DongKi Lee

Capecitabine combined with gemcitabine (CapGem) as first‐line treatment in patients with advanced/metastatic biliary tract carcinoma

Biliary tract carcinoma is an aggressive cancer, with median survival rarely exceeding 6 months. There is currently no established palliative standard of care. A Phase II trial was conducted to study a combination of oral capecitabine and gemcitabine (CapGem) as first‐line therapy in patients with advanced and/or metastatic biliary carcinoma.

Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation

BACKGROUND An anastomotic biliary stricture is a complication of living donor liver transplantation (LDLT) performed using duct-to-duct anastomosis. Despite advances in treating this complication, there is no one established treatment protocol. OBJECTIVE To investigate the safety, effectiveness, and mid-term outcome of magnetic compression anastomosis (MCA) for treating biliary obstruction after LDLT when the obstruction cannot be resolved by using percutaneous or peroral methods. DESIGN Retrospective, observational study with standardized treatment and follow-up. SETTING Tertiary-care academic medical center. PATIENTS Twelve patients underwent MCA procedures to treat anastomosis site stricture after LDLT. INTERVENTIONS MCA. MAIN OUTCOME MEASUREMENTS Bile duct patency, technique performance, and complications were evaluated. RESULTS We achieved magnet approximation at the anastomotic stricture in 10 of 12 patients (83.3%). The magnets failed to approximate in 2 patients. We achieved recanalization of the stricture site in 10 of 10 patients. We removed an internal catheter in 9 patients. The mean interval from magnet approximation to removal was 74.2 days (range 14-181 days). The mean time from recanalization to removal of the internal catheter was 183 days (range 51-266 days). Patients were examined regularly after removing the internal catheter with a mean follow-up period of 331 days (range 148-581 days). The observed MCA-related complications consisted of 1 case of mild cholangitis and 1 recurrence of the anastomotic stricture. LIMITATIONS Nonrandomized study design. CONCLUSIONS MCA safely and effectively resolved post-LDLT biliary duct-to-duct anastomotic strictures that could not be resolved using conventional methods, such as ERCP and percutaneous transhepatic biliary drainage.

Comparison of the characteristics for in‐hospital and out‐of‐hospital ischaemic strokes

Background and purpose:  Patients who are being admitted to a hospital due to diseases other than stroke may develop a stroke (in‐hospital stroke; IHS).

Drug-eluting stent in malignant biliary obstruction

Endoscopic stent insertion is the treatment of choice for patients with malignant biliary obstruction. However, conventional stents enable only mechanical palliation of the obstruction, without any anti-tumor effects. Drugeluting stent (DES), which was first introduced in coronary artery disease, are currently under investigation for sustaining stent patency and prolonging patient survival by inhibiting tumor ingrowth in malignant biliary obstruction. Many factors affecting efficient drug delivery have been studied to determine how drugs with antitumor effects suppress tumor ingrowth, including the specific drugs incorporated, means of incorporating the drugs, mode of drug release, and stent structure. Advances have resulted in the construction of more effective non-vascular DES and ongoing clinical research. Non-vascular DES is expected to play a vital role in prolonging the survival of patients with malignant biliary obstruction.

ENDOSCOPIC PAPILLARY LARGE BALLOON DILATION AFTER ENDOSCOPIC SPHINCTEROTOMY FOR TREATMENT OF LARGE COMMON BILE DUCT STONE

The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy is successful in most cases. However, the procedure often requires a prolonged time and repeated trials, therefore, subsequent occurrence of procedure‐related complications are not uncommon. The purpose of the present paper was to investigate the utility of a combined endoscopic papillary large balloon dilation (EPLBD) preceded by a mid‐incision endoscopic sphincterotomy for the removal of large CBD stones. Stone removal was surprisingly effective with EPLBD in patients with large CBD stones. Occurrence of major complication, such as pancreatitis, bleeding, and perforation, was not observed in any patients who were treated with EPLBD. EPLBD also can be safely carried out on patients with anatomic alteration, such as a periampullary diverticulum, and on patients who have undergone a Billroth II operation. EPLBD is a landmark method of removing a large CBD stone, the impact of which is comparable to that of the introduction of endoscopic mechanical lithotripsy. However, further investigation is required to address the applications and potential outcomes of this procedure. Also, procedure guidelines should be established to avoid major complications.

EST, EPBD, and EPLBD (Cut, Stretch, or Both?)

