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  • Wiley  (16)
  • Park, Do Hyun  (16)
  • 1
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    Preoperative Left Portal Vein Embolization for Left Liver Resection in High‐Risk Hepatobiliary Malignancy Patients
    Wiley ; 2016
    In:  World Journal of Surgery Vol. 40, No. 11 ( 2016-11), p. 2758-2765
    Details
    In: World Journal of Surgery, Wiley, Vol. 40, No. 11 ( 2016-11), p. 2758-2765
    Abstract: Preoperative portal vein embolization (PVE) is performed for right liver (RL) and sometimes left liver (LL) resection to prevent postoperative surgical complications. Methods We retrospectively reviewed 10 patients who underwent preoperative left PVE before LL resection for hepatobiliary malignancies along with 3 propensity score‐matched control groups ( n = 40 each). Results Mean patient age was 68.6 ± 6.9 years. Diagnoses included intrahepatic cholangiocarcinoma ( n = 4), perihilar cholangiocarcinoma ( n = 3), neuroendocrine carcinoma ( n = 1), recurrent cholangiocarcinoma ( n = 1), and inflammatory liver mass ( n = 1). The reason for left PVE was a large LL 〉 40 % of the total liver volume (TLV) with a major comorbidity or age 〉 70 years with a poor overall condition. All patients underwent preplanned operations, including LL resection at 1–3 weeks post PVE. The LL volume proportion of the TLV was 44.9 ± 1.7 and 40.7 ± 2.3 % before and after PVE; thus, 1–2 weeks post PVE, the kinetic shrinkage rate of the LL was 9.4 ± 3.3 %, and the kinetic growth rate of the RL was 7.6 ± 2.7 %. The overall surgical complication rates were 40, 50, and 39.2 % in the left PVE, large LL control, and all three control groups, respectively ( p ≥ 0.727). In contrast, the adjusted rates of major complications were 0 % in the left PVE group versus 36.8 % ( p = 0.040), 25.6 % ( p = 0.123), and 15.8 % ( p = 0.295) in the large‐, medium‐, and small‐sized LL control groups, respectively. Conclusions Our experience indicates that left PVE is safe and induces atrophy of the LL effectively. We suggest that it can be a useful option to reduce the risk of postoperative complications in elderly high‐risk patients.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-016-3618-7
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 2
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    Usefulness of argon plasma coagulation ablation subsequent to endoscopic snare papillectomy for ampullary adenoma
    Wiley ; 2018
    In:  Digestive Endoscopy Vol. 30, No. 4 ( 2018-07), p. 485-492
    Details
    In: Digestive Endoscopy, Wiley, Vol. 30, No. 4 ( 2018-07), p. 485-492
    Abstract: Endoscopic snare papillectomy ( ESP ) is an effective treatment for ampullary adenoma. Argon plasma coagulation ( APC ) is widely used as an additional method to control bleeding or ablate the residual tumor. However, the efficacy of this procedure has not yet been fully evaluated. This study aimed to evaluate the usefulness of APC as an additional method to ESP . Methods Patients who underwent ESP for ampullary adenoma between September 2005 and September 2015 were retrospectively reviewed. Using propensity score matching, we compared short‐ and long‐term outcomes between the ESP ‐with‐additional‐ APC group ( ESP  +  APC group) and the ESP ‐only group. Primary outcome was early post‐ ESP adverse events ( AE ), and secondary outcomes were late AE and recurrence. Results Among 109 patients, additional APC was carried out in 59 (54.1%) patients. After matching, 41 patients were included in both groups, respectively. Bleeding rate was significantly lower in the ESP  +  APC group than in the ESP ‐only group (7.3% vs 31.7%, odds ratio = 0.180, P  〈   0.01). However, there were no significant differences in other procedure‐related early AE such as pancreatitis (12.2% vs 19.5%, P  =   0.365), cholangitis (2.4% vs 9.8%, P  =   0.198), and perforation (2.4% vs 2.4%, P  =   1.000) between the ESP  +  APC group and the ESP ‐only group. During the follow‐up period (mean 904 ± 868 days), papillary stricture (9.8% vs 4.9%, P  =   0.405) and recurrence rates (24.4% vs 24.4%, P  =   0.797) were not significantly different between the ESP  +  APC group and the ESP ‐only group. Conclusion Additional APC during ESP may have a beneficial effect by decreasing bleeding rate without harmful effects.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.2018.30.issue-4
    DOI: 10.1111/den.13008
