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Cheng HE, Shiu SI, Ko CW. Systematic review and meta-analysis: the efficacy and safety of radiofrequency ablation for early superficial esophageal squamous cell neoplasia. BMC Gastroenterol 2024; 24:152. [PMID: 38698314 PMCID: PMC11067246 DOI: 10.1186/s12876-024-03250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/29/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND AIM Esophageal squamous cell neoplasia (ESCN) is predominant in Asia. Endoscopic mucosal resection and endoscopic submucosal dissection (ESD) have both been recommended worldwide, however the application of endoscopic radiofrequency ablation (RFA) for treatment of early superficial ESCN remains inconclusive. We conducted a meta-analysis to study the effectiveness of RFA for early superficial ESCN. METHODS Three major bibliographic databases were reviewed for the enrollment of case series and cohort trials prior to August 23, 2023. We included adults diagnosed with early superficial ESCN who had been receiving endoscopic RFA or ESD if the treatments were available. Our focus was on the 12-month histological complete response rate (CR) and 3-month histological CR, as well as the acute and late postoperative adverse events (AEs) rate during the at follow-up periods. RESULTS Nine studies were enrolled for qualitative synthesis of narrative review, with eight trials involving a total of 447 participants for analysis. The pooled 12-month and 3-month histological CR were 0.83 (95% CI, 0.59-0.94, I2 = 80%) and 0.74 (95% CI, 0.67-0.80, I2 = 0%), respectively. As for safety, the acute and late postoperative AEs were 0.11 (95% CI, 0.05-0.26, I2 = 68%) and 0.19 (95% CI, 0.14-0.26, I2 = 0%), respectively. In subgroup analysis, the incidence of bleeding, laceration and perforation after endoscopic RFA showed 0.06, 0.06 and 0.02, respectively. When compared with ESD, RFA showed lower acute AEs and late AEs without any obvious significance. CONCLUSIONS For early superficial ESCN, endoscopic RFA achieved both higher 12-month complete remission and late complication postoperatively when compared to 3-month histological CR and acute AEs separately, while the stricture was encountered most commonly. The choice between endoscopic RFA and ESD remains inconclusive.
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Affiliation(s)
- Hsu-En Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Department of Critical Care Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
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Hu H, Tong K, Tsang JY, Ko CW, Tam F, Loong TC, Tse GM. Subtyping of triple-negative breast cancers: its prognostication and implications in diagnosis of breast origin. ESMO Open 2024; 9:102993. [PMID: 38613910 PMCID: PMC11024544 DOI: 10.1016/j.esmoop.2024.102993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) subtyping by gene profiling has provided valuable clinical information. Here, we aimed to evaluate the relevance of TNBC subtyping using immunohistochemistry (IHC), which could be a more clinically practical approach, for prognostication and applications in patient management. METHODS A total of 123 TNBC cases were classified using androgen receptor (AR), CD8, Forkhead box C1 protein (FOXC1), and doublecortin-like kinase 1 (DCLK1) into luminal androgen receptor (LAR), basal-like immunosuppressive (BLIS), mesenchymal-like (MES), and immunomodulatory (IM) subtypes. The IM cases were further divided into the IM-excluded and IM-inflamed categories by CD8 spatial distribution. Their clinicopathological and biomarker profiles and prognoses were evaluated. RESULTS LAR (28.6%) and MES (11.2%) were the most and least frequent subtypes. The IHC-TNBC subtypes demonstrated distinct clinicopathological features and biomarker profiles, corresponding to the reported features in gene profiling studies. IM-inflamed subtype had the best outcome, while BLIS had a significantly poorer survival. Differential breast-specific marker expressions were found. Trichorhinophalangeal syndrome type 1 (TRPS1) was more sensitive for IM-inflamed and BLIS, GATA-binding protein 3 (GATA3) for IM-excluded and MES, and gross cystic disease fluid protein 15 (GCDFP15) for LAR subtypes. CONCLUSIONS Our findings demonstrated the feasibility of IHC surrogates to stratify TNBC subtypes with distinct features and prognoses. The IM subtype can be refined by its CD8 spatial pattern. Breast-specific marker expression varied among the subtypes. Marker selection should be tailored accordingly.
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Affiliation(s)
- H Hu
- Division of Breast Surgery, Department of General Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - K Tong
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - J Y Tsang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - C W Ko
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - F Tam
- Department of Pathology, Kwong Wah Hospital, Hong Kong
| | - T C Loong
- Department of Pathology, Tuen Mun Hospital, Hong Kong
| | - G M Tse
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Chuang TJ, Ko CW, Shiu SI. The metabolic influence of duodenal mucosal resurfacing for nonalcoholic fatty liver disease. Medicine (Baltimore) 2023; 102:e35147. [PMID: 37800801 PMCID: PMC10553053 DOI: 10.1097/md.0000000000035147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) is a leading cause of chronic liver disease worldwide with decreased life expectancy. Duodenal mucosal resurfacing (DMR) has been associated with metabolic improvement in glycemic and hepatic parameters of type 2 diabetes, but the metabolic impact of DMR for NAFLD/NASH remains inconclusive. We conducted a meta-analysis to investigate metabolic effects of DMR in patients with NAFLD/NASH. METHODS Three major bibliographic databases were reviewed for enrollment of trials prior to January 28, 2022. We included adults with biopsy-proven NAFLD/NASH or liver magnetic resonance imaging proton density fat fraction (MRI-PDFF) >5% at baseline and focused on the metabolic difference of MRI-PDFF at 12 weeks, and HbA1c or homeostatic model assessment index for insulin resistance (HOMA-IR) at 24 weeks. RESULTS Two studies involved a total of 67 participants for analysis. When compared with pre-intervention status, mean difference of MRI-PDFF, HbA1c, and HOMA-IR after DMR were -2.22 (95% CI: -12.79~8.34), -0.32% (95% CI: -0.80~0.16), and 0.15 (95% CI: -5.11~5.41) without statistical significance. CONCLUSIONS For patients with NAFLD/NASH, DMR has the trend to improve liver fat at 12 weeks, and glycemic control in terms of HbA1c level at 24 weeks based on a very low quality of evidence.
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Affiliation(s)
- Te-Jung Chuang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri Service General Hospital, Taipei, Taiwan
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Che CC, Shiu SI, Ko CW, Tu YK, Chang CH. Comparisons Between Endoscopic Band Ligation, Radiofrequency Ablation and Endoscopic Thermal Therapy for Gastric Antral Vascular Ectasia: A Meta-Analysis. Dig Dis Sci 2023; 68:3534-3541. [PMID: 37490152 PMCID: PMC10444674 DOI: 10.1007/s10620-023-08028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/25/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Endoscopic band ligation (EBL) and radiofrequency ablation (RFA) have emerged as alternative therapies of gastric antral vascular ectasia (GAVE) in addition to endoscopic thermal therapy (ETT), but the optimum choice remains inconclusive. AIM We conducted a meta-analysis in order to compare these three treatments for GAVE. METHODS We searched the electronic databases of PubMed, Embase and Cochrane Central Register of Controlled Trials without any language restrictions and also performed a manual literature search of bibliographies located in both retrieved articles and published reviews for eligible publications prior to December 8, 2021. We included comparative trials which had evaluated the efficacy and safety of interventions in adults (aged ≥ 18 years) diagnosed with symptomatic GAVE and was confirmed according to clinical backgrounds and upper gastrointestinal endoscopy. We included reports that compared three interventions, ETT, EBL, and RFA. The study was comprised of adults diagnosed with GAVE and focused on overall mortality, bleeding cessation, endoscopic improvement, complications, hospitalization, hemoglobin improvement, number of sessions and transfusion requirements. RESULTS Twelve studies were performed involving a total of 571 participants for analysis. When compared with ETT, EBL achieved better bleeding cessation (OR 4.48, 95% CI 1.36-14.77, p = 0.01), higher hemoglobin improvement (MD 0.57, 95% CI 0.31-0.83, p < 0.01) and lower number of sessions (MD - 1.44, 95% CI - 2.54 to - 0.34, p = 0.01). Additionally, EBL was superior to ETT in endoscopic improvement (OR 6.00, 95% CI 2.26-15.97, p < 0.01), hospitalization (MD - 1.32, 95% CI - 1.91 to - 0.74, p < 0.01) and transfusion requirement (MD - 2.66, 95% CI - 4.67 to - 0.65, p = 0.01) with statistical significance, with the exception of mortality (OR 0.58, 95% CI 0.19-1.77, p = 0.34) and complication rate (OR 5.33, 95% CI 0.58-48.84, p = 0.14). CONCLUSION For GAVE, we suggest that EBL be initially recommended, and APC and RFA be used as alternative treatment choices based upon a very low quality of evidence.
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Affiliation(s)
- Cheng-Che Che
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Evidence-Based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Heath Data Research Center, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Lee SW, Peng YC, Lien HC, Ko CW, Tung CF, Chang CS. Clinical values of Barcelona Clinic Liver Cancer subgroup and up-to-7 criteria in intermediate stage hepatocellular carcinoma with transcatheter arterial chemoembolization. World J Clin Cases 2022; 10:7275-7284. [PMID: 36157996 PMCID: PMC9353889 DOI: 10.12998/wjcc.v10.i21.7275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/28/2021] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is a recommended treatment for patients with intermediate stage hepatocellular carcinoma (HCC) but with variable treatment outcomes.
AIM To determine factors for predicting outcomes of TACE in patients with intermediate stage B HCC.
METHODS Patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC who underwent TACE as the primary treatment were enrolled at Taichung Veterans General Hospital from January 2005 to December 2009. Patients were assigned to either the objective responder (OR) group or the non-OR group according to mRECIST criteria. Clinical and radiological characteristics were compared between the 2 groups. The overall survival of enrolled subjects was analyzed.
