BACKGROUND/AIMS: Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction. METHODS: A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates. RESULTS: The total technical success rate of ERBD was 100% (105/105) in the IDUS-ERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups. CONCLUSIONS: IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage* ; Humans ; Outcome Assessment (Health Care) ; Radiation Exposure ; Retrospective Studies ; Ultrasonography

BACKGROUND/AIMS: Percutaneous coronary intervention (PCI) is often performed therapeutically, and antithrombotic treatment is required for at least 12 months after stent implantation. However, the development of post-PCI upper gastrointestinal bleeding (UGIB) increases morbidity and mortality. We investigated the incidence and risk factors for UGIB in Korean patients within 1 year after PCI. METHODS: The medical records of 3,541 patients who had undergone PCI between January 2006 and June 2012 were retrospectively reviewed. We identified 40 cases of UGIB. We analyzed the incidence and clinical risk factors associated with UGIB occurring within 1 year after PCI by comparing the results for each case to matched controls. The propensity score matching method using age and sex was utilized. RESULTS: UGIB occurred in 40 patients (1.1%). Two independent risk factors for UGIB were a history of peptic ulcer disease (odds ratio [OR], 12.68; 95% confidence interval [CI], 2.70 to 59.66; p=0.001) and the use of anticoagulants (OR, 7.76; 95% CI, 2.10 to 28.66; p=0.002). CONCLUSIONS: UGIB after PCI occurred at a rate of 1.1% in the study population. Clinicians must remain vigilant for the possibility of UGIB after PCI and should consider performing timely endoscopy in patients who have undergone PCI and are suspected of having an UGIB.
Aged ; Anticoagulants/adverse effects ; Case-Control Studies ; Female ; Gastrointestinal Hemorrhage/epidemiology/*etiology ; Humans ; Incidence ; Male ; Middle Aged ; Peptic Ulcer/complications ; Percutaneous Coronary Intervention/*adverse effects ; *Postoperative Complications ; Propensity Score ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: The cyclin-dependent kinase inhibitors (CDKI) including p21, p27, and p57 of the kinase inhibitor protein (KIP) family are negative regulators of cell cycle progression and potentially act as tumor suppressor. Tumor behavior and growth are influenced by the extent of tumor cell proliferation. The aim of this study was to evaluate the expression of KIP family CDKI in gastric cancer tissue, and to examine the relationship between these expression and various clinicopathological parameters including tumor cell proliferation. METHODS: We conducted an immunohistochemical analysis of p21, p27, and p57 expression in 109 gastric cancer tissues. Tumor cell proliferation was assessed by immunohistochemistry with antibody against Ki-67. RESULTS: Negative expression of p21, p27, and p57 was demonstrated in 45.9%, 65.1%, and 57.8% of cancer tissues, respectively. Negative expression of p21 correlated with larger tumor size, poor differentiation, depth of invasion, lymph node metastasis and advanced TNM stage (p=0.048, 0.041, 0.001, 0.005, and 0.001 respectively). Negative expression of p21 correlated with poor survival (p=0.037). Tumors with negative p21 expression had higher Ki-67 expression than those with positive p21 expression (p=0.024). No significant correlation could be observed between status of p27 and p57 expression and various clinicopathological parameters including survival and tumor cell proliferation. CONCLUSIONS: These results suggest that negative expression of p21 may play an important role in carcinogenesis by stimulating tumor cell proliferation, and may help in predicting the prognosis of gastric cancer.
Adult ; Aged ; Cell Division ; Cyclin-Dependent Kinase Inhibitor Proteins/*metabolism ; Cyclin-Dependent Kinase Inhibitor p21/metabolism ; Cyclin-Dependent Kinase Inhibitor p27/metabolism ; Cyclin-Dependent Kinase Inhibitor p57/metabolism ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Stomach Neoplasms/*metabolism/mortality/pathology ; Survival Rate

