Jung Hyun Jo

Transition zone defect associated with the response to proton pump inhibitor treatment in patients with globus sensation

Few data describing short‐term proton pump inhibitor (PPI) treatment in patients with globus sensation exist. The aim of this study was to evaluate the use of high‐resolution manometry (HRM) for predicting the response to PPI treatment in patients with globus sensation.

Clinical characteristics of long-term survivors of inoperable pancreatic cancer: An 8-year cohort analysis in Korea

Objectives Inoperable pancreatic ductal adenocarcinoma is known to have an extremely poor prognosis. Although rare, there are some patients who have unexpected long-term survival, but the reason is not yet clear. Methods A total of 482 inoperable pancreatic ductal adenocarcinoma of 1602 patients diagnosed at Severance Hospital between 2002 and 2009 were evaluated, who were selected statistically with a retrospective cohort study. They were divided into locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC). Short-term survivors (SS group) were defined as patients who survived less than 9 months with LAPC and 6 months with MPC. Patients who survived 3 times longer than the SS group were classified as long-term survivors (LS group). Predictive factors of long-survival were identified by comparing the 2 groups, and effects of these factors on survival were investigated statistically. Results In multivariate analysis, better performance status and lower CA19-9 were related to overall survival in LAPC. In MPC, younger age, better performance status, peritoneal metastasis, higher serum albumin, lower CA19-9, and CA19-9 variation were related to overall survival. Conclusions These parameters related to long-term survivors of advanced pancreatic cancer can be useful for the expectation of survival. In the near future, conjunction of these clinical factors and novel molecular biologic characteristics of individual patients can be used for the personalized therapy.

Combination Therapy with Capecitabine and Cisplatin as Second-Line Chemotherapy for Advanced Biliary Tract Cancer

Background/Aims: Palliative chemotherapy is the main treatment for advanced biliary tract cancer (BTC). However, there is a lack of established second-line chemotherapy to treat disease progression after first-line chemotherapy. We examined combination therapy with capecitabine and cisplatin for advanced BTC as a second-line regimen. Methods: We analyzed the medical records of 40 patients diagnosed with BTC who received palliative second-line chemotherapy with capecitabine and cisplatin. Results: The median overall survival from the start of second-line chemotherapy was 6.3 months. The median overall survival from diagnosis was 17.9 months. The median progression-free survival during second-line chemotherapy was 2.3 months. Nine (30%) patients experienced adverse events of grade ≥3. Eastern Cooperative Oncology Group performance score was an independent predictor of adverse events. Conclusions: Combination therapy with capecitabine and cisplatin may be an option for second-line chemotherapy in some of patients with advanced BTC.

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

AIM To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA). METHODS We retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging. RESULTS The median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01). CONCLUSION NACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.

VIPoma that arose from the rectum in a 65-year-old male patient

Dear Editor: VIPomas are rare neuroendocrine tumors that secrete vasoactive intestinal polypeptide. They are detected in 1 in 10 million people per year. VIPomas commonly are detected within the pancreas, and the majority of extrapancreatic VIPomas are neurogenic tumors. Non-neurogenic extrapancreatic VIPomas are very rare. We are going to report a patient who has rectal VIPoma with liver metastases. The 65-year-old male patient was admitted to our hospital with persistent watery diarrhea and an 8-kg weight loss for 6 months. He showed mild hypokalemia (3.3 mEq/L) and elevated 24-h urine 5-HIAA level (10.74 mg/day). Colonoscopy revealed an engorged lesion at the rectum, which was a suspected rectal SMT. In abdominopelvic CT (APCT), there was a mass in the rectum with multiple liver metastases. The metastatic lesions were unresectable because the masses were scattered in multiple lobes. Liver biopsy was performed, and metastatic neuroendocrine carcinoma was revealed in the pathology report. In immunohistochemical staining, chromogranin and synaptophysin stains were positive. We diagnosed rectal neuroendocrine tumor (NET) with liver metastasis. We proceeded with transcatheter arterial chemo-infusion to the liver metastases, and we initiated short-acting octreotide injections to improve symptoms. Diarrhea improved steadily, so we converted subcutaneous octreotide acetate to long-acting octreotide acetate. After 1 month, the patient received etoposide/cisplatin chemotherapy for nine cycles. APCT was taken every three cycles and showed stable disease. The patient remained in good physical condition throughout chemotherapy, and the 24-h urine 5-HIAA level decreased (0.1 mg/day). After a year, the patient was admitted again due to severe diarrhea. The patient had suffered from general weakness and immense watery diarrhea. Biochemical examination revealed metabolic acidosis (pH 7.266; HCO3, 7.8 mEq/L), hypokalemia (2.0 mEq/L), and elevated urea (50.2 mg/dL) and creatinine (2.17 mg/dL). Progression of liver metastases and newly developed mesentery metastases were seen in APCT. Urine 5-HIAAwas elevated (9 mg/dL). The findings indicated a presumptive diagnosis of watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome. At that time, the blood level of VIP was needed to diagnose VIPoma, but it was unavailable due to the patients refusal of examination because of the cost. Patients should receive massive hydration and electrolyte replacement. We converted long-acting octreotide to a shortacting agent. The WDHA syndrome seemed to subside temporarily, but massive watery diarrhea appeared repeatedly. We used interferon-α subcutaneous injections, but there was no effect. Urine 5-HIAA (10.2 mg/dL) and serum chromogranin A (257.45 U/mL) were at elevated levels. We applied everolimus daily for 3 months. Still, the WDHA syndrome did not improve. APCT showed increased liver metastases, and serum chromogranin Awas further elevated (544.65 U/mL). Subsequently, we administered Adriamycin/5-FU chemotherapy. However, symptoms continued, J. H. Jo : S. Lim :M. S. Han : I. R. Cho : J. B. Ahn : J. K. Roh : S. J. Shin (*) Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, South Korea e-mail: ssj338@yuhs.ac