RESULTS In 128 enrolled patients, 66 (51.6%) were in the OR group and 62 (48.4%) in the non-OR group. Compared with the non-OR group, the OR group had a significantly smaller HCC size (6.55 cm vs 9.50 cm, P = 0.001) and was within the up-to-7 criteria (50% vs 26.7%, P = 0.001). After multivariable analyses, these significant associations still existed. Overall survival rate of all the subjects averaged 20.65 ± 13.26 mo. The survival rate at 1-year was 64.8%, 2-year was 46.9%, and 3-year was 31.2%. For those patients with OR to TACE, smaller tumor size and within up-to-7 criteria were associated with significantly better overall survival. Those patients with subgroup B1 had the highest OR ratio (75%) and better overall survival (26.70 ± 12.07 mo) after TACE.
CONCLUSION BCLC stage B HCC patients with smaller tumor size or within up-to-7 criteria had better survival outcomes to TACE. BCLC stage B subgroup is useful to predict refractoriness to TACE.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taichung 40227, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yen-Chun Peng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taichung 40227, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chun-Fang Tung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
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Lin YC, Liao SC, Chang CH, Chen CC, Lin WT, Chiu FW, Ko CW. Endoscopic features and clinical course of patients with asymptomatic cecal ulcers. BMC Gastroenterol 2022; 22:309. [PMID: 35751028 PMCID: PMC9229120 DOI: 10.1186/s12876-022-02383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Cecal ulcers are
sometimes encountered in asymptomatic individuals. Their clinical outcomes and
management recommendations remain uncertain. Methods Asymptomatic patients who underwent a colonoscopic exam
for colon cancer screening were retrospectively reviewed from July 2009 to
November 2016. Patients with cecal ulcers were included. Patients who had
colorectal symptoms, such as abdominal pain, had nonsteroidal anti-inflammatory
drugs or were lost to follow-up were excluded. Results A total of 34,036 patients underwent colon cancer
screening. Cecal ulcers were found in 35 patients. After exclusion, 24 patients
(mean duration, 52 months) received follow-up colonoscopy. In 20 patients,
(83.3%), cecal ulcer resolved without intervention, but 4 patients (16.7%)
developed clinical significant diseases, including intestinal tuberculosis
(n = 2), Crohn’s disease (n = 1), and ulcerative colitis (n = 1). Patients who
developed clinically significant diseases had a higher percentage of ulcers
larger than 1 cm (75% vs. 15%, p = 0.035), terminal ileum involvement (100% vs.
15.4%, p = 0.006) and ulcers with irregular fold (75% vs. 5%, p = 0.008). Conclusions In patients with
asymptomatic cecal ulcers, the endoscopic features included larger ulcer size,
terminal ileum involvement and ulcers with irregular fold may predict
development of clinically significant diseases. If the above-mentioned features
are present, even asymptomatic patients should be closely monitored.
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Affiliation(s)
- Ying-Cheng Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Szu-Chia Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan.,School of Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Chia-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Wan-Tzu Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Fang-We Chiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, No. 1, Rongguang Rd., Puli Township, 54552, Nantou, Taiwan.
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan. .,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Shiu SI, Chang CH, Tu YK, Ko CW. The comparisons of different therapeutic modalities for idiopathic achalasia: A systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e29441. [PMID: 35713453 PMCID: PMC9276088 DOI: 10.1097/md.0000000000029441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND : Current guidelines recommend per-oral endoscopic myotomy (POEM) and laparoscopic Heller's myotomy (LHM) as first-line treatment of idiopathic achalasia, but the optimum choice between different endoscopic and surgical modalities remains inconclusive. We conducted a network meta-analysis to compare the efficacy of 8 treatments for idiopathic achalasia. MATERIALS AND METHODS : Three major bibliographic databases were reviewed for enrollment of randomized controlled trials between January 2000 and June 2021. We included adults with idiopathic achalasia and compared two or more of eight interventions including botulinum toxin injection (BTI), pneumatic dilation (PD), BTI + PD, LHM without fundoplication, LHM followed with Dor or Toupet fundoplication, and POEM using either the anterior or posterior approach. Our focus was on clinical success rate, postsurgical acid reflux, and moderate-to-severe adverse events. RESULTS : Twenty-four studies involved a total of 1987 participants for analysis. When compared with PD, POEM with anterior approach, POEM with posterior approach, LHM + Toupet, and LHM + Dor were all significantly superior to the other regimens in short-term efficacy, with POEM with anterior approach and LHM + Dor showing better improvement in mid-term efficacy. BTI showed a significantly lower efficacy than PD in both periods. Regarding safety, only LHM without fundoplication was significantly associated with higher acid reflux than PD, while LHM + Toupet, LHM without fundoplication, and LHM + Dor showed a non-significant increase in moderate-to-severe adverse events. CONCLUSIONS : For idiopathic achalasia, we suggest that POEM with an anterior or posterior approach and LHM with Dor or Toupet fundoplication be initially recommended. On the contrary, both LHM without fundoplication and BTI are not recommended as definitive therapy.
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Affiliation(s)
- Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Evidence-based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Lee SW, Yang SS, Lien HC, Peng YC, Ko CW, Lee TY. Efficacy of Lenvatinib and Sorafenib in the Real-World First-Line Treatment of Advanced-Stage Hepatocellular Carcinoma in a Taiwanese Population. J Clin Med 2022; 11:jcm11051444. [PMID: 35268535 PMCID: PMC8911194 DOI: 10.3390/jcm11051444] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Aim: Currently, atezolizumab combined with bevacizumab is the standard first-line treatment for unresectable hepatocellular carcinoma (HCC), but lenvatinib or sorafenib are still recommended for these patients for some reasons. The aim of the study was to determine the outcomes of Taiwanese patients with advanced-stage HCC who received lenvatinib or sorafenib. Methods: Data on patients with BCLC stage C HCC who were receiving lenvatinib or sorafenib as the first-line therapy from May 2018 to August 2020 was collected. The individuals with lenvatinib and sorafenib were propensity score-matched at a ratio of 1:2. Results: A total of 22 patients with lenvatinib and 44 patients with sorafenib were enrolled. The ORR (36.4% vs. 11.4%, p = 0.023) and DCR (81.9% vs. 56.9%, p = 0.039) were both higher in the lenvatinib group compared with the sorafenib group. The median overall survival (OS) of the lenvatinib group and the sorafenib group was 9.36 months and 8.36 months, respectively. The best median OS was detected in patients receiving lenvatinib and having an objective tumor response (11.29 months), with a significant difference (p = 0.031) compared with the other groups. Conclusion: Lenvatinib, compared to sorafenib, had better ORR and DCR, but similar OS, in Taiwanese patients with advanced-stage HCC. The patients with an objective tumor response had a better OS.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-W.L.); (S.-S.Y.); (H.-C.L.); (Y.-C.P.); (C.-W.K.)
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taichung 40227, Taiwan
| | - Sheng-Shun Yang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-W.L.); (S.-S.Y.); (H.-C.L.); (Y.-C.P.); (C.-W.K.)
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Ph.D. Program in Translational Medicine, Chung Hsing University, Taichung 40227, Taiwan
- Institute of Biomedical Sciences, Chung Hsing University, Taichung 40227, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-W.L.); (S.-S.Y.); (H.-C.L.); (Y.-C.P.); (C.-W.K.)
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taichung 40227, Taiwan
| | - Yen-Chun Peng
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-W.L.); (S.-S.Y.); (H.-C.L.); (Y.-C.P.); (C.-W.K.)
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-W.L.); (S.-S.Y.); (H.-C.L.); (Y.-C.P.); (C.-W.K.)
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Teng-Yu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-W.L.); (S.-S.Y.); (H.-C.L.); (Y.-C.P.); (C.-W.K.)
