Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Background/Aims: This study aimed to investigate the perceptions and behaviors of patients with inflammatory bowel disease (IBD) during the early coronavirus disease 2019 (COVID-19) pandemic in the major epidemic area in Korea. Methods: Between April and May 2020, a cross-sectional survey was performed at two tertiary hospitals in Daegu, South Korea, on patients’ experiences, coping strategies and perceptions. Results: Most of the 544 patients participating in the survey strictly adhered to personal protection guidance against COVID-19. In the early COVID-19 crisis, many patients canceled or postponed hospital visits (57.5%) and rescheduled biologics administrations (26.4%). Although 13.6% utilized telemedicine, the frequency of individuals leaving their homes remained unchanged. Although 50.4% were concerned about their susceptibility to COVID-19, 72.2% adhered to their treatment for IBD. In patients taking biologics or Janus kinase inhibitors, 86.8% disagreed that they should discontinue their medication as a preventative measure against COVID-19, but 21.9% actually discontinued their medications. Of those with discordance between the perception of IBD drug adherence and active behaviors, 5.4% of all and 39.4% of biologics or Janus kinase inhibitors withheld drugs specifically due to fear of COVID-19. Only 7% of all patients discussed drug safety with their physicians. The level of concern for COVID-19 depended on the type of drug used. Conclusions Patients with IBD showed concerns about the increased risk of COVID-19 due to IBD or their medications, and a considerable number of patients withheld their medications without consulting medical staff. Enhanced active communications with patients with IBD and appropriate health-related education should be provided.

BACKGROUND/AIMS: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn's disease (CD). METHODS: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender-matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls. RESULTS: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p<0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of <60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p<0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients. CONCLUSIONS: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those <60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.
Adolescent ; Adult ; Age Factors ; Aged ; Colitis, Ulcerative/complications/diagnosis/drug therapy ; Crohn Disease/complications/diagnosis/drug therapy ; Female ; Helicobacter Infections/complications/diagnosis/*epidemiology ; *Helicobacter pylori ; Humans ; Inflammatory Bowel Diseases/*complications/diagnosis/drug therapy ; Korea ; Male ; Middle Aged ; Phenotype ; Prevalence

Metronidazole is a 5-nitroimidazole compound known as an antimicrobial agent widely used for the treatment of protozoal infection, anaerobic infection, Helicobacter pylori infection and hepatic encephalopathy. It may produce a number of neurologic side effects including peripheral neuropathy, seizure, encephalopathy, ataxic gait and dysarthritic speech. There have been ten or more reports of metronidazole-induced encephalopathy in the literatures including a few reports of brain imaging changes by magnetic resonance images (MRI). However, none of the case of metronidazole-induced encephalopathy in patients with hepatic encephalopathy has been reported yet. Recently, we experienced two cases of metronidazole-induced encephalopathy in patients with liver cirrhosis caused by chronic hepatitis B, which were diagnosed by brain MRI and MR spectroscopy. In this report, we present 2 cases of metronidazole-induced encephalopathy with MR imaging and MR spectroscopic changes including follow- up imaging performed after the discontinuation of the metronidazole with a review of the literatures.
Anti-Infective Agents/*adverse effects ; Brain Diseases/*chemically induced/diagnosis ; English Abstract ; Female ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Male ; Metronidazole/*adverse effects ; Middle Aged

