Prevalence of clonorchiasis in patients with gastrointestinal disease: A Korean nationwide multicenter survey

AIM: To investigate prevalence of Clonorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea.METHODS: Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire.RESULTS: Of 3080 patients with gastrointestinal diseases, 396 (12.9%) had clonorchiasis and 1140 patients (37.2%) had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 (20.9%) patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than non-infected patients [34/396 (8.6%) vs 145/2684 (5.4%), P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation (P = 0.008). Choledocholithiasis, cholecystolithiasis, cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis.CONCLUSION: Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.

Histologic characteristics of gastric polyps in Korea: Emphasis on discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimen

瞄准：在朝鲜人口调查胃的息肉的组织学的特征。方法：我们与胃的息肉考察了内视镜的相片和病人的医药记录通过 2003 年 2 月从 1996 年 4 月经历了内视镜的粘膜切除术。结果：从 74 个病人的 85 胃的息肉的一个总数被考察。Male-to-female 比率是 1:1.96。吝啬的年龄是 59.9 +/- 10.8 年。多重息肉在 10.8% 被观察。胃的息肉最经常发生在窦(58.8%) 。resected 标本上的病理学的结果如下：管状腺瘤 45.9% ，增生的息肉 31.8% ，煽动性的息肉 9.4% ，错构瘤 3.5% ，底的腺息肉 2.4% ， tubulovillous 腺瘤 2.4% ，腺癌 2.4% ，发育异常 1.1% ，并且粘膜 pseudolipomatosis 1.1% 。在 resected 标本的内视镜的活体检视和病理之间的差异率是 27.1% 。在息肉和词语索引率的尺寸之间没有关系。结论：在在内视镜的钳活体检视和 resected 标本之间的 histologic 调查结果有可观的差异。全部息肉的组织学的评论的途径应该被执行，特别当一个腺瘤被怀疑时。

Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

AIM: To investigate differences in the effects of biliary drainage procedures in patients with inoperable Klatskin’s tumor based on Bismuth type, considering endoscopic retrograde biliary drainage (ERBD), external percutaneous transhepatic biliary drainage (EPTBD) and internal biliary stenting via the PTBD tract (IPTBD). METHODS: The initial success rate, cumulative patency rate, and complication rate were compared retrospectively, according to the Bismuth type and ERBD, EPTBD, and IPTBD. Patency was defined as the duration for adequate initial bile drainage or to the point of the patient’s death associated with inadequate drainage. RESULTS: One hundred thirty-four patients (93 men, 41 women; 21 Bismuth type Ⅱ, 47 Ⅲ, 66 Ⅳ; 34 ERBD, 66 EPTBD, 34 IPTBD) were recruited. There were no differences in demographics among the groups. Adequate initial relief of jaundice was achieved in 91% of patients without a significant difference in the results among different procedures or Bismuth types. The cumulative patency rates for ERBD and IPTBD were better than those for EPTBD with Bismuth type Ⅲ. IPTBD provided an excellent response for Bismuth type Ⅳ. However, there was no difference in the patency rate among drainage procedures for Bismuth type Ⅱ. Procedure-related cholangitis occurred less frequently with EPTBD than with ERBD and IPTBD. CONCLUSION: ERBD is recommended as the first- line drainage procedure for the palliation of jaundice in patients with inoperable Klatskin’s tumor of Bismuth type Ⅱ or Ⅲ, but IPTBD is the best option for Bismuth type Ⅳ.

Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach

BACKGROUND: For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. METHODS: Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. RESULTS: Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).CONCLUSION: Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.