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Correspondence: ; Tel.: +886-4-23592525 (ext. 3306); Fax: +886-4-23595046
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Tsai HJ, Tai JJ, Chen LT, Wu MS, Yeh KH, Lin CW, Wang TE, Wang HP, Yu FJ, Liou JM, Hsiao CF, Cheng TY, Yeh HJ, Ko CW, Chen MJ, Lo GH, Hsu PI, Chang CS, Hwang WS, Chuang SS, Lee HW, Shun CT, Chiu CF, Wang WM, Hsieh CY, Liu TW, Lin JT, Kuo SH, Cheng AL. A multicenter prospective study of first-line antibiotic therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma with histological evidence of mucosa-associated lymphoid tissue. Haematologica 2019; 105:e349-e354. [PMID: 31727764 DOI: 10.3324/haematol.2019.228775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hui-Jen Tsai
- National Institute of Cancer Research, National Health Research Institutes, Tainan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan
| | - John Jen Tai
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
| | - Chung-Wu Lin
- Department of Pathology, National Taiwan University Hospital, Taipei
| | - Tsang-En Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Fang-Jung Yu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Jyh-Ming Liou
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Chin-Fu Hsiao
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Tsu-Yao Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Hong-Jen Yeh
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Chung-Wang Ko
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Gin-Ho Lo
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Ping-I Hsu
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Cheng-Shyong Chang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua City
| | | | - Shih-Sung Chuang
- Department of Pathology, National Taiwan University Hospital, Taipei.,Department of Pathology, Chi-Mei Medical Center, Tainan.,Department of Pathology, School of Medicine, Taipei Medical University, Taipei
| | - Hsiao-Wei Lee
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei
| | - Chang-Fang Chiu
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung
| | - Wen-Ming Wang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Ching-Yun Hsieh
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Jaw-Town Lin
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
| | - Ann-Lii Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
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10
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Lee SW, Lien HC, Peng YC, Lin MX, Ko CW, Chang CS. The incidence of esophageal cancer and dysplasia in a Chinese population with nondysplastic Barrett's esophagus. JGH Open 2018; 2:214-216. [PMID: 30483592 PMCID: PMC6207007 DOI: 10.1002/jgh3.12075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 01/05/2023]
Abstract
Aim The aim of this study was to investigate the incidence of dysplastic transformation of Barrett's esophagus (BE) in a Chinese population. Method Data from nondysplastic BE patients at Taichung Veterans General Hospital were collected from May 2008 to June 2017. The enrolled individuals received regular upper gastrointestinal (UGI) endoscopy during follow up. The pathological transformations, including low-grade dysplasia (LGD), high-grade dysplasia (HGD), or esophageal adenocarcinoma (EAC), were collected prospectively until June 2017. Rates of progression were calculated in cases with a diagnosis of dysplasia or EAC. Results There were 51 subjects who met the inclusion criteria, with a mean follow up of 3.71 years (SD, 1.61) and a total follow up of 189.1 patient-years. Eight cases (15.7%) developed LGD, with a calculated incidence rate of 2.9% per year. The mean time to development of LGD was 3.26 years (SD, 2.68-3.84). One subject (2%) developed EAC, with a calculated incidence rate of 0.4% per year. No case with HGD was detected. Conclusion In a Chinese population with nondysplastic BE, 15.7% of cases developed LGD, with an incidence rate of 2.9% per year, and 2% of cases developed EAC, with an incidence rate of 0.4% per year.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine Taichung Veterans General Hospital Taichung Taiwan.,Department of Internal Medicine Chung Shan Medical University Taichung Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Department of Internal Medicine Taichung Veterans General Hospital Taichung Taiwan.,Department of Internal Medicine National Yang-Ming University Taipei Taiwan
| | - Yen-Chun Peng
- Division of Gastroenterology, Department of Internal Medicine Taichung Veterans General Hospital Taichung Taiwan.,Department of Internal Medicine National Yang-Ming University Taipei Taiwan
| | - Ming-Xian Lin
- Division of Gastroenterology, Department of Internal Medicine Taichung Veterans General Hospital Taichung Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Department of Internal Medicine Taichung Veterans General Hospital Taichung Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine Taichung Veterans General Hospital Taichung Taiwan.,Department of Internal Medicine Chung Shan Medical University Taichung Taiwan
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11
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Lee SW, Lien HC, Chang CS, Lin MX, Chang CH, Ko CW. Benefits of the Seattle biopsy protocol in the diagnosis of Barrett’s esophagus in a Chinese population. World J Clin Cases 2018; 6:753-758. [PMID: 30510939 PMCID: PMC6264992 DOI: 10.12998/wjcc.v6.i14.753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/04/2018] [Accepted: 10/16/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the benefits of the Seattle protocol in the diagnosis of Chinese individuals with Barrett’s esophagus.
METHODS Subjects enrolled were patients from one center with endoscopically-suspected esophageal metaplasia. These patients first received narrow-band imaging-targeted biopsy, and later, the Seattle protocol-guided biopsy, within a period from October 2012 to December 2014. Those cases without initial pathologic patterns of intestinal metaplasia (IM) and then appearance or loss of IM tissue were designated as Group A or B, respectively. Those with initial pathologic patterns of IM, which then persisted or were lost were designated as Group C or D, respectively.
RESULTS The number of cases for each group was as follows: A: 20, B: 78, C: 31 and D: 14. The distribution of the Prague criteria M levels of Group A was significantly higher than Group B (P = 0.174). Among these groups, Group C had the highest proportions of hiatus hernia (54.8%), long segment Barrett’s esophagus (29%), and also the highest Prague criteria M levels. The sensitivity of IM detection was 69.2% for the narrow-band imaging-targeted biopsy and 78.5% for the Seattle protocol-guided biopsy. The difference was not significant (P = 0.231). The number of detectable dysplasias increased from one case via the NBI-target biopsy to five cases via the Seattle protocol-guided biopsy, including one case of adenocarcinoma.
CONCLUSION The Seattle protocol improved the IM detection in our subjects with higher Prague criteria M levels and disclosed more cases with dysplastic tissues.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Ming-Xian Lin
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei 11221, Taiwan
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12
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Lee SW, Lien HC, Chang CS, Chang CH, Ko CW, Yeh HZ. Differences of risk factors and clinical presentations in male and female Taiwanese individuals with Barrett's esophagus. J Chin Med Assoc 2018; 81:860-864. [PMID: 29778551 DOI: 10.1016/j.jcma.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/01/2017] [Accepted: 12/03/2017] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Barrett's esophagus (BE) is a disorder more often found in obese men. Differences between the two genders are not known in the Asian countries. Here, we studied their gender differences in the Taiwanese population in terms of risk factors and clinical presentations. METHODS Data from Taichung Veteran General Hospital were prospectively collected during an approximately two year-period (October 2012 to December 2014). Patients all underwent endoscopic surveillance, and BE was diagnosed based on the typical pattern of intestinal metaplasia. The patient characteristics were compared between the two genders. RESULTS We enrolled 152 BE patients: 103 men and 49 women. We found in the males, when compared with the females, significantly older mean age, higher waist circumference, greater BMI (ratio of obesity BMI ≧25 kg/m2), and more cases with dyslipidemia and hiatus hernia. Long-segment BE and high-grade dysplasia/adenocarcinoma appeared only in males. Self-reported reflux symptoms were noted 80.6% in men and 89.8% in women. In those with dysplastic BE, we found these patients having higher ratios of obesity, hiatus hernia, alcohol drinking, cigarette smoking and reflux symptom. CONCLUSION Gender differences were found in our BE patients, males were older in age, more obese, and suffered more serious signs from BE in terms of both endoscopic and pathologic presentations.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
| | - Han-Chung Lien
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan, ROC
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Chung-Hsin Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chung-Wang Ko
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan, ROC
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan, ROC
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13
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Kim J, Suh BK, Ko CW, Lee KH, Shin CH, Hwang JS, Kim HS, Chung WY, Kim CJ, Han HS, Kwon NY, Cho SY, Yoo HW, Jin DK. Recombinant growth hormone therapy for prepubertal children with idiopathic short stature in Korea: a phase III randomized trial. J Endocrinol Invest 2018; 41:475-483. [PMID: 29103133 PMCID: PMC5852196 DOI: 10.1007/s40618-017-0786-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/25/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Several studies have evaluated the effects of growth hormone (GH) on auxological and biochemical parameters in children with non-GH-deficient, idiopathic short stature (ISS). This study evaluated the efficacy and safety of Growtropin®-II (recombinant human GH) in Korean patients with ISS. METHODS This was a 1-year, open-label, multicenter, phase III randomized trial of Growtropin®-II in Korean patients with ISS. In total, 70 prepubertal subjects (39 males, 31 females) between 4 and 12 years of age were included in the study. All patients were naive to GH treatment. RESULTS Annual height velocity was significantly higher in the treatment group (10.68 ± 1.95 cm/year) than the control group (5.72 ± 1.72, p < 0.001). Increases in height and weight standard deviation scores (SDSs) at 26 weeks were 0.63 ± 0.16 and 0.64 ± 0.46, respectively, for the treatment group, and 0.06 ± 0.15 and 0.06 ± 0.28, respectively, for the control group (p < 0.001). Serum insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) increased significantly in the treatment group at week 26 compared to baseline. However, the SDS for body mass index (BMI) at 26 weeks did not change significantly in either group. Growtropin®-II was well tolerated and safe over 1 year of treatment. CONCLUSIONS One-year GH treatment for prepubertal children with ISS demonstrated increased annualized velocity, height and weight SDSs, and IGF-1 and IGFBP-3 levels, with a favorable safety profile. Further evaluations are needed to determine the optimal dose, final adult height, and long-term effects of ISS treatment.