Efficacy and treatment-related adverse events of gemcitabine plus nab-paclitaxel for treatment of metastatic pancreatic cancer in Korean population: A single-center cohort study

Pancreatic cancer has poor prognosis because of its rapid progression and treatment resistance. Based on the results of the Metastatic Pancreatic Adenocarcinoma Clinical Trial (MPACT), a combination regimen of gemcitabine with nab-paclitaxel is currently used as standard therapy for the treatment of metastatic pancreatic cancer. However, because studies in Asian populations are lacking, we investigated the treatment efficacy and safety of this combination therapy in Korean population. Patients with metastatic pancreatic cancer (n=81) treated with gemcitabine and nab-paclitaxel (1,000 and 125 mg/m2, respectively) as the first-line chemotherapy from January 2016 were identified using the Severance Hospital Pancreatic Cancer Cohort Registry. Treatment efficacy and treatment-related adverse events (AEs) were analyzed. The median follow-up period was 10.7 months (range, 1.5-23.3 months). Median overall survival, progression-free survival, and objective response rates were 12.1 months (95% confidence interval [CI], 10.7-not estimable), 8.4 months (95% CI, 5.0-11.8), and 46.9%, respectively. The incidence of grade ≥3 neurotoxicity and neutropenia were 18.5% and 46.9%, respectively. Febrile neutropenia and grade ≥3 gastrointestinal AEs occurred in 13 (16.0%) and 16 (19.8%) patients, respectively. Dose reductions because of AEs were required in 60.5% of patients. The combination of gemcitabine with nab-paclitaxel is an effective anti-cancer regimen in Korean population of patients with metastatic pancreatic adenocarcinoma. However, careful monitoring and management are required because of occurrence of treatment-related AEs.

Rediscover the clinical value of small intestinal bacterial overgrowth in patients with intestinal Behçet's disease

Many patients with intestinal Behçets disease (BD) still suffer from gastrointestinal symptoms despite the disease being in endoscopic or radiological remission. Previous studies report that small intestinal bacterial overgrowth (SIBO) can be associated with inflammatory bowel disease. However, there have been no reports about SIBO in patients with intestinal BD. We sought to identify the frequency of SIBO in patients with inactive intestinal BD by hydrogen breath test (HBT) and to investigate the efficacy of rifaximin as a treatment for SIBO.

Clinical characteristics of second primary pancreatic cancer

Purpose Several studies reported the increased risk of second primary pancreatic ductal adenocarcinoma (2nd PDAC) in cancer survivors. However, data on the characteristics of 2nd PDAC are insufficient. Methods This retrospective cohort study included 1759 patients with PDAC. They were classified as having 2nd PDAC or first primary PDAC (1st PDAC) according to a prior diagnosed cancer of different origin, at least 6 months before PDAC diagnosis. Results There were 110 patients (6.4%) with 2nd PDAC and 1606 (93.6%) patients with 1st PDAC. Patients with 2nd PDAC presented with older age (66.5 vs. 62.2 years, p < 0.001) and higher rate of resectability (26.4% vs. 15.9%, p = 0.004) at diagnosis than those with 1st PDAC. Multivariate analysis without considering resectable status showed that 2nd PDAC (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56–0.94, p = 0.016) was associated with better overall survival. After adjusting for resectable status, however, 2nd PDAC (HR 0.85, 95% CI 0.66–1.09, p = 0.198) was no longer associated with overall survival. When subgroups were separately analyzed according to initial treatment modality, the effectiveness of surgery and chemotherapy were similar between 2nd and 1st PDAC (33.1 vs. 28.5 months, p = 0.860 and 10.8 vs. 10.7 months, p = 0.952). Conclusions The proportion of resectable cases was significantly higher in 2nd PDAC. When surgery with curative aim was possible, the overall survival was increased even in patients with 2nd PDAC. These results suggest the importance of screening for second primary cancer in cancer survivors.