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Contrast Does Not Affect Cholangioscope Image Quality.

Jeffrey LACZEK ; Mark FLASAR ; Eric GOLDBERG ; Peter DARWIN

Gut and Liver.2011;5(1):115-116.

BACKGROUND/AIMS: Peroral cholangioscopy is a rapidly evolving technique that allows direct examination of the bile duct. We sought to determine if there was a difference in image quality with the cholangioscope immersed in normal saline compared with radiologic contrast or a mixture of contrast and normal saline. METHODS: Images were captured using the SpyGlass(R) cholangioscope system (Boston Scientific Corp.) immersed in solutions ranging from 0 to 100% contrast. The images were then reviewed in a blinded fashion by a panel of 9 endoscopists with experience using the SpyGlass(R) system. The reviewers scored the quality of each image based on a scale of 0 (extremely poor) to 10 (excellent). RESULTS: With the cholangioscope immersed in saline and 100% contrast, the mean image quality scores were 7.6 (95% confi dence interval [CI], 6.7-8.5) and 6.9 (95% CI, 5.8-8.0), respectively. The highest mean image quality score was 7.8 (95% CI, 6.7-8.9), obtained in 70% contrast. No signifi cant difference was noted in mean image quality scores using a one way analysis of variance technique (p=0.414). CONCLUSIONS: Although there are limitations to ex vivo studies, we encourage endoscopists to use intraductal contrast prior to peroral cholangioscopy, if needed for lesion localization.
Bile Ducts ; Endoscopes

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Delayed Viral Clearance of Chronic Hepatitis C in Patients after Treatment Failure.

Su Hyun CHO ; Sung Wook LEE ; Seok Reyol CHOI ; Sang Young HAN ; Myung Hwan ROH ; Jong Hoon LEE ; Jin Seok JANG ; Yang Hyun BAEK ; Su Young KIM

Gut and Liver.2011;5(1):110-114.

Hepatitis C virus (HCV) infection usually progresses to chronic hepatitis, with rare cases of spontaneous viral eradication. We present herein four cases involving patients that were initially declared to have failed to respond to treatments, based on the presence of HCV RNA that was still detectable after completion of the standard treatment for chronic hepatitis C with genotype 2. However, the HCV RNA became undetectable, with a delayed response, after discontinuation of therapy. Two of the four patients were diagnosed as treatment failures after extended treatment, and the other two received no further treatment after the standard treatment. All four patients maintained a sustained virological response during the periodic follow-up after delayed viral clearance.
Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; RNA ; Treatment Failure

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A Case of Congenital Duodenal Web Causing Duodenal Stenosis in a Down Syndrome Child: Endoscopic Resection with an Insulated-Tip Knife.

Sang Seon LEE ; Seon Tae HWANG ; Nam Gil JANG ; Hann TCHAH ; Duk Young CHOI ; Hyun Young KIM ; Eell RYOO

Gut and Liver.2011;5(1):105-109.

A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down's syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient's abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an age-appropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure.
Cicatrix ; Communicable Diseases ; Constriction, Pathologic ; Diet ; Down Syndrome ; Ductus Arteriosus, Patent ; Duodenal Obstruction ; Duodenum ; Endoscopy ; Fasting ; Follow-Up Studies ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Preschool Child ; Respiratory Tract Infections ; Vomiting

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The Advantage of an Endoscopic Submucosal Tunneling Technique for Rectal Carcinoid Tumors.