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Affiliation(s)
- J Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - B-K Suh
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - C W Ko
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - K-H Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - C H Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - J S Hwang
- Department of Pediatrics, Ajou University Hospital, Suwon, Republic of Korea
| | - H S Kim
- Department of Pediatrics, Severance Hospital, Onsei University Health System, Seoul, Republic of Korea
| | - W Y Chung
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - C J Kim
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H-S Han
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - N Y Kwon
- Data Management and Clinical Statistics Team, Dong-A ST Co., LTD, Seoul, Republic of Korea
| | - S Y Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - H-W Yoo
- Department of Pediatrics, Medical Genetics Clinic and Laboratory, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - D-K Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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14
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Lee SW, Lien HC, Chang CS, Ko CW, Tung CF, Yeh HZ. Health-related quality of life of subjects with Barrett's esophagus in a Chinese population. PLoS One 2017; 12:e0190201. [PMID: 29267355 PMCID: PMC5739499 DOI: 10.1371/journal.pone.0190201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/08/2017] [Indexed: 01/15/2023] Open
Abstract
Aim The aim of this study was to investigate health-related quality of life (HRQoL) of a Chinese population with Barrett's esophagus (BE). Methods Data from subjects with BE from a single hospital were prospectively collected from October 2012 to December 2014. The exclusion criteria included total esophagectomy, severe cardiopulmonary deficiency, malignancy, or other unsuitable conditions for scope. All the enrolled cases were asked to complete the Reflux Disease Questionnaire (RDQ), the short form-12, (SF-12), and the Hospital Anxiety and Depression Scale (HADS). Results In total, 139 subjects were enrolled, and the mean age of the cases was 61.85 years old. Most subjects had short-segment BE (SSBE) (92.8%) and non-dysplastic BE tissue (94.2%). The mean physical and mental composite scores, PCS and MCS, of SF-12 were 44.14 and 45.53, respectively. The SF-12 scores in BE individuals were similar in men and women, elderly and non-elderly, LSBE and SSBE, coexisting EE and no-EE, and dysplastic and non-dysplastic. The appearance of reflux symptoms tended to decrease SF-12 scores in affected individuals, especially heartburn. The rates of anxiety and depression accounted for 25.2% and 17.3% of these cases, respectively. Conclusion Our study found HRQoL in BE patients was strongly associated with presentation of reflux symptoms.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
- * E-mail:
| | - Han-Chung Lien
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Fang Tung
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
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15
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Wei GY, Ko CW, Yeh GZ, Wu CP, Chang CH, Wang RC. A 28-year-old man with abdominal cramping pain and tarry stool for 6 months. Advances in Digestive Medicine 2017. [DOI: 10.1002/aid2.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- g-Yu Wei
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Taichung Veterans General Hospital; Taichung Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Taichung Veterans General Hospital; Taichung Taiwan
| | - g-Zen Yeh
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Taichung Veterans General Hospital; Taichung Taiwan
| | - Cheng-Pin Wu
- Health Examination Center; China Medical University Hospital; Taichung Taiwan
- Preventive Medicine Center; China Medical University Hospital; Taichung Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Taichung Veterans General Hospital; Taichung Taiwan
| | - Ren-Ching Wang
- Department of Pathology and Laboratory Medicine; Taichung Veterans General Hospital; Taichung Taiwan
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Chang CH, Wu CP, Wang JD, Lee SW, Chang CS, Yeh HZ, Ko CW, Lien HC. Alcohol and tea consumption are associated with asymptomatic erosive esophagitis in Taiwanese men. PLoS One 2017; 12:e0173230. [PMID: 28264069 PMCID: PMC5338804 DOI: 10.1371/journal.pone.0173230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/18/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Asymptomatic erosive esophagitis (AEE) is commonly found in men, and might be a risk factor of developing esophageal adenocarcinoma. We aimed to determine if specific dietary habits increase the risk of AEE in asymptomatic Taiwanese men. Methods We recruited male adults undergoing upper gastrointestinal endoscopy for health check. We excluded subjects with reflux symptoms, or taking anti-reflux medications or drugs that potentially impair lower esophageal sphincter function or cause mucosal injury. The frequency of consuming reflux-provoking diets including alcohol, tea, coffee, tomato/citric juice, chocolate, sweet food, and spicy food was assessed. The erosive esophagitis was diagnosed based on the Los Angeles Classification after endoscopy. Frequent consumption of a specific diet was defined as ≥4 days/week of consuming that diet. Results A total of 1256 participants were recruited. After excluding 424 ineligible subjects, AEE was identified in 180 (22%) among 832 asymptomatic subjects. The risk of AEE increased with the number of days per week of consuming alcohol or tea: nondrinkers (19%, 17%), occasional drinkers (<1 day/week; 19%, 15%), regular drinkers (1–3 days/week; 26%, 21%), frequent drinkers (4–6 days/week; 32%, 22%), and daily drinkers (42%, 28%), respectively (trend test P < 0.001 for both). Multivariate analysis showed that hiatus hernia (adjusted odds ratio (aOR) 5.0, 95% confidence interval (CI) 2.6–9.6), drinking alcohol ≥4 days/week (aOR 2.3, 95% CI 1.3–4.0), and drinking tea ≥4 days/week (aOR 1.6, 95% CI 1.1–2.3) are independent risk factors of AEE. The risk of AEE was 3.8 times greater for those drinking both alcohol and tea ≥4 days/week than the non-drinkers. Conclusions Frequent alcohol and tea consumption increased the risk of AEE in Taiwanese men.
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Affiliation(s)
- Chung-Hsin Chang
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Pin Wu
- Health Examination Center, China Medical University Hospital, Taichung, Taiwan
- Preventive Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shou-Wu Lee
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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17
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Lee SW, Ko CW, Liao SC, Chang CS, Yeh HZ, Chang CS. A Case With Vitamin D Deficiency-Induced Cytomegalovirus Enteritis Presenting as Bowel Pseudo-Obstruction. Gastroenterology Res 2017; 10:193-195. [PMID: 28725308 PMCID: PMC5505286 DOI: 10.14740/gr823w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/03/2017] [Indexed: 11/15/2022] Open
Abstract
Cytomegalovirus (CMV) infection in small intestines has rarely been reported. We report a 67-year-old woman with abdominal pain for 2 weeks. Abdominal computed tomography (CT) revealed wall-thickening of the segmental small bowel. Enteroscopy disclosed discrete ulcers at the jejunum, and biopsy histopathology showed positive CMV immunoreactivity. Laboratory tests showed positive blood CMV with a viral load of 9,400 DNA copies/mL and high IgG titer and low vitamin D level. After antiviral therapy and oral vitamin D supply, her symptoms improved. Follow-up CT and enterology showed resolved enteritis.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
- Corresponding Author: Shou-Wu Lee, Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 1650 Taiwan Boulevard, Sec. 4, Taichung 40705, Taiwan, Repblic of China.
| | - Chung-Wang Ko
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- Department of Internal Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
| | - Szu-Chia Liao
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Chung-Shihn Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- Department of Internal Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
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Wu CP, Liang WM, Wang CC, Chang CS, Yeh HZ, Hsu JY, Ko CW, Lee SW, Chang SC, Sung FC, Lien HC. The suitability of the GERDyzer instrument in pH-test-proven laryngopharyngeal reflux patients. Medicine (Baltimore) 2016; 95:e4439. [PMID: 27495070 PMCID: PMC4979824 DOI: 10.1097/md.0000000000004439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The use of validated patient-reported outcome (PRO) instruments for the treatment outcome measure of laryngopharyngeal reflux (LPR) is crucial given the lack of objective markers. However, current symptom-based PRO instruments can only partially capture the impact of LPR. The GERD Analyzer (GERDyzer), an existing disease-specific PRO instrument, which measures multidimensional health-related quality of life (HRQL) affected by the illness rather than by any specific symptoms, has been validated in patients with erosive gastroesophageal reflux disease (GERD). Following the U.S. Food and Drug Administration PRO guidance, we cross-culturally adapted the GERDyzer instrument into Chinese, and examined the qualitative and quantitative psychometric properties of the Chinese version GERDyzer in pH-test-proven LPR patients.The GERDyzer comprises 10 dimensions of HRQL, including general well-being, pain/discomfort, physical health, diet, energy, activities, leisure activities, social life, mood, and sleep. To examine the content validity, we recruited 26 pH-test-proven LPR participants to conduct 4 focus group meetings for direct patient input on clinical manifestations and HRQL impacts. We also tested the quantitative psychometric properties, including reliability, validity, and responsiveness in 100 pH-test-proven LPR patients.Saturation of concept elicitation was achieved from the 4 focus groups, and a strong conceptual match was evident between the GERDyzer contents and responses from the focus group participants. Cognitive debriefing assessment showed that the Chinese version GERDyzer was adequate for use by patients as it demonstrated linguistic validation and cultural harmonization. Quantitative psychometric properties showed evidence of high internal consistency (Cronbach α: 0.96), good to excellent test-retest reliability (intraclass correlation coefficient: 0.84-0.98). Confirmatory factor analysis supported a 2-factor structure. Convergent validity was confirmed by moderate correlation assessments referencing the Reflux Symptoms Index and the Reflux Questionnaire. The discriminant validity was supported by the ability to discriminate moderate-to-severe disease from mild disease. The responsiveness was also high in participants with and without typical GERD symptoms (effect sizes 1.20 and 1.21, respectively).In conclusion, the Chinese version GERDyzer instrument is a reliable, valid, and responsive instrument for assessing HRQL in Taiwanese patients with LPR.
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Affiliation(s)
- Cheng-Pin Wu
- Health Examination Center, China Medical University Hospital, Taichung, Taiwan
- Preventive Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Chen-Chi Wang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Speech Language Pathology & Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jeng-Yuan Hsu
- Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shou-Wu Lee
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shu-Chuan Chang
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
- Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
- Correspondence: Han-Chung Lien, Division of Gastroenterology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung 40705, Taiwan ROC (e-mail: )
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Liao SC, Ko CW, Yeh HZ, Chang CS. Severe diarrhea caused by cytomegalovirus in an elderly man. Advances in Digestive Medicine 2015. [DOI: 10.1016/j.aidm.2015.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lien HC, Wang CC, Lee SW, Hsu JY, Yeh HZ, Ko CW, Chang CS, Liang WM. Responder Definition of a Patient-Reported Outcome Instrument for Laryngopharyngeal Reflux Based on the US FDA Guidance. Value Health 2015; 18:396-403. [PMID: 26091593 DOI: 10.1016/j.jval.2015.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 11/01/2014] [Accepted: 01/01/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Different end-point measures may contribute to inconsistent therapeutic responses in relief of laryngopharyngeal reflux (LPR) symptoms. OBJECTIVES We aimed to determine an a priori responder definition for a patient-reported outcome instrument, the Reflux Symptom Index (RSI), using an anchor-based method, to interpret individual treatment benefit in patients with LPR, on the basis of the US Food and Drug Administration guidance. METHODS Patients with chronic laryngeal symptoms suggestive of LPR underwent twice-daily 40 mg esomeprazole treatment for 12 weeks. We used a 50% or more reduction in the primary laryngeal symptom at week 12, an empirical criterion, as an anchor to dichotomize the participants into two groups, and to establish a responder definition of the RSI score change. The optimal cutoff point of the RSI score change was determined on the basis of the maximal Youden index of the receiver operating characteristic analysis. RESULTS The mean reduction in the RSI score was significantly greater in subjects with a 50% or more reduction in the primary laryngeal symptom than in those without (-11.0 ± 7.8 vs. -3.1 ± 8.3, P < 0.0001). A reduction of six points or more in the RSI score at week 12 was considered to be the responder definition with a sensitivity of 0.79 and a specificity of 0.70. CONCLUSIONS We propose an a priori responder definition derived from an empirical criterion according to the Food and Drug Administration guidance: a reduction of six points or more in the RSI score at week 12. This preliminary estimate provides a clinically meaningful change at an individual level, although additional studies and validations across various languages are required.
