modified tubular self-expanding metal stents, have been developed to improve efficacy and safety of these procedures. This article has reviewed newly developed stents for EUSguided interventions and their therapeutic outcomes. Korean J Pancreas Biliary Tract 2021;26(4):248-253

Successful Removal of a Difficult Common Bile Duct Stone by Percutaneous Transcholecystic Cholangioscopy

Hyunsuk Lee,Sang Hyub Lee,Gunn Huh,Yeji Kim,허세범,Moonhaeng Hur,Minwoo Lee,Byeongyun Ahn 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2

Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinicalmanifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography,but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Althoughpercutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and riskyif the intrahepatic duct is not dilated. We report a case of a large CBD stone that was successfully removed using percutaneoustranscholecystic cholangioscopy.

Efficacy of Nab-Paclitaxel Plus Gemcitabine and Prognostic Value of Peripheral Neuropathy in Patients with Metastatic Pancreatic Cancer

( Min Su You ),( Ji Kon Ryu ),( Young Hoon Choi ),( Jin Ho Choi ),( Gunn Huh ),( Woo Hyun Paik ),( Sang Hyub Lee ),( Yong-tae Kim ) 대한소화기학회 2018 Gut and Liver Vol.12 No.6

Background/Aims: The combination of nab-paclitaxel and gemcitabine (nab-P/Gem) is widely used for treating metastatic pancreatic cancer (MPC). We aimed to evaluate the therapeutic outcomes and prognostic role of treatment-related peripheral neuropathy in patients with MPC treated with nab-P/Gem in clinical practice. Methods: MPC patients treated with nab-P/Gem as the first-line chemotherapy were included. All 88 Korean patients underwent at least two cycles of nab-P/Gem combination chemotherapy (125 and 1,000 mg/㎡, respectively). Treatment-related adverse events were monitored through periodic follow-ups. Overall survival and progression-free survival were estimated by the Kaplan-Meier method, and the Cox proportional hazards regression linear model was applied to assess prognostic factors. To evaluate the prognostic value of treatment-related peripheral neuropathy, the landmark point analysis was used. Results: Patients underwent a mean of 6.7±4.2 cycles during 6.3±4.4 months. The median overall survival and progression-free survival rates were 14.2 months (95% confidence interval [CI], 11.8 to 20.3 months) and 8.4 months (95% CI, 7.1 to 13.2 months), respectively. The disease control rate was 84.1%; a partial response and stable disease were achieved in 30 (34.1%) and 44 (50.0%) patients, respectively. Treatment-related peripheral neuropathy developed in 52 patients (59.1%), and 13 (14.8%) and 16 (18.2%) patients experienced grades 2 and 3 neuropathy, respectively. In the landmark model, at 6 months, treatment-related peripheral neuropathy did not have a significant correlation with survival (p=0.089). Conclusions: Nab-P/Gem is a reasonable choice for treating MPC, as it shows a considerable disease control rate while the treatment-related peripheral neuropathy was tolerable. The prognostic role of treatment-related neuropathy was limited. (Gut Liver 2018;12:728-735)

Simulator-based training method in gastrointestinal endoscopy training and currently available simulators

Yuri Kim,Jeong Hoon Lee,Gin Hyug Lee,Ga Hee Kim,Gunn Huh,Seung Wook Hong,Hwoon-Yong Jung 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.1

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventionalABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, theycannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary dueto financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damagecaused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternativeto the ABTM, owing to the SBTM’s advantages. Since the 1960s, many GI endoscopy training simulators have been developedand numerous studies have been published on their effectiveness. While previous studies have focused on the simulator’s validity, thisreview focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GIendoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into animproved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace theABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

