Young Soo Moon

Review of 67 patients with autoimmune pancreatitis in korea: A multicenter nationwide study

Objectives: The ideal diagnostic criteria of autoimmune pancreatitis (AIP) are still challenging. Therefore, we investigated the clinical features of AIP in Korea and assessed the clinical use of new Korean diagnostic criteria. Methods: We reviewed 67 patients with AIP enrolled in 16 hospitals via a multicenter study. The diagnosis was confirmed according to the Korean diagnostic criteria that included pancreatic imaging, laboratory findings, histopathology, and response to steroid. Results: Mean age of the patients was 56 years, and 73% were men. Obstructive jaundice (52%) was the most common symptom, and 14 patients (21%) had other organ involvement. Fifty-four patients (81%) revealed diffuse swelling of the pancreas. Either immunoglobulin (Ig)G or IgG4 was elevated in 76%. According to the Korean criteria, 65 patients had definite diagnostic criteria, and 2 patients had probable criteria. Fifteen patients were fulfilled with image, serological, and histopathologic criteria, and 4 patients could be diagnosed with image and steroid responsiveness. Ten patients experienced recurrent attacks of AIP during the mean 20-month follow-up. Conclusions: Among 67 cases of AIP, either IgG or IgG4 was elevated in 76% of patients, and 14 patients (21%) had other organ involvement. New Korean diagnostic criteria are useful for diagnosis of AIP.

The efficacy and safety of carbon dioxide insufflation during colonoscopy with consecutive esophagogastroduodenoscopy in moderately sedated outpatients: a randomized, double-blind, controlled trial.

Goals and Background: Colonoscopy with consecutive esophagogastroduodenoscopy (CCEGD) can be more convenient than performing each procedure individually. There has been no randomized controlled trial comparing carbon dioxide (CO2) versus air insufflations during CCEGD in sedated patients. CO2 insufflation instead of air during CCEGD may reduce abdominal pain and be more comfortable. We investigated the efficacy and safety of CO2 insufflation during CCEGD in moderately sedated outpatients. Study: This was a randomized, double-blind, controlled trial. A total of 96 outpatients were randomly assigned to the groups of CO2 or air insufflation. Postprocedure pain was assessed using a 0 to 10 visual analogue scale, and the proportion of pain-free patients was compared between the groups. Waist circumferences and end-tidal CO2 (ETCO2) were measured. Results: Among 96 patients, cecal intubation failed in 2 patients, who were excluded from the analysis. Forty-eight patients in the CO2 and 46 patients in the air group completed the study. There was significant difference between the 2 groups regarding the proportion of pain-free patients 30 minutes after the procedures [air group, 35/46 (76.1%) vs. CO2 group, 44/48 (91.6%)] (P=0.03). However, there was no significant difference in the proportion at 6 and 24 hours after the procedures. The mean increase in waist circumference was greater with air than with CO2 (1.54 vs. 0.18 cm, P<0.001). The ETCO2 measured immediately after the procedures was slightly higher in the CO2 group than in the air group (38.6 vs. 37.2 mm Hg, P=0.02), but the values were within the normal range. No significant adverse events occurred. Conclusions: CO2 insufflation during CCEGD reduced postprocedural pain and distension compared with air. It was comfortable and safe to use in moderately sedated outpatients.

Determination of the optimal time for premedication with pronase, dimethylpolysiloxane, and sodium bicarbonate for upper gastrointestinal endoscopy.

Goals and Background: Premedication with pronase, dimethylpolysiloxane, and sodium bicarbonate improves visibility during upper gastrointestinal (UGI) endoscopy. However, the optimal time for this combination to take effect is unknown. We investigated the optimal time of pre-UGI endoscopy medication. Study: A randomized, investigator-blind, controlled trial. The 300 patients who were to receive premedication were randomized into 3 groups according to the following medication time before UGI endoscopy: 10 minutes (group A, n=98), 10 to 30 minutes (group B, n=97), and 30 minutes premedication (group C, n=99). Visibility scores (range, 1 to 4, with lower scores indicating better gastric mucosal visibility) were assessed for the antrum, lower body, upper body, and fundus and compared, including the sum of the scores, between the 3 groups. Results: Group B had significantly lower visibility scores for the lower body, upper body, and fundus than group C (P=0.001, 0.009, and 0.002, respectively). Group A obtained significantly lower scores for the antrum and lower body than group C (P=0.007 and 0.005, respectively). The total visibility scores of groups A and B were significantly lower compared with those of group C (P=0.001, 0.003, respectively). Conclusions: Administration of pronase, dimethylpolysiloxane, and sodium bicarbonate within 30 minutes before UGI endoscopy significantly improved endoscopic visualization. However, the optimal time to achieve the best visibility was between 10 to 30 minutes before UGI endoscopy.