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Affiliation(s)
- Han-Chung Lien
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chen-Chi Wang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Speech Language Pathology & Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Shou-Wu Lee
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jeng-Yuan Hsu
- Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Sen Chang
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan.
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Lee SW, Lee TY, Lien HC, Yeh HZ, Chang CS, Ko CW. The risk factors and quality of life in patients with overlapping functional dyspepsia or peptic ulcer disease with gastroesophageal reflux disease. Gut Liver 2013; 8:160-4. [PMID: 24672657 PMCID: PMC3964266 DOI: 10.5009/gnl.2014.8.2.160] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/18/2013] [Accepted: 05/03/2013] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Gastroesophageal reflux disease (GERD), functional dyspepsia (FD), and peptic ulcer disease (PUD) impact the daily lives of affected individuals. The aim of this study was to compare the risk factors and impacts on life quality of overlapping FD or PUD in patients with GERD. Methods Data from patients diagnosed with GERD were collected between January and November 2009. FD was defined using the Rome III diagnostic criteria. The overlapping GERD-FD or GERD-PUD groups were classified as concomitant GERD and FD or peptic ulcers. The characteristics of these individuals were analyzed. Results There were 63, 48, and 60 patients in the GERD only, overlapping GERD-FD, and overlapping GERD-PUD groups, respectively. Significantly younger age, female gender, lower body weight and body mass index, and higher rates of tea consumption were noted in the GERD-FD group. Patients in the GERD-FD group exhibited the lowest quality of life scores, both with respect to physical and mental health, on the Short Form 36 domains. Conclusions Patients with concomitant GERD and FD were more likely to be younger and female. Overlapping GERD and FD had the worst impact on the quality of life of the affected individuals.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Teng-Yu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Medicine, Yang Ming University, Taipei, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Medicine, Yang Ming University, Taipei, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. ; Department of Medicine, Yang Ming University, Taipei, Taiwan
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Lee SW, Lee TY, Lien HC, Yeh HZ, Chang CS, Ko CW. Comparison of Risk Factors and Disease Severity Between Old and Young Patients With Gastroesophageal Reflux Disease. Gastroenterology Res 2013; 6:91-94. [PMID: 27785235 PMCID: PMC5051151 DOI: 10.4021/gr549w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 12/24/2022] Open
Abstract
Background Gastroesophageal reflux disease (GERD) tends to relapse and develop complications. The aim of the study was to compare the risk factors and disease severity of GERD in young and old patients. Methods Data from patients with GERD were collected between January and November 2009. The enrolled cases were assigned to the younger group if they were below 65 years, or the elderly group if 65 years or older. The general demographic data, lifestyle characteristics and endoscopic findings of the two groups were compared. Results Among all enrolled 111 patients, 78 and 33 patients were classified in the younger and elderly groups, respectively. The elderly group had significantly more men than the younger group did (72.7% vs 39.7%, P = 0.001). Lower rates of smoking (3% vs 6.4%, P = 0.029) and tea drinking (21.3% vs 34.6%, P = 0.001) were noted in the elderly patients, but similar rates of alcohol and coffee drinking. There were more severe esophagitis, esophagocardiac junction (ECJ) ulcers (21.2% vs. 2.6%, P = 0.003) and hiatal hernia (36.4% vs 16.9%, P = 0.025) in the elderly group. Conclusion Elderly GERD patients were more likely to be male, and having severe esophagitis, but lower rates of cigarette smoking and tea drinking, than those of younger patients.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Teng-Yu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Internal Medicine, Yang-Ming University, Taipei, Taiwan
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Chen CC, Yeh HZ, Chang CS, Ko CW, Lien HC, Wu CY, Hung SW. Transarterial embolization of metastatic mediastinal hepatocellular carcinoma. World J Gastroenterol 2013; 19:3512-3516. [PMID: 23801848 PMCID: PMC3683694 DOI: 10.3748/wjg.v19.i22.3512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/05/2013] [Accepted: 04/19/2013] [Indexed: 02/06/2023] Open
Abstract
This paper introduces an innovative treatment for extra-hepatic metastasis of hepatocellular carcinoma. A 71-year-old patient had a stable liver condition following treatment for hepatocellular carcinoma, but later developed symptomatic mediastinal metastasis. This rapidly growing mediastinal mass induced symptoms including cough and hoarseness. Serial sessions of transarterial embolization (TAE) successfully controlled this mediastinal mass with limited side effects. The patient’s survival time since the initial diagnosis of the mediastinal hepatocellular carcinoma was 32 mo, significantly longer than the 12 mo mean survival period of patients with similar diagnoses: metastatic hepatocellular carcinoma and a liver condition with a Child-Pugh class A score. Currently, oral sorafenib is the treatment of choice for metastatic hepatocellular carcinoma. Recent studies indicate that locoregional treatment of extra-hepatic metastasis of hepatocellular carcinomas might also significantly improve the prognosis in patients with their primary hepatic lesions under control. Many effective locoregional therapies for extrahepatic metastasis, including radiation and surgical resection, may provide palliative effects for hepatocellular carcinoma-associated mediastinal metastasis. This case report demonstrates that TAE of metastatic mediastinal hepatocellular carcinoma provided this patient with tumor control and increased survival time. This finding is important as it can potentially provide an alternative treatment option for patients with similar symptoms and diagnoses.
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Tsai AS, Ko CW, Yeh HZ, Chang CS, Wang RC. Peripheral T-cell lymphoma of the colon associated with hemophagocytic lymphohistiocytosis. J Chin Med Assoc 2013; 76:169-72. [PMID: 23497971 DOI: 10.1016/j.jcma.2012.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 09/23/2011] [Indexed: 11/23/2022] Open
Abstract
Peripheral T-cell lymphoma (PTCL) of the colon is classified as a subtype of intestinal T-cell lymphoma, which usually has multiple ulcerations. Herein, we report a case of multiple ulcers in the large intestine of a 55-year-old male, who presented to us with symptoms of abdominal pain and watery diarrhea for a month. In addition, results of his endoscopic biopsy revealed crypt abscess with dense inflammatory cells infiltrated in the lamina propria of the colon. One week later, he presented with pancytopenia and jaundice, and results of a biopsy of the bone marrow showed the appearance of hemophagocytosis. Unfortunately, colon perforation occurred during the 10th day of hospitalization, and a histopathological analysis of the colonic resection revealed PTCL. Finally, the patient died of sepsis on the 29th day of hospitalization. The endoscopic character of ulcerative colon T-cell lymphoma is easily confused with Crohn's disease, tuberculosis colitis, and viral colitis. In addition, it is also difficult to distinguish between lymphoma cells and dense inflammatory cells while performing endoscopic biopsy of the mucosa in colon lymphoma. Once a typical geographic and punched out ulcers of the colon are found accompanying the presentation of hemophagocytic lymphohistiocytosis, the diagnosis of PTCL involving the colon should be highly suspected, even if the initial endoscopic biopsy has failed to confirm it.
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Affiliation(s)
- An-Swen Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Lee SW, Lien HC, Chang CS, Peng YC, Ko CW, Chou MC. Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease. World J Gastroenterol 2012; 18:5090-5. [PMID: 23049219 PMCID: PMC3460337 DOI: 10.3748/wjg.v18.i36.5090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/14/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the symptom presentation and quality of life in obese Chinese patients with gastroesophageal reflux disease (GERD).
METHODS: Data from patients diagnosed with GERD according to the Montreal definition, were collected between January 2009 to March 2010. The enrolled patients were assigned to the normal [body mass index (BMI) < 25 kg/m2], overweight (25-30 kg/m2), and obese (BMI > 30 kg/m2) groups. General demographic data, endoscopic findings, and quality of life of the three groups of patients were analyzed and compared.
RESULTS: Among the 173 enrolled patients, 102, 56 and 15 patients were classified in the normal, overweight, and obese, respectively. There was significantly more erosive esophagitis (73.3% vs 64.3% vs 39.2%, P = 0.002), hiatal hernia (60% vs 33.9% vs 16.7%, P = 0.001), and males (73.3% vs 73.2% vs 32.4%, P = 0.001) in the obese cases. The severity and frequency of heartburn, not acid regurgitation, was positively correlated with BMI, with a significant association in men, but not in women. Obese patients were prone to have low quality of life scores, with obese women having the lowest scores for mental health.
CONCLUSION: In patients with GERD, obese men had the most severe endoscopic and clinical presentation. Obese women had the poorest mental health.