BACKGROUND/AIMS: Intraductal ultrasonography (IDUS) has been performed as an adjunct to endoscopic retrograde cholangiography (ERC) during radiocontrast cholangiography (RC). Radiation exposure during RC poses a health risk to both patients and examiners. We evaluated the feasibility of IDUS without RC in various extrahepatic biliary diseases. METHODS: IDUS was performed with the insertion of an IDUS probe from the papilla of Vater to the confluent portion of the common hepatic duct without fluoroscopy. The technical success rate and procedure-related complications were evaluated retrospectively. RESULTS: Wire-guided IDUS without RC was performed in 105 patients. The mean age was 66.5 years, and 50 (47.6%) were male. The IDUS diagnoses included choledocholithiasis (73, 69.5%), benign biliary stricture (11, 10.5%), choledocholithiasis with biliary pancreatitis (9, 8.6%), bile duct cancer (5, 4.8%), pancreatic cancer (1, 0.9%), and others (6, 5.7%). After IDUS, 66 (62.8%) underwent stone removal, 19 (18.1%) underwent biliary drainage, and 7 (6.6%) underwent brush cytology and biopsy. No significant complications such as perforation or severe pancreatitis occurred. CONCLUSIONS: IDUS without RC was a feasible and safe approach in patients with various extrahepatic biliary diseases. We anticipate a potentially important role of IDUS in various ERC procedures because it lacks the hazards of RC.
Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Extrahepatic/pathology/*ultrasonography ; Biliary Tract Diseases/*ultrasonography ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects/*methods ; Contrast Media ; Drainage/methods ; Endosonography/*methods ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis/ultrasonography ; Retrospective Studies ; Treatment Outcome ; Ultrasonography, Interventional/*methods

BACKGROUND/AIMS: The incidence of corrosive injury has been decreased, compared with past years. However, the ingestion of corrosive agent for suicidal attempt is on an increasing trend. Though corrosive injury on gastrointestinal tract is very common, there are few clinical studies on this field. METHODS: Retrospective study was performed on 48 patients who ingested corrosive agent from 1992 to 1998. The kinds of corrosive agent, cause of ingestion, symptoms, gastroscopic findings, treatment and complications were analyzed. RESULTS: The most common agent of ingestion was acetic acid (47.9%), followed by hydrocholoric acid (18.8%), cresol (10.4%), lye (10.4%), sulfuric acid (4.2%). Ingestion for suicidal attempt (60.4%) was more frequent than accidental ingestion (39.6%). The frequent symptoms were sore throat (31.3%), dysphagia (27.1%), epigastric pain (22.9%), vomiting (18.8%), chest pain (18.8%), GI bleeding (12.5%), dyspnea (12.5%) and hematuria (8.3%). The esophagus was the most common site of corrosive injury and Grade IIa injury was the most frequent finding on gastroscopy. In most cases, prophylactic antibiotics with or without steroid was administered for conservative treatment. For long-term sequelae, there were 7 cases (14.6%) of esophageal stricture, and 2 cases (4.2%) of gastric outlet obstruction. CONCLUSIONS: Corrosive injury on gastrointestinal tract is frequently observed on early gastroscopy and can cause significant late sequelae, such as stricture. Therefore, it is necessary to evaluate regular follow up gastroscopy for the management of late sequelae.
Acetic Acid ; Anti-Bacterial Agents ; Chest Pain ; Constriction, Pathologic ; Deglutition Disorders ; Dyspnea ; Eating ; Esophageal Stenosis ; Esophagus ; Follow-Up Studies ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Gastroscopy ; Hematuria ; Hemorrhage ; Humans ; Incidence ; Lye ; Pharyngitis ; Retrospective Studies ; Sulfur ; Upper Gastrointestinal Tract* ; Vomiting

Hepatocellular carcinoma (HCC) usually spreads to lung, regional lymph node, bone and the other organs by hematogenous, lymphatic route and direct extention at the advanced stage. Extrahepatic metastases from small HCC are, however, rare events. The frequent involving bony metastases are spine, rib and long bone. These are rare in cranial bone. Therefore, a case of small HCC diagnosed by first manifestation of cranial bone metastasis is very rare. We report a case of cranial bone metastasis with left eyelid ptosis from small HCC and review the literature pertaining to this condition.
Blepharoptosis* ; Carcinoma, Hepatocellular* ; Eyelids* ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Ribs ; Spine