Obesity, insulin resistance, and the risk of an elevated alanine aminotransferase activity in the Korean adolescent population.

Abstract Background: It is unclear to what extent insulin resistance (IR) modulates the association linking obesity to alanine aminotransferase (ALT) activity elevation. Methods: We measured the homeostatic model assessment for IR (HOMA-IR) in 1591 participants aged 12–18 years from the 2008 to 2009 Korea National Health and Nutrition Examination Survey. Results: Overweight adolescents had an odds ratio of 7.23 [95% confidence interval (95% CI), 4.33–12.10] for an elevated ALT activity compared with normal-weight adolescents, and the corresponding risk was 23.62 (95% CI, 12.98–42.98) in obese adolescents. Adjustments for other participant factors did not substantially affect the results. The addition of the HOMA-IR data decreased the estimate for overweight adolescents by 27% and for obese adolescents, the decrease was 47%. Both obesity and IR markers remained independent predictors of outcome. Conclusions: The greater the obesity level, the more that IR contributes to the association between obesity and an elevated ALT activity.

Shorter waiting times from education to colonoscopy can improve the quality of bowel preparation: A randomized controlled trial

BACKGROUND/AIMSnAdequate bowel preparation is essential for an effective and safe colonoscopy. This study aimed to evaluate the quality of bowel preparation according to waiting times from education to colonoscopy.nnnMATERIALS AND METHODSnA prospective, investigator-blinded, randomized study was performed from December 2016 to March 2017. Patients were divided into two groups: within 2 weeks (group A, n=64) or more than 2 weeks (group B, n=66) from education about bowel preparation to colonoscopy. The primary outcome was the quality of bowel preparation as assessed by the Boston Bowel Preparation Scale (BBPS). The secondary outcome was the polyp and adenoma detection rate.nnnRESULTSnA total of 130 patients were enrolled. The total BBPS score was significantly higher in group A (within 2 weeks from education to colonoscopy) than in group B (more than 2 weeks). Total BBPS scores were 8.25x81}0.97 in group A and 7.75x81}1.32 in group B (P=.017). The rate of good preparation (BBPS≥8) was higher in group A than in group B (78.1% vs. 59.1%, P=.020). The rates of polyp and adenoma detection were both slightly higher in group A (polyps, 42.2% vs. 38.5%, P=.667; adenoma, 31.2% vs. 22.7%, P=.275). A numerical trend was observed for the slightly superior polyp and adenoma detection rate in group A, but it was not statistically significant.nnnCONCLUSIONnThis study demonstrated that shorter waiting times from education to colonoscopy can improve the quality of bowel preparation. Ensuring sufficient staff and equipment for endoscopy is one approach to reducing waiting times to colonoscopy. If waiting times can not be reduced, more contact through telephone, e-mail, and text messaging could be used to remind patients about information regarding bowel preparation.

Predictors of High-Risk Adenoma Occurrence at Surveillance Colonoscopy in Patients Who Undergo Colorectal Adenoma Removal