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Chang CS, Ko CW, Lien HC, Chou MC. Effect of Electroacupuncture on St. 36 (Zusanli) and LI. 10 (Shousanli) Acupuncture Points on Heart Rate Variability. Am J Chin Med 2012; 38:231-9. [DOI: 10.1142/s0192415x10007804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Electrical stimulation of St. 36 (Zusanli) has been shown to enhance the regularity of gastric myoelectrical activity in healthy subjects. However, the underlying mechanism by which acupuncture alters gastric myoelectrical activity is still not clear. To elucidate the possible role of the autonomic nervous system in mediating the effect of acupuncture, we monitored heart rate variability (HRV), a widely used index of vagal discharge at the sinoatrial node of the heart before, during and after electroacupuncture. In this study, we applied two different frequencies (2 Hz and 100 Hz) of electrical stimulation at St. 36 (Zusanli) and LI. 10 (Shousanli) in 15 healthy volunteers. Low frequency (LF, sympathetic activity), high frequency (HF, vagal activity) and LF/HF ratio (sympathovagal balance) were analyzed and compared at the two different frequencies. The results showed an increase in the LF/HF ratio (indicating greater sympathetic activity) during the post-acupuncture period using 2 Hz of electrical stimulation at St. 36 (Zusanli). However, the overall change was not statistically significant. In addition, the power of LF and HF did not change significantly with electroacupuncture at St. 36 (Zusanli) and LI. 10 (Shousanli). In conclusion, applying 2 Hz or 100 Hz electroacupuncture at St. 36 (Zusanli) or LI. 10 (Shousanli) did not affect cardiovagal activity in normal volunteers. This phenomenon might be due to a difference in presentation in the autonomic nervous system between cardiac and abdominal vagal activity.
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Affiliation(s)
- Chi-Sen Chang
- Institute of Medicine, Chung Shan Medical University, Taiwan
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Wang Ko
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- National Yang-Ming Medical University, Taipei, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- National Yang-Ming Medical University, Taipei, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taiwan
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Abstract
The postnatal persistence of fetal hydronephrosis requires further evaluation to establish whether pathological abnormalities are present. This study determined the necessity for voiding cystourethrography (VCUG) to identify vesicoureteral reflux (VUR) in children (n = 195) with prenatally diagnosed hydronephrosis. Among the study population, the prevalence of VUR was 17.4% (24 males, 10 females). There was a poor correlation between the severity of hydronephrosis, ureteral dilatation, presence of bilateral hydronephrosis and presence of VUR. Except for the frequency of urinary tract infections and the presence of renal damage on (99m)Tc-dimercaptosuccinic acid scans, VCUG was the only reliable method for confirming VUR in this study. The diagnosis of VUR is important for the early detection of renal damage. Further information is needed to develop the optimal approach to the evaluation of prenatal hydronephrosis, with reliable parameters that avoid invasive procedures such as VCUG.
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Affiliation(s)
- H H Hwang
- Department of Paediatrics, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
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Abstract
BACKGROUND Several studies have supported the hypothesis of different presentations in the autonomic nervous system (ANS) between cardiac and gastric vagal activity. Due to the regionality of the ANS, different responses among different organ systems to the same stimulation (such as a meal) are quite possible. METHODS In this study we monitored the postprandial changes of heart rate variability (HRV) and gastrointestinal (GI) hormones to determine whether both responded in a similar pattern. Twenty-two healthy volunteers (6 males and 16 females) were enrolled. After recording a baseline ECG rhythm, further recordings were made at 20 min intervals for 120 min after a test meal. Serum human pancreatic polypeptide (PP), leptin, and total and active ghrelin levels were measured. KEY RESULTS After the meal, HR increased significantly from baseline at each time point, except for 20 min after the meal. The high frequency (HF) power decreased significantly from 40 min to 120 min after the meal. In addition, the low frequency (LF) power also decreased significantly from 60 min to 120 min. However, the LF:HF ratio increased significantly from 20 min to 120 min. There was a marked increase (>2 fold) of PP at 20 min after the meal, and the increase was sustained throughout the test period. CONCLUSIONS & INFERENCES These findings suggest that HRV reflects cardiac, but not equivalently, abdominovagal activity. Therefore, HRV as an abdominovagal activity measurement in patients with GI functional problems should be used with caution, and other markers such as PP should be included.
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Affiliation(s)
- C S Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Lai PH, Weng HH, Chen CY, Hsu SS, Ding S, Ko CW, Fu JH, Liang HL, Chen KH. In vivo differentiation of aerobic brain abscesses and necrotic glioblastomas multiforme using proton MR spectroscopic imaging. AJNR Am J Neuroradiol 2008; 29:1511-8. [PMID: 18499784 PMCID: PMC8119023 DOI: 10.3174/ajnr.a1130] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Abscesses caused by aerobic bacteria (aerobic abscesses) can simulate intracranial glioblastomas multiforme (GBMs) in MR imaging appearance and single voxel (SV) proton MR spectroscopy of the central cavity. The purpose of our study was to determine whether MR spectroscopic imaging (SI) can be used to differentiate aerobic abscesses from GBMs. Our hypothesis was that metabolite levels of choline (Cho) are decreased in the ring-enhancing portion of abscesses compared with GBMs. MATERIALS AND METHODS Fifteen patients with aerobic abscesses were studied on a 1.5T MR scanner using an SV method and an SI method. Proton MR spectra of 15 GBMs with similar conventional MR imaging appearances were used for comparison. The resonance peaks in the cavity, including lactate, cytosolic amino acids, acetate, succinate, and lipids, were analyzed by both SV MR spectroscopy and MRSI. In the contrast-enhancing rim of each lesion, peak areas of N-acetylaspartate (NAA), choline (Cho), lipid and lactate (LL), and creatine (Cr) were measured by MRSI. The peak areas of NAA-n, Cho-n, and Cr-n in the corresponding contralateral normal-appearing (-n) brain were also measured. Maximum Cho/Cr, Cho/NAA, LL/Cr-n, and Cho/Cho-n and minimum Cr/Cr-n and NAA/NAA-n ratios in abscesses and GBMs were compared using the Wilcoxon rank sum test. After receiver operating characteristic curve analysis, diagnostic accuracy was compared. RESULTS Cytosolic amino acid peaks were found in the cavity in 7 of 15 patients with aerobic abscesses. Means and SDs of maximum Cho/Cr, Cho/NAA, LL/Cr-n, and Cho/Cho-n and minimum Cr/Cr-n and NAA/NAA-n ratios were 3.38 +/- 1.09, 3.88 +/- 2.13, 2.72 +/- 1.45, 1.98 +/- 0.53, 0.53 +/- 0.16, and 0.44 +/- 0.09, respectively, in the GBMs, and 1.77 +/- 0.49, 1.48 +/- 0.51, 2.11 +/- 0.67, 0.81 +/- 0.21, 0.48 +/- 0.2, and 0.5 +/- 0.15, respectively, in the abscesses. Significant differences were found in the maximum Cho/Cr (P = .001), Cho/NAA (P = .006), and Cho/Cho-n ratios (P < .001) between abscesses and GBMs. Diagnostic accuracy was higher by Cho/Cho-n ratio than Cho/Cr and Cho/NAA ratios (93.3% versus 86.7% and 76.7%). CONCLUSION Metabolite ratios and maximum Cho/Cho-n, Cho/Cr, and Cho/NAA ratios of the contrast-enhancing rim were significantly different and useful in differentiating aerobic abscesses from GBMs by MRSI.
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Affiliation(s)
- P H Lai
- Department of Radiology, Veterans' General Hospital, Kaohsiung, and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.
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Buscaglia JM, Shin EJ, Clarke JO, Giday SA, Ko CW, Thuluvath PJ, Magno P, Dray X, Kantsevoy SV. Endoscopic retrograde cholangiopancreatography, but not esophagogastroduodenoscopy or colonoscopy, significantly increases portal venous pressure: direct portal pressure measurements through endoscopic ultrasound-guided cannulation. Endoscopy 2008; 40:670-4. [PMID: 18561105 DOI: 10.1055/s-2008-1077341] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND STUDY AIMS Changes in portal pressure during endoscopy have not been previously evaluated. The aims of this study were to assess the effect of esophagogastroduodenoscopy (EGD), colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP) on portal vein, inferior vena cava (IVC), and systemic pressures. PATIENTS AND METHODS Five acute experiments were performed on 50-kg pigs utilizing endoscopic ultrasound (EUS)-guided catheterization of the portal vein and IVC. Systemic, intra-abdominal, IVC, and portal vein pressures were monitored during colonoscopy, EGD, and ERCP with endoscopic sphincterotomy. After endoscopy the animals were sacrificed for necropsy. The main outcome measure was pressure change during each type of endoscopic procedure. RESULTS There were no significant changes in heart rate or systemic pressure during all endoscopic procedures. Intra-abdominal pressure increased during colonoscopy ( P = 0.02) and ERCP ( P = 0.007). However, mean portal venous pressure was significantly elevated only after the injection of contrast into the common bile duct, reaching its peak value at the time of biliary sphincterotomy (39.0 +/- 15.2 mm Hg vs. 13.4 +/- 3.6 mm Hg at baseline, P = 0.006). Mean peak IVC pressure was also elevated during ERCP, but it did not reach statistical significance (24.0 +/- 10.7 mm Hg vs. 12.6 +/- 4.1 mm Hg at baseline, P = 0.06). CONCLUSION EGD and colonoscopy did not cause significant changes in portal vein, IVC, or systemic pressures. ERCP with biliary sphincterotomy increased portal pressure with only limited effect on IVC and systemic pressures. These new data indicate a possible connection between ERCP with sphincterotomy and portal pressure, and may be clinically important for patients with liver disease and other causes of portal hypertension who undergo this procedure.