Endoscopic management of occluded metal biliary stents:Metal versus 10F plastic stents

AIM:To compare the efficacy of self-expandable metal stents(SEMSs) with 10F plastic stents(PSs) in the endoscopic management of occluded SEMSs.METHODS:We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage(ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008.RESULTS:Subsequent ERBD with SEMS was performed in 29 patients and with PS in 27.The median time to stent occlusion after subsequent ERBD was 186 d in the SEMS group and 101 d in the PS group(P= 0.118).Overall median stent patency was 79 d for the SEMS group and 66 d for the PS group(P = 0.379).The mean number of additional biliary drainage procedures after subsequent ERBD in patients that died(n = 50) during the study period was 2.54 ± 4.12 for the SEMS group and 1.85 ± 1.95 for the PS group(P = 0.457).The mean total cost of additional biliary drainage procedures after the occlusion of subsequent SEMS or PS was $410.04 ± 692.60 for the SEMS group and $630.16 ± 671.63 for the PS group(P = 0.260).Tumor ingrowth as the cause of initial SEMS occlusion was the only factor associated with a shorter time to subsequent stent occlusion(101 d for patients with tumor ingrowth vs 268 d for patients without tumor ingrowth,P = 0.008).CONCLUSION:Subsequent ERBD with PSs offered similar patency and number of additional biliary drainage procedures compared to SEMSs in the management of occluded SEMS.

Metastasis to the gallbladder:A single-center experience of 20 cases in South Korea

AIM:To evaluate the clinicopathologic characteristics of patients with metastases to the gallbladder (MGBs).METHODS: We performed a single-center retrospective study of 20 patients with MGBs diagnosed pathologically from 1999 to 2007.RESULTS: Among 417 gallbladder (GB) malignancies, 20 (4.8%) were MGBs. The primary malignancies originated from the stomach (n=8), colorectum (n=3), liver (n=2), kidney (n=2), skin (n=2), extrahepatic bile duct (n=1), uterine cervix (n=1), and appendix (n=1). Twelve patients were diagnosed metachronously, presenting with cholecystitis (n=4), abdominal pain (n=2), jaundice (n=1), weight loss (n=1), and serum CA 19-9 elevation (n=1); five patients were asymptomatic. The median survival after the diagnosis of MGB was 8.7 mo. On Cox regression analysis, R0 resection was the only factor associated with a prolonged survival [hazard ratio (HR):0.01,P =0.002]; presentation with cholecystitis was associated with poor survival (HR:463.27, P=0.006).CONCLUSION: MGBs accounted for 4.8% of all pathologically diagnosed GB malignancies. The most common origin was the stomach. The median survival of MGB was 8.7 mo.

Clobenpropit enhances anti-tumor effect of gemcitabine in pancreatic cancer

AIM:To evaluate the anti-tumor effect of clobenpropit,which is a specific H3 antagonist and H4 agonist,in combination with gemcitabine in a pancreatic cancer cell line.METHODS:Three kinds of human pancreatic cancer cell lines(Panc-1,MiaPaCa-2,and AsPC-1)were used in this study.Expression of H3 and H4 receptors in pancreatic cancer cells was identified with Western blotting.Effects of clobenpropit on cell proliferation,migration and apoptosis were evaluated.Alteration of epithelial and mesenchymal markers after administration of clobenpropit was analyzed.An in vivo study with a Panc-1xenograft mouse model was also performed.RESULTS:H4 receptors were present as 2 subunits in human pancreatic cancer cells,while there was no expression of H3 receptor.Clobenpropit inhibited cell migration and increased apoptosis of pancreatic cancer cells in combination with gemcitabine.Clobenpropit up-regulated E-cadherin,but down-regulated vimentin and matrix metalloproteinase 9 in real-time polymerase chain reaction.Also,clobenpropit inhibited tumor growth(gemcitabine 294±46 mg vs combination 154±54 mg,P=0.02)and enhanced apoptosis in combination with gemcitabine(control 2.5%,gemcitabine25.8%,clobenpropit 9.7%and combination 40.9%,P=0.001)by up-regulation of E-cadherin and downregulation of Zeb1 in Panc-1 xenograft mouse.CONCLUSION:Clobenpropit enhanced the anti-tumor effect of gemcitabine in pancreatic cancer cells through inhibition of the epithelial-mesenchymal transition process.