Objectives: Surveillance colonoscopy is recommended after polypectomy because adenoma recurrence is common. The aim of this study was to evaluate the predictors of high-risk adenoma occurrence at surveillance colonoscopy in patients who undergo colorectal adenoma removal and to clarify the association between age and recurrent colorectal adenoma. Methods: This retrospective study included 563 patients who had colorectal adenomas at baseline colonoscopy and who underwent surveillance colonoscopy. The risk factors for recurrent adenoma were evaluated and the 5-year cumulative incidence rates of overall and high-risk adenoma were compared according to age group. Results: During a mean follow-up period of 3.1 years, 305 (54.2%) patients had overall adenoma recurrence, and 80 (14.2%) patients had high-risk adenoma at surveillance colonoscopy. In a multivariate analysis, old age (≥60 years) and presence of multiple adenomas (3 or more) were significantly associated with high-risk adenoma (p = 0.002 and p = 0.006 respectively). The 5-year cumulative incidence rates of high-risk adenoma were 7.4, 16.7, and 24.1% in the < 50, 50–59, and ≥60 years group respectively (p < 0.001). Conclusions: Old age (≥60 years) and presence of multiple adenomas (3 or more) were strongly associated with the occurrence of high-risk adenoma at surveillance colonoscopy. The 5-year cumulative incidence of high-grade adenoma was significantly high in the old age group.

The Effectiveness of Personalized Bowel Preparation Using a Smartphone Camera Application: A Randomized Pilot Study

Background We aimed to investigate the effectiveness of a smartphone application that analyzes and judges the optimal dosage of polyethylene glycol (PEG) for bowel preparation. Methods Patients were assigned to use the smartphone camera application (app group) or written instructions (non-app group). The smartphone camera application was programmed to analyze the bowel preparation quality and automatically determine the dosage of PEG from an analysis of stool images. In contrast, the non-app group consumed PEG solution according to the manual. Results The primary outcome was the quality of the bowel preparation based on blinded ratings using the Ottawa bowel preparation scale (OBPS). There was no statistically significant difference in the mean OBPS scores between the two groups (P = 0.950). However, the app group consumed a lower dose of PEG than the non-app group (mean dosage (mL): 3713.2u2009±u2009405.8 versus 3979.2u2009±u2009102.06, P = 0.001). The app group (5-point Likert scale; mean score 4.37u2009±u20090.895) had high acceptance of the application. Conclusions Although the app group consumed a lower PEG dose, the bowel preparation quality was similar in the two groups. Moreover, use of the smartphone camera application enhanced compliance with the bowel preparation.

Features of intraductal papillary mucinous neoplasm presenting as acute pancreatitis

s / Pancreatology 13 (2013) S1–S80 S57 Jong-Jae Park , Hong Sik Lee , Chang Duck Kim , Young-Tae Bak , Jae Seon Kim 1 Gastroenterology, Korea University Guro Hospital, Seoul, South Korea Gastroenterology, Korea University Anam Hospital, Seoul, South Korea Background/aim: Although pancreatic cystic neoplasm (PCNs) is a surgical indication, the decision for surgery is still very difficult especially in elderly patients. The aim of this study was to elucidate the clinical outcome of PCNs in patients with 65 years or older. Methods: Patients with follow-up duration > 1 year for incidentally detected PCNs between January 2005 and December 2009 were included and analyzed retrospectively. Results: Total 201 patients were included (104 patients S 65 years, older group and 97 patients < 65 years, younger group). Surgical resection was done in 27 cases of the older group and 41 cases of the younger group. 133 patients were fallowed without surgery (mean fallow-up duration 1⁄4 41 months), 77 patients were the older group (mean age 1⁄4 73.3 yrs, m:f 1⁄4 46:31) and 56 patients were the younger group (mean age 1⁄4 54.6 yrs, m:f 1⁄4 32:24). Patients with the risk for malignancy were 13 cases in each group. In older group, 9 cases were fallowed without surgery due to high perioperative morbidity, and 4 cases refused surgery. In younger group, all refused surgery. Postoperative morbidity developed in 22.2% (6/27) of the older group and 21.9% (9/41) of the younger group. Malignancy after surgical resection was in 1 case of the older group and 2 cases of the younger group. The diameter of PCNs increased in 20 cases during fallow-up, 16.9% (13/77) in the older group and 12.5% (7/56) in the younger group. Among them, 4 cases of the older group and 1 case of the younger group were proved to have no cancer after operation. In other fallowed patients of both groups, neither new cancerous changes nor any PCN-related mortality developed. Conclusions: In patients over 65 years old with incidental PCNs, follow-up observation by imaging without surgery seems to be a rather safe option.