BACKGROUND/AIMS: Pancreatic cancer is fatal with a dismal 6-month median survival from diagnosis. Diabetes mellitus is reported to be present up to 33.3 percent of patients with pancreatic cancer. The reason for the high frequency of diabetes is unknown. We studied the prevalence and duration of diabetes in patients with pancreatic cancer and the relationship between the two diseases. METHODS: A total of 152 patients with pancreatic cancer diagnosed at Yeungnam University Hospital from January 1999 to December 2001 were enrolled in this study. Clinical features, family history, smoking history, and characteristics of the tumor were compared between diabetic and non-diabetic groups. RESULTS: Among 152 patients with pancreatic cancer, 43 patients (28.3%) had diabetes. In diabetic group, mean age of diagnosis was significantly younger than non- diabetic group (62.0 +/- 7.2 vs. 65.0 +/- 8.8, p<0.05). Most of the patients with diabetes had non-insulin dependent diabetes mellitus (NIDDM) and did not have family history. Diabetes was diagnosed within 2 years after the diagnosis of pancreatic cancer in 35 patients (74.3%) of the diabetic group. There were no differences in the location and stage of tumor, chief complaints, presence of weight loss, and body mass index between the two groups. CONCLUSIONS: Diabetes mellitus occurs frequently in patients with pancreatic cancer and does not influence clinical features of pancreatic cancer. Pancreatic cancer should be suspected in patients with recent onset diabetes, especially in patients without family history of diabetes and with type of NIDDM.
*Diabetes Complications ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*complications/diagnosis

Ascaris lumbricoides is the commonest intestinal parasite. The parasites are the most numerous intestinal parasites in less-developed countries and in areas with poor sanitation. However, it's prevalence is very low in Korea recently. A. lumbricoides produces no symptoms in most patients but sometimes it may give rise to intestinal obstruction or pancreatobiliary disease. Highly motile mature worms may enter the ampulla of Vater and migrate into the bile or pancreatic ducts and can cause cholangitis, biliary stone, cholecystitis, pancreatitis and liver abscess. The cases of biliary ascariasis are rare in Korea. We report a 59-year-old female, who presented with intermittent epigastic pain, diagnosed as biliary ascariasis associated with common bile duct stone after endoscopic retrograde cholangiopancreatography (ERCP). The common bile duct (CBD) stone was removed by sphincterotomy and lithotripsy, and then we directly removed ascaris with a basket without any complication.
Ampulla of Vater ; Ascariasis* ; Ascaris ; Ascaris lumbricoides ; Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Common Bile Duct* ; Developing Countries ; Female ; Humans ; Intestinal Obstruction ; Korea ; Lithotripsy ; Liver Abscess ; Middle Aged ; Pancreatic Ducts ; Pancreatitis ; Parasites ; Prevalence ; Sanitation

BACKGROUND/AIMS: Second-look endoscopy is generally performed to prevent rebleeding in patients with bleeding peptic ulcers. However, considering recent technologic advances of endoscopic hemostasis and decreasing rate of rebleeding, a small benefit with second-look endoscopy is suggested. Prospective study was carried out to evaluate the efficacy of second-look endoscopic examinations. METHODS AND RESULTS: One hundred thirty six patients with bleeding from peptic ulcer were included. Emergency endoscopic treatments consisting of the injection of hypertonic saline-epinephrine (HSE), band ligation and/or clipping were performed in patients with Forrest class I-IIb. They were scheduled to receive second-look endoscopy in 48 hours after initial endoscopy. Nine patients (6.6%) received endoscopic retreatment during second-look endoscopy and emergency endoscopic retreatment was required before scheduled endoscopy in six patients (4.4%) because of the evidence of rebleeding. Factors influencing retreatment were Forrest classification of initial endoscopy and methods of hemostasis. None of the patients with Forrest class IIb-III and the patients receiving endoscopic band ligation or clipping on initial endoscopy required retreatment during follow-up endoscopy. CONCLUSION: Routine second-look endoscopy may not be recommended after initial successful endoscopic treatment of peptic ulcer bleeding, especially in case of Forrest class IIb, IIc or III and in the patients treated with band ligation or clipping.
Classification ; Emergencies ; Endoscopy* ; Follow-Up Studies ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Ligation ; Peptic Ulcer* ; Prospective Studies ; Retreatment