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Affiliation(s)
- J M Buscaglia
- Department of Medicine, Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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Magno P, Giday SA, Gabrielson KL, Shin EJ, Clarke JO, Ko CW, Buscaglia JM, Jagannath SB, Canto MI, Kantsevoy SV. EUS-guided submucosal implantation of a radiopaque marker: a simple and effective procedure to facilitate subsequent surgical and radiation therapy. Gastrointest Endosc 2008; 67:1147-52. [PMID: 18513556 DOI: 10.1016/j.gie.2008.02.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 02/15/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endosonography (EUS) is widely used for locoregional staging of malignant GI tumors. Delineation of a tumor's margins with a long-lasting fluoroscopically visible material will facilitate subsequent surgical and radiation therapy. OBJECTIVE To assess the feasibility of EUS-guided submucosal implantation of a radiopaque marker in a porcine model. SETTING Survival experiments on four 50-kg pigs. METHODS A linear array echoendoscope was introduced into the esophagus and advanced to the stomach. With a 19-gauge FNA needle, a submucosal bleb was created by injecting 3 mL of normal saline solution into the gastric and esophageal wall followed by injection of 1 mL of tantalum suspension under fluoroscopic observation. Fluoroscopy was repeated after 1, 2, and 4 weeks followed by euthanasia and necropsy. MAIN OUTCOME MEASUREMENTS Long-term depositions of the marker in the injection sites. RESULTS Submucosal injections of tantalum were easily performed through the 19-gauge FNA needle, resulting in good fluoroscopic opacification of injected material. Follow-up fluoroscopy in 1, 2, and 4 weeks demonstrated stable deposition of the tantalum at the sites of injection. There were no complications during and after the tantalum implantation. Histologic examination of the injection sites demonstrated submucosal tantalum depositions without signs of infection, inflammation, tissue damage, or necrosis. LIMITATIONS Animal experiments with 4 weeks' follow-up. CONCLUSIONS EUS-guided implantation of tantalum as a radiopaque marker into the submucosal layer of the GI tract in a porcine model is technically feasible and safe. Long-lasting fluoroscopically visible tantalum markings could facilitate subsequent surgical and radiation therapy.
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Affiliation(s)
- Priscilla Magno
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, Maryland 21205, USA
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Giday SA, Clarke JO, Buscaglia JM, Shin EJ, Ko CW, Magno P, Kantsevoy SV. EUS-guided portal vein catheterization: a promising novel approach for portal angiography and portal vein pressure measurements. Gastrointest Endosc 2008; 67:338-42. [PMID: 18226699 DOI: 10.1016/j.gie.2007.08.037] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 08/20/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Portal vein (PV) pressure measurements can provide valuable information for the management of patients with liver disease and portal hypertension. OBJECTIVE To evaluate the feasibility and the safety of EUS-guided PV catheterization and pressure measurements in a porcine model. SETTING Acute and survival experiments on five 50-kg pigs. DESIGN AND INTERVENTIONS Intrahepatic PV was punctured under EUS guidance by using a 19-gauge FNA needle. A 0.035-inch guidewire was advanced through the needle into the PV. The needle was withdrawn. A 5.5F ERCP catheter was advanced over the guidewire into the PV and then connected to a pressure monitor. Continuous PV measurements were obtained for an hour. Afterward, the catheter was removed, and the animals were observed for 30 minutes. Three animals were then immediately euthanized for a necropsy. The other two animals were observed for two weeks and then were euthanized. MAIN OUTCOME MEASUREMENTS The ability to perform EUS-guided PV catheterization and pressure measurement without complications. RESULTS PV catheterization, angiography, and pressure measurements were performed without any problems or complications. There were no changes in vital signs and hemodynamic parameters during PV catheterizations, angiography, pressure measurements, and catheter removal. Survival experiments did not demonstrate any change in animal condition, behavior, or eating habits after the procedure. A necropsy in all animals revealed no active bleeding, and no damage to the liver, other intra-abdominal organs, or blood vessels. LIMITATIONS No validation of measured PV pressure was made. CONCLUSIONS EUS-guided PV catheterization is feasible, safe, and can be used for portal angiography and pressure measurements.
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Affiliation(s)
- Samuel A Giday
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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Shin EJ, Ko CW, Magno P, Giday SA, Clarke JO, Buscaglia JM, Sedrakyan G, Jagannath SB, Kalloo AN, Kantsevoy SV. Comparative study of endoscopic clips: duration of attachment at the site of clip application. Gastrointest Endosc 2007; 66:757-61. [PMID: 17905019 DOI: 10.1016/j.gie.2007.03.1049] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 03/05/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several designs of endoscopic clips are now commercially available, and the indications for endoclip application are rapidly expanding. However, very limited data have been published to aid in choosing between the different types of endoclips. OBJECTIVE To compare the duration of clip attachment between all commercially available endoclips. SETTING Long-term experiments on 50-kg pigs under general anesthesia. DESIGN AND INTERVENTIONS Upper endoscope was inserted into the stomach. One clip of each type (Resolution clip, TriClip, and HX-5L clip) was placed along the same gastric fold at a distance of 0.5 to 1 cm from each other. The animals were recovered. In pig nos. 1 and 2, repeat endoscopy was performed after 2 and 4 weeks. In pig nos. 3 to 5, endoscopy was repeated after 1, 2, and 5 weeks. MAIN OUTCOME MEASUREMENTS Duration of clip retention at the site of application. RESULTS In all animals, only the Resolution endoclip remained attached to the site of application for the entire duration of the study (4-5 weeks). No TriClips or HX-5L clips were attached at the 4- to 5-week follow-up endoscopies. Most of the TriClips (67%) detached within the first week after application. Most of the HX-5L clips (80%) dislodged within the first 2 weeks of follow-up. LIMITATIONS The study was performed in a porcine model with a small number of animals. CONCLUSIONS The Resolution clip has the longest duration of retention at the site of application (more than 4-5 weeks) and should be preferred when long-term attachment of endoclips is necessary.
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Affiliation(s)
- Eun Ji Shin
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Giday SA, Ko CW, Clarke JO, Shin EJ, Magno P, Jagannath SB, Buscaglia JM, Kantsevoy SV. EUS-guided portal vein carbon dioxide angiography: a pilot study in a porcine model. Gastrointest Endosc 2007; 66:814-9. [PMID: 17905028 DOI: 10.1016/j.gie.2007.05.056] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 05/31/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Direct portal vein (PV) angiography can provide valuable clinical information but is not performed due to the high risk of complications. OBJECTIVE To assess the feasibility of EUS-guided PV angiography with a small-caliber FNA needle by using carbon dioxide (CO(2)) as a contrast agent in a porcine model. SETTING Acute experiments with 50-kg pigs under general anesthesia. DESIGN AND INTERVENTIONS Under linear array EUS guidance, the intrahepatic PV branch was punctured with a 25-gauge FNA needle. Portal venography was performed with iodinated contrast (Hypaque) and then with medical grade CO(2). After portography, the needle was removed from the PV and the animals were observed for 30 minutes, then euthanized for necropsy. MAIN OUTCOME MEASUREMENT Ability to visualize portal anatomy. RESULTS Six animal experiments were performed without complications. EUS-guided PV puncture with 25-gauge FNA needle was technically straightforward. Injection of ionic iodinated contrast through the 25-gauge FNA needle was arduous (mean [+/-SD] pressure 76.7 +/- 5.2 pounds per square inch [psi]), resulting in short (6.02 +/- 1.15 seconds) and poor opacification of the PV (visualization score 1.33 +/- 0.52). CO(2) injection through a 25-gauge needle was simple and easy (pressure 20.8 +/- 2.0 psi), producing prolonged (19.83 +/- 1.68 seconds) opacification of the entire portal system (visualization score 4.33 +/- 0.52). There was a statistically significant difference in all compared parameters (P < .0001) favoring injection of CO(2) over viscous iodinated contrast during portal angiography through a 25-gauge FNA needle. Postmortem examination revealed no active bleeding and no damage to the liver, other intra-abdominal organs, or blood vessels. LIMITATION Acute animal experiments. CONCLUSIONS EUS-guided portal venography with CO(2) using a small (25 gauge) FNA needle appears feasible, technically simple, and safe.
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Affiliation(s)
- Samuel A Giday
- Department of Medicine, Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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Magno P, Ko CW, Buscaglia JM, Giday SA, Jagannath SB, Clarke JO, Shin EJ, Kantsevoy SV. EUS-guided angiography: a novel approach to diagnostic and therapeutic interventions in the vascular system. Gastrointest Endosc 2007; 66:587-91. [PMID: 17725951 DOI: 10.1016/j.gie.2007.01.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 01/04/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Indications for diagnostic and therapeutic procedures under EUS guidance continue to expand. OBJECTIVE To assess the feasibility and safety of EUS-guided angiography in a live porcine model. SETTING Five acute experiments under general anesthesia. DESIGN AND INTERVENTIONS A linear echoendoscope was advanced into the stomach. Thoracic and abdominal aorta, celiac axis, superior mesenteric and splenic artery, splenic, portal, and hepatic veins were injected with contrast by using FNA needles under fluoroscopy. The animals were then killed for postmortem examination. MAIN OUTCOME MEASUREMENTS Ability to achieve angiography without complications. RESULTS All vessels were identified and punctured without technical difficulties. Injections of the large-caliber vessels resulted in a blush of contrast, whereas selective injection of the smaller vessels (splenic artery, hepatic veins) demonstrated clear vascular opacification. Injection of contrast was technically easiest with the 19-gauge FNA needle and most difficult with the 25-gauge needle. There were no changes in vital signs and hemodynamic parameters during vascular injection of any vessel. At necropsy, the 25-gauge FNA needle did not cause any visible vascular injury or bleeding. The 22-gauge needle left a visible puncture mark without active bleeding. In 1 of 5 pigs, the 19-gauge needle caused a localized vascular hematoma around large-caliber vessels and 150 mL of intra-abdominal blood. LIMITATION Technical challenges remain to achieve an adequate flow rate of contrast for prolonged visualization of large vessels. CONCLUSION EUS-guided angiography is technically easy and safe and has potential for a wide array of diagnostic and therapeutic vascular interventions.
