Eun Taek Park

Hepatitis C virus (HCV) genotypes and the influence of HCV subtype 1b on the progression of chronic hepatitis C in Korea: a single center experience

Background/Aims There is some controversy regarding whether or not hepatitis C virus (HCV) subtype 1b is more influential than non-1b subtypes on the progression of chronic hepatitis (CH) C to liver cirrhosis (LC) and hepatocellular carcinoma (HCC). Methods We retrospectively analyzed 823 patients with chronic HCV infection, including 443 CH patients, 264 LC patients, and 116 HCC patients, who were HCV RNA positive and HBsAg negative. These patients had not received any prior treatment with either interferon alone or a combination of interferon and ribavirin. Results HCV subtypes 1b (51.6%) and 2a/2c (39.5%) were the two most common genotypes. The proportions of genotypes 2 (2a/2c, 2b, and 2) and 3 were 45.8% and 1.1%, respectively. One case of genotype 4 was found. HCV subtype 1b (47.3%) was less common than the non-1b subtypes (52.7%) in non-LC patients, but its proportion (56.9%) was higher than that of non-1b subtypes (43.1%) in LC patients (P=0.006). The proportions of patients with HCV subtype 1b did not differ significantly between the LC (55.3%) and HCC (60.3%) groups. Older age, male gender, and the relative progression of liver damage (non-LC vs. compensated LC vs. decompensated LC) were significant risk factors for HCC, with odds ratios of 1.081 (95% confidence interval [CI], 1.056-1.106), 5.749 (95% CI, 3.329-9.930), and 2.895 (95% CI, 2.183-3.840), respectively. HCV subtype 1b was not a significant risk factor for HCC (odds ratio, 1.423; 95% CI, 0.895-2.262). Conclusions HCV subtypes 1b and 2a/2c were the two most common HCV genotypes. HCV subtype 1b seemed to be more influential than non-1b subtypes on the progression of CH to LC, but not on the development of HCC from LC.

Prognostic Validity of the American Joint Committee on Cancer and the European Neuroendocrine Tumors Staging Classifications for Pancreatic Neuroendocrine Tumors: A Retrospective Nationwide Multicenter Study in South Korea.

Objectives Pancreatic neuroendocrine tumors (pNETs) are diverse diseases with different prognosis. The American Joint Committee on Cancer (AJCC) and the European Neuroendocrine Tumor Society (ENETS) introduced 2 different tumor node metastasis (TNM) stages, and the World Health Organization (WHO) proposed WHO 2010 grading system for pNETs. Therefore, we aimed to validate the prognostic relevance of these 3 systems for pNETs in South Korea. Methods The Korean Society of Gastrointestinal Cancer created a retrospective registry of pNETs in 153 patients from 15 hospitals between 2002 and 2012. Results On the basis of the WHO 2010 grade, 2-year progression-free-survival (PFS) rates for G1, G2, and G3 were 92%, 62%, and 25% (P < 0.01). According to ENETS and AJCC staging, 2-year PFS rates for stages I through IV were 94%, 87%, 49%, 20%, and 92%, 61%, 60%, 20%, respectively (P < 0.01). A Cox multivariate regression analysis revealed that the only statistically significant prognostic factor was the TNM classification of either the AJCC or the ENETS stage (P < 0.01). In addition, the &kgr; value between the AJCC and the ENETS stages was 0.46 indicating a “moderate” agreement (P < 0.01). Conclusions The AJCC and ENETS TNM classifications for pNETs are prognostic for PFS and can be adopted in clinical practice in South Korea.

Efficacy of Magnesium Trihydrate of Ursodeoxycholic Acid and Chenodeoxycholic Acid for Gallstone Dissolution: A Prospective Multicenter Trial.