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 3
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    Long‐term outcomes of endoscopic ultrasound‐guided gallbladder drainage versus in situ or ex situ percutaneous gallbladder drainage in real‐world practice
    Wiley ; 2023
    In:  Digestive Endoscopy Vol. 35, No. 5 ( 2023-07), p. 658-667
    Details
    In: Digestive Endoscopy, Wiley, Vol. 35, No. 5 ( 2023-07), p. 658-667
    Abstract: Many studies showed better outcomes of endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) when compared with percutaneous transhepatic gallbladder drainage (P‐GBD) in which most tubes were left in situ. However, no studies have directly compared EUS‐GBD with P‐GBD after tube removal (ex situ). We compared the long‐term outcomes of EUS‐GBD and ex situ or in situ P‐GBD in high surgical risk patients with acute cholecystitis. Methods We reviewed the records of 182 patients (EUS‐GBD, n  = 75; P‐GBD, n  = 107) who underwent gallbladder drainage. The procedural outcomes, long‐term outcomes, and adverse events were compared. Results The EUS‐GBD group and the P‐GBD group had similar rates of technical and clinical success. Early adverse events were less common in the EUS‐GBD group (5.5% vs. 18.9%, P  = 0.010). The long‐term outcomes were evaluated in 168 patients (EUS‐GBD, n  = 67; P‐GBD ex situ, n  = 84; P‐GBD in situ, n  = 17). The rate of cholecystitis recurrence in the EUS‐GBD group (6.0%) was similar to that in the P‐GBD ex situ group (9.6%, P  = 0.422), but significantly lower than that in the P‐GBD in situ group (23.5%, P  = 0.049). P‐GBD in situ was a significant predictor of recurrent cholecystitis (hazard ratio 14.6; 95% confidence interval 2.9–72.8). Conclusion The long‐term recurrence rate of acute cholecystitis in patients who underwent EUS‐GBD was comparable to that in patients whose P‐GBD could be removed. However, patients in whom P‐GBD could not be removed showed higher rates of recurrent cholecystitis than patients with EUS‐GBD.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.v35.5
    DOI: 10.1111/den.14485
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 4
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    Clinical clues to suspicion of IgG4‐associated sclerosing cholangitis disguised as primary sclerosing cholangitis or hilar cholangiocarcinoma
    Wiley ; 2010
    In:  Journal of Gastroenterology and Hepatology Vol. 25, No. 12 ( 2010-12), p. 1831-1837
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 25, No. 12 ( 2010-12), p. 1831-1837
    Abstract: Background and Aim:  This study aimed to determine the clinical characteristics of immunoglobulin G4 (IgG4)‐associated sclerosing cholangitis (ISC) and provide clinical clues differentiating ISC from primary sclerosing cholangitis (PSC) or hilar cholangiocarcinoma (CCC). Methods:  Sixteen patients with ISC manifesting as hilar/intrahepatic strictures were analyzed for clinical characteristics and compared with patients with PSC and hilar CCC as disease controls for histology and serum IgG4 levels. Results:  Distinguished biliary imaging findings of ISC included multifocal biliary tree involvement ( n  = 14), concentric bile duct thickening with preserved luminal patency ( n  = 13), and relatively mild proximal dilatation, despite prominent bile duct thickening ( n  = 11). Serum IgG4 levels were elevated in 12 patients (75%), but not in any of the 25 patients with hilar CCC. Ten patients (63%) had a past or concurrent history of autoimmune pancreatitis (AIP). The significant infiltration of IgG4‐positive cells was observed with endobiliary or liver biopsy in 11 of 16 patients (69%) with ISC, but not in any patients with PSC or hilar CCC. Extrabiliary organ involvement, including sialadenitis, inflammatory pseudotumor of the liver and kidney, and retroperitoneal fibrosis, was present in seven patients. Marked improvement of biliary strictures and/or extrabiliary involvement was observed in all ISC patients after steroid therapy. Conclusions:  ISC should be considered in the differential diagnosis of hilar/intrahepatic biliary strictures. Past or concurrent AIP or extrabiliary organ involvement strongly suggests the possibility of ISC. Significant infiltration of IgG4‐positive cells on endobiliary or liver biopsy specimens, and/or elevated serum IgG4 levels, highly support the diagnosis of ISC and provide the rationale for steroid therapy.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.2010.25.issue-12