S-35 Seasonal Variation in Acute Gastrointestinal Bleeding in Korea

( Gukhwan Choi ),( Han Myung Lee ),( Jue Lie Kim ),( Sun A Park ),( Hosim Soh ),( Min Su You ),( Gunn Huh ),( Jaeyoung Chun ),( Kyoung Sup Hong ),( Jong Pil Lim ),( Joo Sung Kim ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Background/Aims: Acute gastrointestinal bleeding (GIB) may have a seasonal variation. The aim of this study was to determine the seasonal and monthly patterns in the presentation of acute GIB in Korea. Methods: From March 2014 to February 2015, the medical records of all patients who visited the emergency room for the management of acute GIB were retrospectively reviewed. We analyzed the association between the number of patients with acute GIB and each temperature parameter. Results: A total of 716 patients with acute GIB were enrolled in this study. The study population comprised 497 males (69.4%) and 219 females (30.6%), and the mean age was 62.3 years. There were 497 (69.4%) and 219 (30.6%) patients with acute upper and lower GIB, respectively. Variceal bleeding was detected in 171 (23.9%) patients. There were significant association of the number of acute GIB with seasons (p=0.021) and months (p=0.018), respectively. The highest incidence of acute GIB was observed in spring while the lowest incidence occurred in summer. The peak number of patients with acute GIB was noticed in April and the lower plateau was observed from June to September. There was no significant correlation between the presentation of acute GIB and average temperature. However, the presentation of acute GIB showed a higher preference of daily temperature difference (correlation efficient=0.112, p=0.05) Conclusions: There is seasonal and monthly variation in the presentation of acute GIB. Acute GIB might occur more commonly in the days with higher temperature difference.

Natural Course and Risk of Cholangiocarcinoma in Patients with Recurrent Pyogenic Cholangitis: A Retrospective Cohort Study

( Min Su You ),( Sang Hyub Lee ),( Jinwoo Kang ),( Young Hoon Choi ),( Jin Ho Choi ),( Bang-sup Shin ),( Gunn Huh ),( Woo Hyun Paik ),( Ji Kon Ryu ),( Yong-tae Kim ),( Dong Kee Jang ),( Jun Kyu Lee ) 대한간학회 2019 Gut and Liver Vol.13 No.3

Background/Aims: Recurrent pyogenic cholangitis (RPC) is a chronic progressive disease frequently accompanied by cholangiocarcinoma (CCA). This study aimed to investigate the natural course of RPC and identify factors associated with CCA. Methods: From January 2005 to December 2016, 310 patients diagnosed with RPC at Seoul National University Hospital were included. Complications and management during follow-up were recorded. CCA-free probability was estimated by Kaplan-Meier method, and risk factors associated with CCA were analyzed using log-rank test and Cox’s proportional hazard regression model. Results: Mean age at diagnosis was 59.1±10.9 years and mean follow-up duration was 84.0±64.1 months. An intrahepatic duct stone was found in 253 patients (81.6%). Liver atrophy was identified in 185 patients (59.7%) and most commonly located at the left lobe (65.4%). Acute cholangitis, liver abscesses, cirrhotic complications, and CCA developed in 41.3%, 19.4%, 9.7%, and 7.4%, respectively. During follow-up, complete resolution rate after hepatectomy, biliary bypass surgery, and choledocholithotomy with T-tube insertion reached 82.3%, 55.2%, and 42.1%, respectively. None of the patients who maintained complete resolution by the last follow-up day developed CCA. In univariate analysis, female, both-sided intrahepatic duct stones, and liver atrophy at any location were associated with increased risk of CCA. Multivariate analysis revealed that both-sided atrophy significantly increased risk of CCA (hazard ratio, 4.56; 95% confidence interval, 1.48 to 14.09; p=0.008). In 21 patients who developed intrahepatic CCA, tumor was located mostly in the atrophied lobe (p=0.023). Conclusions: In RPC patients, acute cholangitis, liver abscess, cirrhotic complications, and CCA frequently developed. Both-sided liver atrophy was a significant risk factor for developing CCA. (Gut Liver 2019;13:373-379)