Intramural gastric abscess is a rare condition representing a localized form of suppurative gastritis. According to the extent of the disorder, suppurative gastritis is classified into diffuse and localized types. The diffuse or phlegmonous type is more common and involves the entire stomach with inflammation spreading to all layers from the submucosa. The localized form referred to as "intramural gastric abscess" accounts for 5% to 15% of cases. The pathogenic mechanism includes direct invasion by microorganisms and hematogenous spread from a distant source. Cases are usually diagnosed with a combination of imaging modalities such as ultrasound, computed tomography, endoscopic ultrasound, and esophagogastroduodenoscopy. Herein we report a case of intramural gastric abscess that developed following ingestion of a fish bone. It was successfully treated with endoscopic incision and drainage of pus.
Abscess ; Cellulitis ; Drainage ; Eating ; Endoscopy, Digestive System ; Gastritis ; Inflammation ; Stomach ; Suppuration

Malignant rhabdoid tumor was first discovered in the kidney, and rhabdoid tumor of the lung was first reported in 1995. These were included as the variants of large-cell carcinoma, according to the 1999 World Health Organization classification of lung tumors. The rhabdoid tumor of the lung exhibits aggressive biological behavior and has a poor prognosis, and only a few reports of this tumor exist. We report a case of lung carcinoma with a rhabdoid phenotype, initially misdiagnosed as an aspergilloma, in a 48-year-old man who presented with recurrent hemoptysis. The chest computed tomography scans showed a huge consolidative lesion with an air crescent sign in the left upper lung and no contrast-enhancing lesion. An aspergilloma was diagnosed by the radiologist. However, after surgical excision and pathological examination, rhabdoid carcinoma was diagnosed. A surgical resection helps to make it possible to pathologically distinguish a malignancy from an aspergilloma.
Aspergillosis ; Classification ; Hemoptysis* ; Humans ; Kidney ; Lung* ; Middle Aged ; Phenotype* ; Prognosis ; Rhabdoid Tumor ; Thorax ; World Health Organization

Malignant rhabdoid tumor was first discovered in the kidney, and rhabdoid tumor of the lung was first reported in 1995. These were included as the variants of large-cell carcinoma, according to the 1999 World Health Organization classification of lung tumors. The rhabdoid tumor of the lung exhibits aggressive biological behavior and has a poor prognosis, and only a few reports of this tumor exist. We report a case of lung carcinoma with a rhabdoid phenotype, initially misdiagnosed as an aspergilloma, in a 48-year-old man who presented with recurrent hemoptysis. The chest computed tomography scans showed a huge consolidative lesion with an air crescent sign in the left upper lung and no contrast-enhancing lesion. An aspergilloma was diagnosed by the radiologist. However, after surgical excision and pathological examination, rhabdoid carcinoma was diagnosed. A surgical resection helps to make it possible to pathologically distinguish a malignancy from an aspergilloma.
Aspergillosis ; Classification ; Hemoptysis* ; Humans ; Kidney ; Lung* ; Middle Aged ; Phenotype* ; Prognosis ; Rhabdoid Tumor ; Thorax ; World Health Organization

Situs inversus totalis (SIT) is very rare autosomal recessive condition, and patients with SIT have complete mirror image reversal of the thoracic and abdominal viscera. There have been no case reports of esophageal bezoar in a patient with situs inversus totalis. Bezoars are retained concretions of indigestible foreign material, including food material, vegetable material and hair, and they are usually founded in the stomach, small intestine and rectum. Esophageal bezoars are very rare, but they are known to occur in patients with anatomical defects or esophageal motility disorders. The treatment of esophageal bezoar is usually based on endoscopic fragmentation and extraction, dissolution with papain, cellulose, pancreatic enzyme and/or Coca cola. We report here on a case of an endoscopically treated primary esophageal bezoar in a patient with situs inversus totalis, and the patient experienced no complications from the treatment.
Bezoars ; Cellulose ; Coca ; Cola ; Esophageal Motility Disorders ; Hair ; Humans ; Intestine, Small ; Papain ; Rectum ; Situs Inversus ; Stomach ; Vegetables ; Viscera