    DOI: 10.1111/j.1440-1746.2010.06411.x
    Language: English
    Publisher: Wiley
    Publication Date: 2010
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  • 5
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    Comparison of the long‐term outcomes between proximal and distal IgG4‐related sclerosing cholangitis: A multicenter cohort study
    Wiley ; 2023
    In:  Journal of Gastroenterology and Hepatology Vol. 38, No. 4 ( 2023-04), p. 648-655
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 38, No. 4 ( 2023-04), p. 648-655
    Abstract: Immunoglobulin G4‐related sclerosing cholangitis (IgG4‐SC) is considered a biliary manifestation of IgG4‐related diseases. However, there has been a controversy on the clinical outcomes according to the location of the involved bile duct. We therefore compared the clinical outcomes and long‐term prognosis of IgG4‐SC with proximal bile duct involvement (proximal IgG4‐SC) and IgG4‐SC with distal bile duct involvement (distal IgG4‐SC). Methods We reviewed the data of patients with IgG4‐SC that were prospectively collected at 10 tertiary centers between March 2002 and October 2020. Clinical manifestations, outcomes, association with autoimmune pancreatitis (AIP), steroid‐responsiveness, and relapse of IgG4‐SC were evaluated. Results A total of 148 patients (proximal IgG4‐SC, n  = 59; distal IgG4‐SC, n  = 89) were analyzed. The median age was 65 years (IQR, 56.25–71), and 86% were male. The two groups were similar in terms of jaundice at initial presentation (51% vs 65%; P  = 0.082) and presence of elevated serum IgG4 (66% vs 70%; P  = 0.649). The two groups showed significant differences in terms of steroid‐responsiveness (91% vs 100%; P  = 0.008), association with AIP (75% vs 99%; P  = 0.001), and occurrence of liver cirrhosis (9% vs 1%; P  = 0.034). During a median follow‐up of 64 months (IQR, 21.9–84.7), the cumulative relapse‐free survival was significantly different between the two groups (67% vs 79% at 5 years; P  = 0.035). Conclusions Relapse of IgG4‐SC frequently occurred during follow‐up. Proximal IgG4‐SC and distal IgG4‐SC had different long‐term outcomes in terms of steroid‐responsiveness, occurrence of liver cirrhosis, and recurrence. It may be advantageous to determine the therapeutic and follow‐up strategies according to the location of bile duct involvement.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.v38.4
    DOI: 10.1111/jgh.16136
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 6
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    Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: A single‐center experience
    Wiley ; 2014
    In:  Journal of Gastroenterology and Hepatology Vol. 29, No. 2 ( 2014-02), p. 409-416
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 29, No. 2 ( 2014-02), p. 409-416
    Abstract: Peripancreatic tuberculous lymphadenopathy is very rare and can be misdiagnosed with pancreatic or peripancreatic malignancies. The clinical characteristics and treatment outcome have not been well known. Herein, we investigated the accuracy of endoscopic ultrasound‐guided fine needle aspiration ( EUS‐FNA ), clinical features, and treatment outcomes. Methods We retrospectively analyzed 42 patients diagnosed with peripancreatic tuberculosis between D ecember 2004 and J anuary 2011 at the tertiary care hospital in K orea. Results Median age was 36 years (interquartile range, 30–55), and female was 66.7% (28/42). Nineteen patients (45.2%) had no symptoms, while the others had non‐specific various symptoms. Thirteen (31.0%) had a previous history of tuberculosis. Initial impressions of the mass were pancreatic cancer in 14 (33.3%) and tuberculous lymphadenopathy in 13 patients (31.0%). EUS‐FNA was performed in all 42 patients, with a diagnostic yield of pathologic examinations in 80.5%, polymerase chain reaction for tuberculosis in 42.9%, culture in 47.4%, and acid‐fast bacilli staining in 10.0%. Tuberculosis is confirmed in 28 (66.7%), and probable tuberculosis in 14 (33.3%). All patients received anti‐tuberculosis treatment, a 6‐months regimen in 12 (28.6%) and a 9‐months regimen in 28 (66.7%). Treatment response evaluated in 35 patients (83.3%) by computed tomography criteria showed complete response in 10 patients (28.6%), partial response in 23 (65.7%), stable disease in 1 (2.9%), and progressive disease in 1 (2.9%). Conclusions Peripancreatic tuberculous lymphadenopathy is frequently mistaken for pancreatic malignancy. EUS‐FNA can be helpful for an accurate diagnosis. Complete resolution of the lesion, however, was not common on following imaging study after treatment.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.2014.29.issue-2