Hideki KOBARA ; Hirohito MORI ; Li CHEI ; Shintaro FUJIHARA ; Noriko NISHIYAMA ; Tsutomu MASAKI

Gut and Liver.2017;11(5):735-737. doi:10.5009/gnl16580

Endoscopic treatment can be a curative option for small carcinoid tumors with an extremely low risk of metastasis. Since most carcinoid tumors are characterized by a specific growth pattern in the submucosal (SM) layer, specialized endoscopic techniques for deeper resection to achieve clear vertical margins are needed. The endoscopic submucosal dissection (ESD) method in the SM space is superior to conventional endoscopic mucosal resection. However, the standard ESD technique sometimes fails to provide complete deep SM dissection due to insufficient SM lifting. Here, to resolve this problem, we describe our initial experience with an endoscopic SM tunneling technique that is effective for treating rectal carcinoid tumors.
Carcinoid Tumor* ; Endoscopy, Gastrointestinal ; Lifting ; Methods ; Neoplasm Metastasis

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Active Helicobacter pylori Infection Is a Risk Factor for Colorectal Mucosa: Early and Advanced Colonic Neoplasm Sequence.

Jannis KOUNTOURAS ; Nikolaos KAPETANAKIS ; Stergios A POLYZOS ; Panagiotis KATSINELOS ; Emmanuel GAVALAS ; Dimitri TZIVRAS ; Christos ZEGLINAS ; Constantinos KOUNTOURAS ; Elizabeth VARDAKA ; Eyripidis STEFANIDIS ; Evagelos KAZAKOS

Gut and Liver.2017;11(5):733-734. doi:10.5009/gnl16389

No abstract available.
Colon* ; Colonic Neoplasms* ; Helicobacter pylori* ; Helicobacter* ; Mucous Membrane* ; Risk Factors*

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Assessment of the Risk of Colorectal Cancer Survivors Developing a Second Primary Pancreatic Cancer.

Joo Won CHUNG ; Moon Jae CHUNG ; Seungmin BANG ; Seung Woo PARK ; Si Young SONG ; Jae Bock CHUNG ; Jeong Youp PARK

Gut and Liver.2017;11(5):728-732. doi:10.5009/gnl16526

BACKGROUND/AIMS: We aimed to investigate the incidence of second primary pancreatic cancer (PC) after colorectal cancer (CRC) and to identify risk factors associated with subsequent PC. METHODS: The observed incidence of a subsequent PC in patients with CRC was standardized using a population with CRC from the Korean Central Cancer Registry (KCCR). The expected incidence rate of PC was obtained by assuming that the select group experienced the same cancer incidence as the corresponding general population in the KCCR. RESULTS: The registry included 4,822 patients with CRC aged 45 to 74 years, representing 16,725.1 person-years of follow-up. Thirteen patients (0.3%) were diagnosed with a subsequent PC, and the overall age-adjusted incidence of second primary PC was 269.6 per 100,000 cases. In contrast, the overall incidence of primary PC in the general population was 18.68 per 100,000 individuals. The standardized incidence ratio of subsequent PC was 14.44, which was significantly higher in patients with CRC than in the general population. Sex, diabetes mellitus, smoking, body mass index, and a history of receiving chemotherapy as a treatment for CRC did not increase the risk of subsequent development of PC. CONCLUSIONS: The risk of a second primary PC was higher in patients with CRC. Further studies are needed to identify the risk factors and generate a screening strategy for cancer survivors.
Body Mass Index ; Colorectal Neoplasms* ; Diabetes Mellitus ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Mass Screening ; Neoplasms, Second Primary ; Pancreatic Neoplasms* ; Risk Factors ; Smoke ; Smoking ; Survivors*

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Direct Acting Antiviral Agents in Korean Patients with Chronic Hepatitis C and Hemophilia Who Are Treatment-Naïve or Treatment-Experienced.