Background/Aims Cholecystectomy is necessary for the treatment of symptomatic or complicated gallbladder (GB) stones, but oral litholysis with bile acids is an attractive alternative therapeutic option for asymptomatic or mildly symptomatic patients. This study was conducted to evaluate the efficacy of magnesium trihydrate of ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) on gallstone dissolution and to investigate improvements in gallstone-related symptoms. Methods A prospective, multicenter, phase 4 clinical study to determine the efficacy of orally administered magnesium trihydrate of UDCA and CDCA was performed from January 2011 to June 2013. The inclusion criteria were GB stone diameter ≤15 mm, GB ejection fraction ≥50%, radiolucency on plain X-ray, and asymptomatic/mildly symptomatic patients. The patients were prescribed one capsule of magnesium trihydrate of UDCA and CDCA at breakfast and two capsules at bedtime for 6 months. The dissolution rate, response rate, and change in symptom score were evaluated. Results A total of 237 subjects were enrolled, and 195 subjects completed the treatment. The dissolution rate was 45.1% and the response rate was 47.2% (92/195) after 6 months of administration of magnesium trihydrate of UDCA and CDCA. Only the stone diameter was significantly associated with the response rate. Both the symptom score and the number of patients with symptoms significantly decreased regardless of stone dissolution. Adverse events necessitating discontinuation of the drug, surgery, or endoscopic management occurred in 2.5% (6/237) of patients. Conclusions Magnesium trihydrate of UDCA and CDCA is a well-tolerated bile acid that showed similar efficacy for gallstone dissolution and improvement of gallstone-related symptoms as that shown in previous studies.

Barriers to treatment of failed or interferon ineligible patients in the era of DAA: single center study

Background/Aims Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs) have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR) rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs. Methods Medical records of patients with positive serum anti-hepatitis C virus (HCV) or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis. Results A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16%) of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse) and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems). Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7%) could not be treated with DAA due to financial, social, or cancer-related conditions. Conclusions Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.

Endoscopic Retrograde Cholangiopancreatography in Bilioenteric Anastomosis

For diagnosis and treatment of pancreatobiliary diseases, endoscopic retrograde cholangiopancreatography (ERCP) is useful method nowadays and its technically success rate is usually in about 90%-95% of patients with normal gastric and pancreaticobiliary anatomy. Recently ERCP is significantly challenging after intestinal reconstruction, particularly in patients who have undergone pancreaticoduodenectomy (PD, classic Whipple’s operation) or pylorus-preserving pancreatoduodenectomy (PPPD) with reconstruction. PD and PPPD relate to numerous techniques have been presented for reconstruction of the digestive tract and pancreaticobiliary tree during the resection bilioenteric stricture commonly occurs later in the postoperative course and developed in 5-year cumulative probability of biliary stricture rate of 8.2% and pancreaticoenteric stricture of 4.6%. This complication was no difference in incidence between patients with benign or malignant disease. In PD or PPPD with reconstruction, short pancreatobiliary limb with biliojejunal anastomosis site is made usually, modestly success rate of intubation to blind loop and cannulation with conventional endoscope. However, in combined Reux-en-Y anastomosis, longer pancreatobiliary limb and additional Reux limb are obstacle to success intubation and cannulation by using conventional endoscope. In this situation, new designed enetroscope with dedicated accessories is efficient.

Endoscopic Retrograde Cholangiopancreatography during Pregnancy: Really Guarantee to Safety?