    DOI: 10.1111/jgh.12410
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 7
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    Feasibility and safety of a novel dedicated device for one‐step EUS‐guided biliary drainage: A randomized trial
    Wiley ; 2015
    In:  Journal of Gastroenterology and Hepatology Vol. 30, No. 10 ( 2015-10), p. 1461-1466
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 30, No. 10 ( 2015-10), p. 1461-1466
    Abstract: EUS‐guided biliary drainage (EUS‐BD) has been proposed as an alternative for patients after failed ERCP. To date, the evaluation of dedicated device for one‐step EUS‐BD has been limited. To determine feasibility and safety of a newly designed 7F stent introducer with tapered metal tip as a push‐type dilator for one‐step metal stent placement without additional fistula dilation in EUS‐BD. Methods Thirty‐two patients with malignant biliary obstruction and failed ERCP were randomly assigned to a dedicated stent introducer with a modified hybrid metal stent (DH group, n  = 16) or a conventional 8.5F biliary metal stent introducer with a fully covered metal stent (FC group, n  = 16). The technical success, procedural times, clinical success rate, and adverse event rates were evaluated. Results One‐step technical success without additional fistula dilation in the DH was 88% (14/16). Multi‐step process in a stent placement was performed in all patients of the FC group. The procedural time in the DH was significantly shorter than the FC (10 vs. 15 min, P  = 0.007). No difference in overall technical or clinical success was seen between the groups. The rate of an early adverse event was common in the FC compared with the DH (31.3% [5/16] in the FC vs. 6.3% [1/16] in the DH, P  = 0.172), although not statistically significant. Conclusions A dedicated device for one‐step EUS‐BD may be technically feasible, safe, and shorten the procedural times with less chance of an additional fistula dilation process, resulting in a potential reduction of the early adverse events.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.2015.30.issue-10
    DOI: 10.1111/jgh.13027
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 8
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    Clinical characteristics of intraductal papillary mucinous neoplasm manifesting as acute pancreatitis or acute recurrent pancreatitis
    Wiley ; 2013
    In:  Journal of Gastroenterology and Hepatology Vol. 28, No. 4 ( 2013-04), p. 731-738
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 28, No. 4 ( 2013-04), p. 731-738
    Abstract: Comparatively little is known about acute pancreatitis or acute recurrent pancreatitis ( AP / ARP ) with intraductal papillary mucinous neoplasm of the pancreas ( IPMN ) as the causative lesion although there have been many reports about the malignant potential of IPMN as a premalignant lesion. Methods From 2000 to 2008, in a single tertiary referral center, out of 784 patients coded by the I nternational C lassification of D isease‐10 with IPMN , 489 patients fulfilled our diagnostic criteria of IPMN . After careful exclusion of all known causes of AP / ARP , 34 patients with IPMN as the cause of AP / ARP were enrolled. Results AP / ARP caused by IPMN occurred in 34 (7%) out of 488 patients with IPMN , and the prevalence rate of AP / ARP was higher in the main‐duct/combined type than in the branch‐duct type (14% [16/111] vs 5% [18/378], respectively, P  = 0.002). The severity of pancreatitis was mild, based on the computed tomography severity index score (median 2, range 0–4). Histologic review of 24 patients with surgical resection revealed four adenomas (17%), 17 borderline malignancies (71%), two carcinomas in situ (8%), and one invasive carcinoma (4%). AP / ARP did not recur in any of the 24 surgically resected patients during the follow‐up period (median 52 months, range 38–115 months). Conclusions AP / ARP caused by IPMN was of infrequent occurrence. AP / ARP caused by IPMN occurred more frequently in the main‐duct/combined type than in the branch‐duct type. Most cases were mild in severity and benign in histopathology. AP / ARP can be an initial manifestation of IPMN , though uncommon, which leads to diagnosis.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.2013.28.issue-4