Endoscopic treatment of extrahepatic bile duct stones is accepted as a treatment modality that can replace surgery and that is performed globally. The application of endoscopic treatment became possible only after the introduction of endoscopic sphincterotomy (EST), which allowed the removal of a stone from the common bile duct (CBD) that was larger than the papillary orifice. Although the function of an endoscope and its accessories has greatly improved during the past three decades, EST-related complications still remain because the basic concept of EST, which is “blind cutting” of the tissue with an electric current, has not changed since its introduction.

Perforated duodenal diverticulitis caused by retained common bile duct stone in the diverticulum.

Perforated Duodenal Diverticulitis Caused by Retained Common Bile Duct Stone in the Diverticulum

The Diagnostic Value of Endoprobe for Small Esophageal Leiomyomas Derived from the Muscularis Mucosae

Esophageal leiomyoma derived from the muscularis mucosae (MM) is a rare condition, and the optimal modality for diagnosis and treatment is controversial. Endoscopic ultrasonography can provide an accurate image of esophageal layer structure, providing information on lesion suitability for potential endoscopic therapy. We attempted to investigate the diagnostic value of a transendoscopic balloon-tipped miniature ultrasonic endoprobe for small esophageal leiomyomas derived from MM. We resected 7 small esophageal leiomyomas derived from MM by endoscopic mucosal resection (EMR), all of which were diagnosed by a balloon-tipped endoprobe. The endosonographic and pathologic features of 7 cases of small esophageal leiomyomas derived from MM were compared. The balloon-tipped endoprobe clearly showed all 7 small esophageal leiomyomas derived from MM, even those under 5 mm in size (smallest lesion, 3.0 mm). The endosonographic characteristics of small esophageal leiomyomas derived from MM were a hypoechoic mass with smooth, regular, and a well-defined outer margin and homogenous inner echogram arising from the second hypoechoic layer. Complete resections were possible in all 7 cases by EMR without any complications. Tumor size was 3.0 - 13.5 mm (mean 7.8 mm) in maximum diameter. In all cases, endosonographic findings by endoprobe were exactly concordant with pathologic finding in determining the tumors depth in the esophageal wall, tissue origin and characteristics, growth pattern, and size. We detail the balloon-tipped endoprobe is a simple, convenient, and very useful in making accurate diagnosis of small esophageal leiomyomas derived from the MM and the appropriate applications of EMR.

EFFECT OF SOLVENT ON EXTRACTION OF POLYCHLORINATED BIPHENYLS AND POLYCHLORINATED DIBENZODIOXINS FROM CHARCOAL

The effect of solvent on the extraction of two polychlorinated biphenyls (PCBs) and five polychlorinated dibenzodioxins (PCDDs) from charcoal is investigated and the variations in recoveries of these analytes are explained. The extraction is performed using chromatographic elution, ultrasound-assisted extraction (UAE) of probe- and bath-type, supercritical fluid extraction (SFE), and enhanced-fluidity liquid extraction (EFLE). In each of the extraction methods used, only the use of isopropanol-toluene mixtures shows higher recoveries than the use of toluene alone. Higher recoveries are obtained using EFLE, compared with other extraction methods, even though the same amount, i.e., 30mL, of extraction solvent is used, because higher temperature is applied under higher pressure. After each extraction, chromatographic interferences are removed through a multilayer silica gel column clean-up. The quantification of PCBs and PCDDs is performed using HPLC-UV.

Tu1931 Gemcitabine-Eluting Membrane Inhibits Pancreatic/ Cholangiocarcinoma Tumor Growth and Metastasis by Blocking the Epidermal Growth Factor Receptor Signaling Pathway

G A A b st ra ct s death or censored at time of last contact (median follow-up 251 days (d), range 0-1758 d). Survival rates were analysed using the Kaplan-Meier method. Pearsons correlation analyses were performed with respect to survival times and concentrations of IGF-1 and DKK-1. Results. At the time of the analysis 54 patients had died. The concentrations of IGF-1 significantly correlated with survival (0.324, p < 0.01) while the concentration of DKK-1 did not (-0.109, p = 0.197). Survival times using previously published cut-offs for BALAD2 score [-0.91] and IGF-1 [30 ng/ml] are given in table 1. Conclusion. IGF-1 and the BALAD-2 score are valuable to predict survival in patients with hepatocellular carcinoma.