BACKGROUND: Proton pump inhibitor-based triple therapy is effective first line treatment for Helicobacter pylori (H. pylori) infection. However, it is unclear that additional acid-suppression therapy should be continued for ulcer healing after eradication of H. pylori in patients with peptic ulcer diseases. We evaluated the effect of H. pylori eradication in the treatment of H. pylori-associated peptic ulcer diseases. METHODS: Eighty patients with endoscopically proven active peptic ulcers with H. pylori infection were randomized to receive either 1 week therapy of omeprazole 20 mg bid plus clarithromycin 500 mg bid plus amoxicillin 1000 mg bid alone (OCA group) or same regimen followed by 3 weeks of ranitidine 150 mg bid (OCAR group). Endoscopy, clinical assessments and urea breath test were performed after treatment. RESULTS: Overall healing rates of peptic ulcer after 4 weeks and 8 weeks of treatment were 89.7% and 97.4% in OCA group and 85.5% and 97.6% in OCAR group, respectively (p>0.05). The H. pylori eradication rates in OCA and OCAR group were 84.6% and 82.9%, respectively (p>0.05). Symptomatic relief rate after 4 weeks of treatment was 89.2% in OCA group and 92.5% in OCAR group (p>0.05). CONCLUSION: One-week OCA therapy without additional acid suppressing therapy seemed to be effective for the treatment of non-complicated H. pylori-associated peptic ulcer diseases. Further study will be necessary to evaluate the effect of H. pylori eradication in the treatment of peptic ulcer disease and factors affecting healing of the ulcer.
Amoxicillin ; Breath Tests ; Clarithromycin ; Endoscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer* ; Proton Pumps ; Ranitidine ; Ulcer* ; Urea

Primary malignant melanoma of the esophagus(PMME) is an extremely rare but aggressive disease that composes less than 0.1% of all primary malignant neoplasm of the esophagus. PMME was first reported in 1906 and nearly 180 cases of primary esophageal malignant melanoma have been published in the medical literature. Symptoms of the primary malignant melanoma of the esophagus mimic that of any malignant obstructing lesion of the esophagus and the metastatic spread by lymphatics and vascular routes are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, however prognosis is poor. At present, chemotherapy and immunotherapy have no major role in treatment. We report a case of 67-year-old man with primary malignant melanoma of the esophagus originated from esophageal melanosis with a review of the literature.
Aged ; Drug Therapy ; Esophagus ; Humans ; Immunotherapy ; Melanoma* ; Melanosis* ; Prognosis

BACKGROUND/AIMS: Recently, it has been well known that the incidence of colonic diverticulosis is increasing in Korea. However, cases of right-sided colonic diverticulitis are rare although diverticula are located in right-sided colon more than left-side. The major clinical symptom of right-sided colonic diverticulitis is acute right lower quadrant pain which may mimic acute appendicitis. Therefore, we evaluated the clinical characteristics of the patients with right-sided colonic diverticulitis and safety of the colonoscopic examinations in these patients. METHODS: The evidence of diverticulitis was confirmed by the presence of pus at the diverticular lesions on colonoscopy. We retrospectively analyzed clinical menifestations, laboratory findings, colonoscopic findings and the presence of complications after colonoscopy, and radiologic findings of the patients with right-sided colonic diverticulitis. RESULTS: All the patients with right-sided colonic diverticulitis had abdominal pain. Physical examinations showed abdominal tenderness in all patients and leukocytosis was noticed in 8 out of 12 patients (66%). There was no complication during and after colonoscopy. All the patients were managed with conservative treatment including broad-spectrum antibiotics and improved without clinical aggravation. CONCLUSIONS: The colonoscopic examination may be helpful to diagnose right-sided colonic diverticulitis.
Abdominal Pain ; Anti-Bacterial Agents ; Appendicitis ; Colon* ; Colonoscopy ; Diagnosis* ; Diverticulitis ; Diverticulitis, Colonic* ; Diverticulosis, Colonic ; Diverticulum ; Humans ; Incidence ; Korea ; Leukocytosis ; Physical Examination ; Retrospective Studies ; Suppuration