    DOI: 10.1111/jgh.12121
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 9
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    Endoscopic ultrasound‐guided ablation of branch‐duct intraductal papillary mucinous neoplasms: Feasibility and safety tests using porcine gallbladders
    Wiley ; 2016
    In:  Digestive Endoscopy Vol. 28, No. 5 ( 2016-07), p. 599-606
    Details
    In: Digestive Endoscopy, Wiley, Vol. 28, No. 5 ( 2016-07), p. 599-606
    Abstract: Radiofrequency ablation (RFA) and ethanol ablation are accepted methods of tissue destruction for treating cystic tumors. The aim of the present study was to evaluate the feasibility, efficacy, and safety of endoscopic ultrasound (EUS)‐guided ablation using normal porcine gallbladders as a substitute model for branch‐duct intraductal papillary mucinous neoplasms (BD‐IPMN). Methods Six adult mini pigs were included in this prospective study. EUS‐guided RFA with or without ethanol ablation of the gallbladder was carried out using a prototype 18‐gauge endoscopic RFA electrode, and RFA and ethanol ablation were done in a single session. Outcomes were assessed in terms of macroscopic and microscopic evaluations of the treated gallbladders. Results The prototype RFA electrode was used for ablation of the mucosa, aspiration of the internal contents of the gallbladder, and ethanol injection. RFA plus ethanol lavage resulted in a greater mean percentage of denuded gallbladder mucosa (97.5%) than RFA alone (55.8%). Effects of ablation extending to the cystic duct and partially denuded cystic duct mucosae were detected in five of the six pigs. There were no major procedure‐related adverse events. Conclusions EUS‐guided ablation of the gallbladder mucosa was feasible and effective in the porcine model. Additional studies will be required to fully assess the risk of procedure‐related damage to the main pancreatic duct before using this technique in a clinical setting.
    Type of Medium: Online Resource
    ISSN: 0915-5635 , 1443-1661
    URL: Issue
    URL: Article
    DOI: 10.1111/den.v28.5
    DOI: 10.1111/den.12628
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 10
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    Spontaneous hemobilia after liver transplantation: Frequency, risk factors, and outcome of endoscopic management
    Wiley ; 2017
    In:  Journal of Gastroenterology and Hepatology Vol. 32, No. 3 ( 2017-03), p. 583-588
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 32, No. 3 ( 2017-03), p. 583-588
    Abstract: Spontaneous hemobilia is an uncommon liver transplantation (LT)‐related biliary complication. The frequency, etiology, and mechanism of spontaneous hemobilia after LT are not known. This study aimed to assess the outcome of endoscopic management for spontaneous hemobilia after LT, and to investigate its frequency and risk factors. Methods The records of patients who underwent endoscopic retrograde cholangiopancreatography to manage hemobilia after LT at the Asan Medical Center, Korea, between January 2006 and April 2014 were retrospectively reviewed. Results A total 2701 cases of LT was performed in the study period, and 33 LT patients with spontaneous hemobilia were included in the study group. Endoscopic nasobiliary drainage was achieved in 33 cases (100%). In 29 of 33 patients (87.9%), hemobilia was improved. The frequency of spontaneous hemobilia was 1.22% (33/2701). On multivariate analysis, United Network for Organ Sharing status I or IIa (odds ratio [OR] 3.095, 95% CI 1.097–8.732, P  = 0.033), alcoholic liver cirrhosis (OR 3.942, 95% CI 1.261–12.324, P  = 0.018), and body mass index  〈  24.5 kg/m 2 (OR 2.329, 95% CI 1.005–5.397, P  = 0.049) were significant risk factors for spontaneous hemobilia after LT. Conclusions Endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage are feasible methods for the management of spontaneous hemobilia after LT. In patients with United Network for Organ Sharing status I and IIa, alcoholic liver cirrhosis, or body mass index  〈  24.5 kg/m 2 , special attention should be paid to the occurrence of spontaneous hemobilia after LT.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.2017.32.issue-3
    DOI: 10.1111/jgh.13497
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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