Hyun Woong LEE ; Ki Young YOO ; Joung Won WON ; Hyung Joon KIM

Gut and Liver.2017;11(5):721-727. doi:10.5009/gnl17209

BACKGROUND/AIMS: Chronic hepatitis C (CHC) is a major comorbidity in patients with hemophilia. METHODS: Patients (n=30) were enrolled between September 2015 and April 2016. Twenty-six patients were genotype 1 (1b, n=21; 1a, n=5) and four patients were genotype 2a/2b. Among 21 patients with genotype 1b, Y93H resistance-associated variants (RAVs) were detected in three patients (14.3%). We evaluated sustained virologic response (SVRs) at 12 weeks, as well as relapse and safety. RESULTS: Five patients with genotype 1a and three patients with genotype 1b (RAV positive) received ledipasvir/sofosbuvir for 12 weeks. SVR12 rate was 100% (8/8). Eleven patients with genotype 1b were treatment-naïve and received daclatasvir plus asunaprevir for 24 weeks. SVR12 rate was 91% (10/11). One patient experienced viral breakthrough without RAV at 12 weeks. Seven treatment-experienced patients with genotype 1b received daclatasvir plus asunaprevir for 24 weeks. SVR12 rate was 85.7% (6/7). One patient experienced viral breakthrough with RAV (L31M, Y93H) at 12 weeks. Four patients with genotype 2a/2b received sofosbuvir plus ribavirin for 12 weeks. SVR12 rate was 100% (4/4). No serious adverse event-related discontinuations were noted. CONCLUSIONS: New direct acting antiviral treatment achieved high SVRs rates at 12 weeks in CHC patients with hemophilia without serious adverse events.
Antiviral Agents* ; Comorbidity ; Genotype ; Hemophilia A* ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Recurrence ; Ribavirin ; Sofosbuvir

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Real-World Single-Center Experience with Sofosbuvir-Based Regimens for the Treatment of Chronic Hepatitis C Genotype 1 Patients.

Hyun Phil SHIN ; Blaire BURMAN ; Richard A KOZAREK ; Amy ZEIGLER ; Chia WANG ; Houghton LEE ; Troy ZEHR ; Alicia M EDWARDS ; Asma SIDDIQUE

Gut and Liver.2017;11(5):711-720. doi:10.5009/gnl16447

BACKGROUND/AIMS: The approval of sofosbuvir (SOF), a direct-acting antiviral, has revolutionized the treatment of chronic hepatitis C virus (HCV). METHODS: We assessed the sustained virological response (SVR) of SOF-based regimens in a real-world single-center setting for the treatment of chronic HCV genotype 1 (G1) patients. This was a retrospective review of chronic HCV G1 adult patients treated with a SOF-based regimen at Virginia Mason Medical Center between December 2013 and August 2015. RESULTS: The cohort comprised 343 patients. Patients received SOF+ledipasvir (LDV) (n=155), SOF+simeprevir (SIM) (n=154), or SOF+peginterferon (PEG)+ribavirin (RBV) (n=34). Of the patients, 50.1% (n=172) had cirrhosis. The SVR rate was 92.2% for SOF/LDV, 87.0% for SOF/SIM, and 82.4% for SOF/PEG/RBV. Compared with the cirrhotic patients, the patients without cirrhosis had a higher SVR (96.8% vs 85.5%, p=0.01, SOF/LDV; 98.2% vs 80.6%, p=0.002, SOF/SIM; 86.4% vs 75.0%, p=0.41, SOF/PEG/RBV). In this study, prior treatment experience adversely affected the response rate in subjects treated with SOF/PEG/RBV. CONCLUSIONS: In this single-center, real-world setting, the treatment of chronic HCV G1 resulted in a high rate of SVR, especially in patients without cirrhosis.
Adult ; Cohort Studies ; Fibrosis ; Genotype ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Retrospective Studies ; Sofosbuvir ; Virginia

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Rifaximin and Propranolol Combination Therapy Is More Effective than Propranolol Monotherapy for the Reduction of Portal Pressure: An Open Randomized Controlled Pilot Study.

