Eun Kwang Choi

The sensitivity and specificity of serum immunoglobulin G and immunoglobulin G4 levels in the diagnosis of autoimmune chronic pancreatitis: Korean experience.

Objectives: Serum immunoglobulin G (IgG) and/or IgG4 elevation is one of the notable characteristics of autoimmune chronic pancreatitis (AIP). The purpose of this study was to compare the sensitivity and specificity of IgG with those of IgG4 in the diagnosis of AIP. Methods: From December 2005 to March 2006, patients who were diagnosed as having ordinary chronic pancreatitis of a certain cause (n = 67) and pancreatic cancer (n = 76) in Asan Medical Center were enrolled. The IgG and IgG4 levels of these patients were compared with those of 35 AIP patients diagnosed in Asan Medical Center. Results: The percentage of patients with serum IgG level more than 1800 mg/dL was 10.4% (7/67), 2.6% (2/76), and 54.3% (19/35) in patients with ordinary chronic pancreatitis, pancreatic cancer, and AIP, respectively. As for serum IgG4 levels more than 135 mg/dL, it was 11.9% (8/67), 1.3% (1/76), and 73.3% (22/30), respectively. The specificity of IgG at 1800 mg/dL and IgG4 at 135 mg/dL was both 93.7%. The serum IgG4 showed high specificity (98.7%) in differentiating AIP from pancreatic cancer. The IgG4 level at 141 mg/dL was determined as the most optimal cutoff value with resulting sensitivity and specificity of 73.3% and 95.1%, respectively (area under the curve, 0.816), whereas for IgG, it was determined as 1770 mg/dL, with sensitivity and specificity of 57.1% and 93.7% (area under the curve, 0.788). Conclusions: The sensitivity of serum IgG4 tended to be higher than that of IgG in the diagnosis of AIP. The IgG4 showed high specificity in the differential diagnosis of AIP from pancreatic cancer. Serum IgG4 should be included in the diagnostic workup for AIP.

Update on endoscopic Management of Main Pancreatic Duct Stones in Chronic Calcific Pancreatitis

Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.

Differences in Pancreatic Immunohistochemical Staining Profiles of TGF-β1, MMP-2, and TIMP-2 Between Autoimmune and Alcoholic Chronic Pancreatitis

Objectives: Tumor growth factor &bgr; (TGF-&bgr;) is an immunosuppressive cytokine and has been implicated in a variety of disease processes, including those in autoimmune disease. Tumor growth factor &bgr; is also involved in fibrosis by regulating matrix metalloproteinases (MMPs) and the tissue inhibitor of MP (TIMP). The purpose of this study was to compare the expression patterns of TGF-&bgr;1, MMP-2, and TIMP-2 between autoimmune chronic pancreatitis (AIP) and alcoholic chronic pancreatitis (ACP) by immunohistochemical staining of pancreatic tissue specimens. Methods: Pancreatic tissue specimens were obtained from 16 of 57 patients who had a diagnosis of AIP at the Asan Medical Center. Pancreatic tissue specimens of ACP were obtained from 10 patients who were surgically treated. Immunohistochemical staining was performed with antibodies specific for TGF-&bgr;1, MMP-2, and TIMP-2. Results: The degree of immunohistochemical staining for TGF-&bgr;1 was significantly weaker in AIP than in ACP in the pancreatic ductal epithelial and mononuclear cells (P = 0.029 and P = 0.018, respectively). Conclusions: This finding suggests that there may be a defect in the function of regulatory T (Treg) cells, which normally prevents autoimmune disease progression via a suppressor mechanism. Further studies are needed to identify the type of regulatory T cell involved in this process.

Increased fat in pancreas not associated with risk of pancreatitis post-endoscopic retrograde cholangiopancreatography

Background A preliminary study has shown increased pancreatic fat in patients with idiopathic pancreatitis and sphincter of Oddi dysfunction. In this study, we aimed to determine if an increased quantity of pancreatic fat is an independent risk factor for pancreatitis post-endoscopic retrograde cholangiopancreatography (ERCP). Methods In this case control study, we retrospectively reviewed a local radiological and ERCP database to identify patients who had had abdominal magnetic resonance imaging (MRI) followed by ERCP no more than 60 days later between September 2003 and January 2011. Percentage of fat was determined by recording signal intensity in the in-phase (Sin) and out-of-phase (Sout) T1-weighted gradient sequences, and calculation of the fat fraction as (Sin − Sout)/(Sin) × 2 by an abdominal radiologist blinded to clinical history. Controls matched for age, gender, and other pancreatobiliary disease were selected from a group with no post-ERCP pancreatitis (before fat content of the pancreas was analyzed). Results Forty-seven patients were enrolled. Compared with controls, subjects with post-ERCP pancreatitis were similar in terms of age (41.4 years versus 41.1 years), gender (21.2% versus 20.2% males), pancreatobiliary disease characteristics, and most ERCP techniques. Measurements of pancreatic head, body, and tail fat and body mass index were similar in patients and controls. Conclusion Increased pancreatic fat on MRI criteria is not an independent predictor of post-ERCP pancreatitis.

Regression of esophageal varices during entecavir treatment in patients with hepatitis-B-virus-related liver cirrhosis

Recent studies suggest that liver cirrhosis is reversible after administering oral nucleos(t)ide analogue therapy to patients with hepatitis B virus (HBV) infection. However, few studies have addressed whether esophageal varices can regress after such therapy. We report a case of complete regression of esophageal varices during entecavir therapy in patients with HBV-related liver cirrhosis, suggesting that complications of liver cirrhosis such as esophageal varices can regress after the long-term suppression of HBV replication.

Su1973 Usefulness of PET-CT Uptake According to Gastric Cancer Morphology

lower 65 (30.1%); Period II: upper 37 (20.0%), middle 85 (45.9%), lower 61 (33.0%), Period III: upper 35 (22.2%), middle (40.5%), lower 55 (35.9%). Pathological examination revealed as follows (differentiated type/ undifferentiated/ others/ unknown); Period I: 132/ 69/0/17; Period II: 123/54/2/6; Period III: 103/43/2/0. These data indicated the locations and pathological features of the stomach cancer in this survey were not changed in recent 10 years. Regarding therapeutic approach to gastric cancer, open laparotomy was mainly applied to the gastric cancer in period I (2002-2004) as 159 out of 216 (73.6%) patients. Endoscopic treatment was performed in 38 patients (17.6%), whereas only 4 patients (1.9%) were treated under laparoscopy. In Period II (2005-2007), the ratio endoscopic treatment increased significantly (24.3%, 45/153). The ratio of laparoscopic surgery increased form 1.9% to 13.0% (24/153), although the number of gastric cancer patients treated by open laparotomy was decreased (58.9% 109/185). In Period III, the ratio of laparoscopic surgery (32.0% 49/153) was markedly increased compared to Periods I & II, while increase in the ratio of endoscopic treatment was limited (52/153 34.0%). because application of endoscopic treatment was limited to the gastric cancer within themucosa. This study clearly demonstrated therapeutic approach to the gastric cancer was replaced open laparotomy with endoscopic treatment and laparoscopic surgery in recent 10 years, although backgrounds of the gastric cancer were not changed.