Acute cholangitis and biliary pancreatitis caused by bile duct stones are not infrequently develop during pregnancy, they can cause serious complications and wastage for both mother and fetus.1 For pancreaticobiliary diseases in pregnancy, endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective alternative to surgery.2 During the procedure, radiation exposure is essentially develop on patient and subsequently exposed to the fetus can result in unpredictable future. These can bring a vague anxiety for patients and operators with regard to the procedure.3 In this issue of Gut and Liver, Lee et al.4 present that ERCP during pregnancy is relatively safe based on check the abnormality of the fetus in the relatively long-term follow-up period after the procedure and major complications associated with the procedure has not occurred. In addition, authors study shows that the ancillary diagnosis using endoscopic ultrasound (EUS) make a more safe and secure to help ERCP procedure when the patient complaint the symptoms obviously with difficult to diagnose the definitive cause. Also the study shows that just applying the shortening the procedure time, pregnant women to wear protectors and small amount of radiation exposure using the method of reducing the radiation exposure of the fetus, whereby they are possible to reach below the level of the international standards for exposure cause a serious problem. According to recently published papers related to the ERCP in the event that the radiation exposure of the fetus, the radiation dose to the fetus exposed is decreased through detailed and attentive care.5,6 That is, limit X-ray beam on-time, limit the number of recorded images acquired and adjust the patient position (supine, prone, or lateral) to minimize fetal exposure. According to published articles,7–9 some authors reported removed common bile duct stones with two-step ERCP for pregnant women according to the stage of pregnancy. If the patients were in late pregnancy, the stones were removed through a second ERCP after the pregnancy was terminated. If the patients were in early or mid-pregnancy, they underwent endoscopic retrograde biliary drainage and continued gestation. Their stents and stones were removed through a third ERCP 1 week after parturition, whereas others reported sphincterotomy with removing bile duct stone during the first ERCP procedure. The two groups were all safe procedures on maternal and fetal status and they did not show statistically significant complication rate related to procedure compare to nonpregnant group. In particular, sphincterotomy itself is secure whether or not the drain tube can be inserted and that significant results are reported to help preventing recurrent cholangitis and biliary pancreatitis. In case of the patients are constantly complaining of biliary pain after performing ERCP, if the cause is confident to face the gallbladder or acute cholecystitis, undergo preventive cholecystectomy is reasonable. In contrast, the gallbladder stones without symptoms, first trimester and bile duct obstruction with stricture itself are recommended to delay surgery. In other words, we should apply in more stringent indications, rather than just indications of cholecystectomy applied in the non-pregnant group.10 If you plan to diagnostic ERCP with treatment due to doubt situation, it will be needed to longstanding procedure time, post-ERCP severe acute pancreatitis and eventually develop maternal and fetal risk. We should use nonradiation exposure techniques for the diagnosis of biliary stones such as EUS, magnetic resonance cholangiopancreatography, and EUS appropriately, thereby it is very important to know whether the ERCP indications are secure.11 In conclusion, ERCP for pancreatobiliary disease during pregnancy can be safe and effective procedure regardless of the period of pregnancy. The using guidelines related to radiation exposure protection in this study are to meet current several international standard recommendations.

Sa1189 Utilizing Intrabolus Pressure and EGJ Relaxation Pressure to Predict Esophageal Bolus Transit in Dysphagia Patients

of the segmental length among the striatedmuscle segment, proximal smoothmuscle segment, and distal smooth muscle segment. While the pressure volume of the proximal segment was significantly higher in the positive responders than the negative responders (900.4 ± 91.5 mmHg cm(-1) s(-1) vs. 780.5 ± 133.3 mmHg cm(-1) s(-1), p = 0.017), the pressure volume of the distal segment was significantly lower in the positive responders (1914.0 ± 159.8 mmHg cm(-1) s(-1)vs. 2140.5 ± 276.2 mmHg cm(-1) s(-1), p = 0.014). A prominent shifting in pressure volume to the distal segment was observed in the negative responders compared to the positive responders (segmental ratio of pressure volume (SRPV): 2.9 ± 0.5 vs. 2.1 ± 0.1, p < 0.001), and 2.39 was found to be the SRPV that best differentiated positive and negative responders (area under curve, 0.88; 95% confidence intervals, 0.71-0.97; p < 0.001). On the other hand, there was no significant difference between the groups in the segmental ratios regarding segmental length and maximal wave amplitude. CONCLUSIONS: A low SRPV was associated with a positive response to high-dose PPI treatment in patients with FCP.