Yoo Li LIM ; Moon Young KIM ; Yoon Ok JANG ; Soon Koo BAIK ; Sang Ok KWON

Gut and Liver.2017;11(5):702-710. doi:10.5009/gnl16478

BACKGROUND/AIMS: Non-selective beta blockers (NSBBs) are currently the only accepted regimen for preventing portal hypertension (PHT)-related complications. However, the effect of NSBBs is insufficient in many cases. Bacterial translocation (BT) is one of the aggravating factors of PHT in cirrhosis; therefore, selective intestinal decontamination by rifaximin is a possible therapeutic option for improving PHT. We investigated whether the addition of rifaximin to propranolol therapy can improve hepatic venous pressure gradient (HVPG) response. METHODS: Sixty-four cirrhosis patients were randomly assigned to propranolol monotherapy (n=48) versus rifaximin and propranolol combination therapy (n=16). Baseline and post-treatment HVPG values, BT-related markers (lipopolysaccharide [LPS], LPS-binding protein [LBP], interleukin-6 [IL-6], and tumor necrosis factor α [TNF-α]), serological data, and adverse event data were collected. HVPG response rate was the primary endpoint. RESULTS: Combination therapy was associated with better HVPG response rates than monotherapy (56.2% vs 87.5%, p=0.034). In combination therapy, posttreatment BT-related markers were significantly decreased (LPS, p=0.005; LBP, p=0.005; IL-6, p=0.005; TNF-α, p=0.047). CONCLUSIONS: Rifaximin combination therapy showed an additive effect in improving PHT compared to propranolol monotherapy. These pilot data suggest that the addition of rifaximin to NSBBs could be a good therapeutic option for overcoming the limited effectiveness of NSBBs.
Bacterial Translocation ; Decontamination ; Fibrosis ; Humans ; Hypertension, Portal ; Interleukin-6 ; Pilot Projects* ; Portal Pressure* ; Propranolol* ; Tumor Necrosis Factor-alpha ; Venous Pressure

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Survival Estimates after Stopping Sorafenib in Patients with Hepatocellular Carcinoma: NEXT Score Development and Validation.

Hye Won LEE ; Hyun Soo KIM ; Seung Up KIM ; Do Young KIM ; Beom Kyung KIM ; Jun Yong PARK ; Sang Hoon AHN ; Mi Young JEON ; Ja Yoon HEO ; Soo Young PARK ; Yu Rim LEE ; Sun Kyung JANG ; Su Hyun LEE ; Se Young JANG ; Won Young TAK ; Kwang Hyub HAN

Gut and Liver.2017;11(5):693-701. doi:10.5009/gnl16391

BACKGROUND/AIMS: Limited information is available regarding patient survival after sorafenib discontinuation in patients with hepatocellular carcinoma (HCC). Thus, we developed and validated a novel survival prediction model. METHODS: Clinical data from 409 patients with HCC who stopped taking sorafenib between September 2008 and February 2015 were reviewed. RESULTS: In the training cohort, four factors were independent negative predictors of survival (p<0.05). Based on the β regression coefficient of each factor, we established the NEXT score (Survival after Stopping Nexavar Treatment), allocating 1 point each for an Eastern Cooperative Oncology Group score ≥2, Child-Pugh class B or C, serum sodium ≤135 mEq/L, and α-fetoprotein >400 ng/mL. Area under the receiver operating characteristic curve values to predict 1-, 3-, and 6-month survival rates were 0.805, 0.809, and 0.774, respectively, in the training cohort and 0.783, 0.728, and 0.673, respectively, in the validation cohort (n=137). When the training and validation cohorts were stratified into three risk groups (NEXT score 0 [low-risk] vs 1 to 2 [intermediate-risk] vs 3 to 4 [high-risk]), survival differed significantly between the groups (p<0.05, log-rank test). CONCLUSIONS: In patients with HCC, survival after stopping sorafenib is poor. However, risk estimates based on a new “NEXT score” may help predict survival and prognosis even in patients who discontinue sorafenib treatment.
Carcinoma, Hepatocellular* ; Cohort Studies ; Humans ; Prognosis ; ROC Curve ; Sodium ; Survival Rate

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