Min Dae Kim

Abdominal Wound Metastasis after Laparoscopic Surgery of Gastrointestinal Stromal Tumor

Surgical resection is the mainstay treatment for gastrointestinal stromal tumors (GISTs). Laparoscopic surgery can be considered for treating these tumors since their biologic behavior lends them to curative resection without requiring large margins or extensive lymphadenectomy. Despite complete resection, GISTs frequently recur specifically in the liver and peritoneum. Although they occur in other upper gastrointestinal malignancies, recurrences of GISTs at the port sites after laparoscopic surgery have rarely been reported. We describe here a patient with abdominal wound metastasis after laparoscopic surgery for GIST.

Double layered self-expanding metal stents for malignant esophageal obstruction, especially across the gastroesophageal junction

AIM To evaluate the clinical outcomes of double-layered self-expanding metal stents (SEMS) for treatment of malignant esophageal obstruction according to whether SEMS crosses the gastroesophageal junction (GEJ). METHODS Forty eight patients who underwent the SEMS insertion for malignant esophageal obstruction were enrolled. Patients were classified as GEJ group (SEMS across GEJ, 18 patients) and non-GEJ group (SEMS above GEJ, 30 patients) according to SEMS position. Double layered (outer uncovered and inner covered stent) esophageal stents were placed. RESULTS The SEMS insertion and the clinical improvement were achieved in all patients in both groups. Stent malfunction occurred in seven patients in the GEJ group and nine patients in the non-GEJ group. Tumor overgrowth occurred in five and eight patients, respectively, food impaction occurred in one patient in each group, and stent migration occurred in one and no patient, respectively. There were no significant differences between the two groups. Reflux esophagitis occurred more frequently in the GEJ group (eight vs five patients, P = 0.036) and was controlled by proton pump inhibitor. Aspiration pneumonia occurred in zero and five patients, respectively, and tracheoesophageal fistula occurred in zero and two patients, respectively. CONCLUSION Double-layered SEMS are a feasible and effective treatment when placed across the GEJ for malignant esophageal obstruction. Double-layered SEMS provide acceptable complications, especially migration, although reflux esophagitis is more common in the GEJ group.

Sa1147 Efficacy of Second-Look Endoscopy After Endoscopic Hemostasis in Acute Peptic Ulcer Bleeding : Risk Factor Analysis of Recurrent Bleeding

G A A b st ra ct s stage IV. RESULTS: All pancreatic tumors were visualized by HIFU ultrasound monitor system. Treatment data in Stage III and IV were followed; mean tumor size was 31.8 vs 30.1 mm, mean treatment sessions: 2.6 vs 2.7 times, mean total treatment time: 2.7 vs 2.2 hours, mean total number of irradiation: 2801 vs 1769, respectively. There was no significant difference in treatment data between two groups. The effects of HIFU therapy in Stage III and IV were the following; the rate of complete tumor ablation was 87.5 vs 71.4%, the rate of symptom relief effect was 80 vs 56%, the effectiveness of primary lesion was CR:0, PR:2, SD:13, PD:1 vs CR:0, PR:2, SD:10, PD:2, and primary disease control rate (DCR) more than SD was 93.8% vs 78.6%. Mean survival time (MST) after HIFU therapy was 14.1 vs 7.2 month, respectively (p,0.01, p=0.0009). MST after diagnosis as PC was 32.4 vs 14.8 month, respectively (p,0.01, p=0.002). Combination therapy of HIFU with chemotherapy in Stage III was better result than common GEM single agent chemotherapy in our hospital. (MST: 14.9month). CONCLUSION: This study suggested that HIFU therapy has the potential of new method of combination therapy for non-metastatic PC.