H.-B. Oh

New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection

BACKGROUNDnCystic tumors of the pancreas are frequently detected and encompass a wide pathologic spectrum, ranging from benign to malignant. A substantial proportion of cystic tumors cannot be histologically classified, even after extensive diagnostic evaluation, and, therefore, ultimately require surgical resection. Recently, complete resolution of cystic tumors by EUS-guided ethanol lavage was reported in a pilot study.nnnOBJECTIVESnThe aim of this study was to evaluate the safety, feasibility, and response after EUS-guided ethanol lavage with paclitaxel injection (EUS-EP) for cystic tumors of the pancreas.nnnDESIGNnA prospective study.nnnSETTINGnA tertiary care, academic medical center, from July 2005 to November 2006.nnnPATIENTSnFourteen patients who underwent EUS-EP were observed for more than 6 months. They were analyzed in terms of procedure safety, feasibility, and response.nnnINTERVENTIONnEUS-EP.nnnMAIN OUTCOME MEASUREMENTSnTo compare changes of cyst volume before and after an EUS-EP.nnnRESULTSnAn EUS-EP was successfully performed in all cases except one patient in whom the cyst fluid was so viscous that it could not be sufficiently aspirated. Acute pancreatitis occurred in one patient, and minor complications, including hyperamylasemia (n = 6) and vague abdominal pain (n = 1), were observed. Complete resolution of a cystic tumor was observed in 11 patients and partial resolution in two patients, and a cyst persisted in one patient.nnnLIMITATIONSnA small patient number, a short follow-up time, a single treatment arm.nnnCONCLUSIONSnEUS-EP appears to be a safe, feasible, and effective method for treating cystic tumors of the pancreas. Further studies that involve larger populations and longer follow-ups are warranted.

Hepatitis B Virus Infection and Intrahepatic Cholangiocarcinoma in Korea: A Case-Control Study

OBJECTIVES:There is a wide variation in risk factors for intrahepatic cholangiocarcinoma (ICC) among various populations. Several studies have suggested that hepatitis C virus (HCV) infection may play a role in the development of ICC, whereas the role of hepatitis B virus (HBV) infection is less clear.METHODS:To determine whether HBV or HCV infection is a risk factor of ICC, we compared baseline demographic and clinical factors in 622 patients diagnosed between 2000 and 2004 with histologically confirmed ICC and 2,488 healthy controls, matched 4:1 with ICC patients for sex and year of birth.RESULTS:HBV infection (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.6–3.3), but not HCV infection, was significantly related to ICC. Other significant risk factors for ICC included liver cirrhosis (OR 13.6), heavy alcohol consumption (OR 6.6), diabetes (OR 3.2), Clonorchis sinensis infection (OR 13.6), hepatolithiasis (OR 50.0), and choledochal cysts (OR 10.7).CONCLUSIONS:Our results indicate that development of ICC seems to be more closely related to HBV infection than to HCV infection in Korea, where both HBV and ICC are endemic.

Cystic Lesions of the Pancreas: Challenging Issues in Clinical Practice

Cystic lesions of the pancreas are being recognized with increasing frequency and have become a common finding in clinical practice. Cystic lesions of the pancreas display a wide spectrum of histopathology and biologic behavior. Differentiating among lesions and choosing an optimal therapy is challenging, and evidence-based guidelines for diagnosis, management, and follow-up for cystic lesions of the pancreas are needed. This review describes the epidemiology and typical features of cystic lesions of the pancreas, including a summary of commonly used descriptive terms, as well as the primary issues in the differential diagnosis and management of these lesions.

The Usefulness of Percutaneous Transhepatic Cholangioscopy for Identifying Malignancies in Distal Commom Bile Duct Strictures

The diagnostic accuracy of percutaneous transhepatic cholangioscopy (PTCS) was compared to that of three radiologic modalities in distal common bile duct (CBD) strictures for the evaluation of clinical application. Ninety-five patients who underwent PTCS for the evaluation of distal CBD strictures (35 malignant and 60 benign) whose masses were not obvious from radiologic imagings were included. Confirmative diagnosis could not be reached by endoscopic retrograde cholangiopancreatography (ERCP) or radiologic findings in all cases. Specific findings on the computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and direct cholangiography were analyzed among 68 (25 malignant and 43 benign) out of the 95 patients in order to determine the sensitivity and specificity of three radiologic studies for the diagnosis of malignant distal CBD strictures, and to compare those results with those by a combination of PTCS-guided biopsy and tumor vessel observation on cholangioscopy. The sensitivity/specificity of CT, MRCP and direct cholangiography including ERCP in diagnosing malignant distal CBD strictures were 42.9%/65.8%, 53.3%/58.3%, and 70.8%/47.6% respectively, while it was 96%/100% for the combination of PTCS-guided biopsy and tumor vessel. PTCS is a useful method for differential diagnosis of distal CBD strictures, particularly when it is difficult to distinguish benign from malignant strictures by radiologic studies and when peroral approach is not feasible.

Clinicopathological Aspects of 542 Cases of Pancreatic Cancer: a Special Emphasis on Small Pancreatic Cancer

Small pancreatic cancers (longest diameter ≤2 cm) have been regarded as preliminary to early pancreatic cancer, which was thought to be highly curable. During our experience since 1989, we evaluated 542 cases of pancreatic cancer. Among them we found 74 cases of tumors ≤2 cm in diameter, small pancreatic cancer (TS1 pancreatic cancer). Well-differentiated adenocarcinomas (18.9%) and absence of symptoms (8.1%) were more frequent in patients with TS1 than in those with larger pancreatic tumors. Only 16 of the 74 patients (21.6%) with small pancreatic cancers had T1 tumors. According to the International Union Against Cancer (UICC) staging, only 11 patients (14.9%) were stage IA: their 5-yr survival rate was 23.3% and their median survival was 30.0 months. Among these 11 patients, 3 had tumors <1 cm; their median survival time was 30.0 months and their 5-yr survival rate was 50.0%. These findings may indicate that small pancreatic cancer is not equivalent to early pancreatic cancer.

A new HLA-A*02 allele, A*02:465

The new allele A*02:465 showed one nucleotide difference with A*02:06:01 (172G>A).

Three novel HLA alleles discovered in Koreans, HLA-A*26:118, DQB1*02:65 and DPB1*05:01:07

Three novel HLA alleles, HLA‐A*26:118, DQB1*02:65 and DPB1*05:01:07, were identified and confirmed by monoallelic sequencing.

Identification of the novel HLA-C*03 allele, HLA-C*03:03:35

The new allele HLA‐C*03:03:35 showed one nucleotide difference with C*03:03:01:01 at position 408 (G>T).

A new HLA-DQB1*04 allele, HLA-DQB1*04:01:05, identified in a Korean individual

HLA‐DQB1*04:01:05 differs from DQB1*04:01:01 by a single nucleotide substitution at codon 30 (TAC>TAT).

Four novel alleles in Korean individuals, HLA-B*40:323, DRB1*14:177, DQB1*03:200, and DQB1*06:205.

Four novel HLA alleles identified in Korean individuals and confirmed by monoallelic sequencing.