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Affiliation(s)
- Priscilla Magno
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA, and Division of Gastroenterology, National Yang-Ming University, Taipei, Taiwan
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Magno P, Giday SA, Gabrielson KL, Shin EJ, Buscaglia JM, Clarke JO, Ko CW, Jagannath SB, Canto MI, Sedrakyan G, Kantsevoy SV. EUS-guided implantation of radiopaque marker into mediastinal and celiac lymph nodes is safe and effective. Gastrointest Endosc 2007; 66:387-92. [PMID: 17643719 DOI: 10.1016/j.gie.2006.12.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 12/26/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS is the preferred modality for local staging of esophageal cancer. The presence of a long-lasting fluoroscopically visible marker of malignant lymph nodes would facilitate subsequent radiation and surgical therapy. OBJECTIVE To assess the feasibility of EUS-guided implantation of a radiopaque marker (tantalum) into mediastinal and celiac lymph nodes in a porcine model. SETTING Survival experiments on six 50-kg pigs. DESIGN AND INTERVENTIONS A linear-array echoendoscope was advanced into the esophagus and the stomach. Mediastinal and celiac lymph nodes were identified and injected with 1 mL tantalum suspension by using 19- and 22-gauge FNA needles under fluoroscopy. The pigs were recovered. Fluoroscopy was repeated after 1, 2, and 4 weeks, then a postmortem examination was performed. MAIN OUTCOME MEASUREMENTS Long-term opacification of lymph nodes. RESULTS It was not possible to inject tantalum through the 22-gauge FNA needle because of its rapid precipitation inside the needle, which caused needle occlusion. Intranodal injection with the 19-gauge FNA needle was easily accomplished and resulted in excellent fluoroscopic opacification of injected lymph nodes. Repeat fluoroscopy at 1, 2, and 4 weeks demonstrated stable tantalum deposition at the injection site. There were no complications. Histologic examination of harvested lymph nodes revealed intranodal tantalum depositions without signs of infection, inflammation, tissue damage, or necrosis. CONCLUSIONS EUS-guided implantation of tantalum as a radiopaque marker into mediastinal and celiac lymph nodes in a porcine model is technically feasible, safe, and results in long-lasting intranodal depositions to facilitate subsequent surgical and radiotherapeutic interventions.
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Affiliation(s)
- Priscilla Magno
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, Maryland 21205, USA
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Giday SA, Magno P, Gabrielson KL, Buscaglia JM, Canto MI, Ko CW, Clarke JO, Kalloo AN, Jagannath SB, Shin EJ, Kantsevoy SV. The utility of contrast-enhanced endoscopic ultrasound in monitoring ethanol-induced pancreatic tissue ablation: a pilot study in a porcine model. Endoscopy 2007; 39:525-9. [PMID: 17554648 DOI: 10.1055/s-2007-966391] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Pancreatic ablation is gaining popularity for the treatment of focal pancreatic lesions. The aim of our study was to evaluate local effects of intrapancreatic alcohol injection and the utility of contrast-enhanced endoscopic ultrasound (EUS) for its monitoring in a porcine model. METHODS We performed four survival experiments on 50-kg pigs. Under linear EUS guidance, 0.5 mL of 50% ethanol plus purified carbon particle solution (GI Spot) was injected into the pancreatic body to create a focal area of pancreatic necrosis. The animals survived for 24-48 hours (pigs # 1, # 2, and # 3) and 7 days (pig # 4). EUS was then repeated with and without perflutren lipid microspheres (Definity) administration through the peripheral vein. Standard and microsphere-enhanced images of the pancreas were compared. Afterwards the animals were euthanized for necropsy. RESULTS Alcohol injection caused focal pancreatic necrosis, which was barely seen by standard EUS as a subtle hypoechoic lesion 1 cm in diameter. Color and power Doppler EUS of this region did not reveal any blood flow. After intravenous injection of microspheres, color Doppler EUS revealed marked contrast enhancement of normal pancreatic parenchyma with a clearly delineated avascular alcohol-treated area, which on postmortem examination corresponded to the discrete necrotic area marked with carbon particles. CONCLUSIONS EUS-guided alcohol injection consistently causes focal areas of pancreatic necrosis. Contrast-enhanced EUS with microspheres improves visualization of altered pancreatic vascular perfusion and can be used to facilitate detection of small pancreatic lesions and its follow-up post-ablation.
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Affiliation(s)
- S A Giday
- Department of Medicine, Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA
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Liao SC, Ko CW, Yeh HZ, Chang CS, Yang SS, Chen GH. Successful treatment of persistent bacteremia after endoscopic injection of N-butyl-2-cyanoacrylate for gastric varices bleeding. Endoscopy 2007; 39 Suppl 1:E176-7. [PMID: 17614066 DOI: 10.1055/s-2007-966556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S C Liao
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
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Abstract
Laparoscopic surgery has several advantages over traditional surgery because it has been shown to be less invasive. The next logical step in the evolution of minimally invasive surgery may be to eliminate all abdominal incisions. The natural orifices provide a port of entry via the gastrointestinal tract to the peritoneal cavity. This approach would require the creation of a perforation, which is considered to be a major complication of endoscopy with significant morbidity and mortality. However, there are several recent studies that have described the technical feasibility and safety of a per-oral transgastric approach to the peritoneal cavity using conventional endoscopes. Theoretically, this approach could reduce postoperative abdominal wall pain, wound infection, hernia formation, and adhesions. This article aims to summarize the current status of transgastric surgery, currently referred to as natural orifice transluminal endoscopic surgery (NOTES), and to address some of its future challenges.
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Affiliation(s)
- Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland 21231, USA
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Ko CW, Chang CS. Inlet patch: an inconspicuous lesion needs more spotlight. South Med J 2006; 99:798. [PMID: 16929869 DOI: 10.1097/01.smj.0000223666.86299.b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Talazko J, Zahn R, Buechert M, Overmans J, Specht K, Ko CW, Moser E, Hüll M. Mapping des Temporal- und des Parietalkortex bei Patienten mit progressiver nichtflüssiger Aphasie und Alzheimer-Krankheit mittels PET, voxelbasierter Morphometrie und Chemical Shift Imaging. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee KW, Poon CM, Leung KF, Lee DWH, Ko CW. Two-port needlescopic cholecystectomy: prospective study of 100 cases. Hong Kong Med J 2005; 11:30-5. [PMID: 15687513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE To test the feasibility of needlescopic cholecystectomy using a two-port technique with 3-mm miniaturised instruments. DESIGN Prospective study. SETTING Regional hospital, Hong Kong. PATIENTS One hundred consecutive patients undergoing elective cholecystectomy from September 2001 to August 2002. INTERVENTION Two-port needlescopic cholecystectomy all performed or supervised by a single laparoscopic surgeon. MAIN OUTCOME MEASURES Conversion of the procedure, the operating time, postoperative analgesic requirement, pain score using the 10-cm visual analog scale, complications, and the postoperative stay. To determine the technical difficulty of this new technique, the data from the first 50 patients were compared with those of the latter 50. Outcome variables were also compared with a group of 58 patients operated on with the standard two-port laparoscopic cholecystectomy in a previous randomised trial. RESULTS One conversion to open cholecystectomy was reported. Three patients required the enlargement of epigastric port to a size of 5 mm and six patients required an additional port to complete the operation. The median operating time was 62 minutes (range, 33-168 minutes). The median pain score was 3.5 (range, 0-9) and the median postoperative stay was 2 days (range, 1-14 days). Six patients had postoperative complications. When the first 50 patients were compared with the latter 50, there were no differences in the conversion rate, operating time, complication rate, and duration of hospital stay. However, the latter 50 patients had significantly lower pain scores (median, 3.5 vs 4.9; P=0.007) and faster resumption of diet (median, 5 vs 9 hours; P<0.001). The median operating time of needlescopic cholecystectomy was notably longer (62 vs 46 minutes; P<0.001) compared with that of the two-port laparoscopic cholecystectomy. Patients undergoing needlescopic cholecystectomy had a better resumption of diet (median, 5 vs 7 hours; P<0.001) and less postoperative pain (overall pain score, median, 3.5 vs 4.8; P=0.052) than the two-port laparoscopic cholecystectomy group. Pain scores at individual port sites were also lower in needlescopic cholecystectomy group (umbilical port: median, 3 vs 4.4, P=0.015; epigastric port: median, 2.0 vs 3.6, P=0.036). CONCLUSION Two-port needlescopic cholecystectomy is technically feasible and may further improve the surgical outcomes in terms of postoperative pain and cosmesis. It can be considered for routine practice by surgeons who are familiar with the two-port laparoscopic cholecystectomy technique.
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Affiliation(s)
- K W Lee
- Department of Surgery, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong.
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Chang CS, Yang SS, Ko CW, Lien HC, Yeh HZ, Chen GH. Predictive factors of the long-term outcome in reflux esophagitis in a low-prevalence gastroesophageal reflux disease region. Scand J Gastroenterol 2003; 38:1131-5. [PMID: 14686715 DOI: 10.1080/00365520310006171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are no data concerning the long-term outcome of patients with reflux esophagitis in Taiwan. In this study the outcome and the specific prognostic indicators associated with outcome in patients were assessed retrospectively, 7 years after diagnosis of esophagitis. METHODS The study comprised a total of 128 patients with endoscopic esophagitis, diagnosed between January and June 1995, at Taichung Veterans' General Hospital. The outcome at 7 years after diagnosis was assessed by outpatient or telephone interview. Factors associated with requiring long-term acid suppression therapy were analyzed. RESULTS In all, 105 patients were eligible for analysis: 61 patients (58.1%) with LA (Los Angeles classification) grade A, 29 patients (27.6%) with grade B, 11 patients (10.5%) with grade C and 4 patients (3.5%) with grade D esophagitis. Seven years after diagnosis, there were 52 patients (49.5%) with no or occasional reflux symptoms, 8 patients (7.6%) with occasional symptoms requiring treatment with histamine-2 receptor antagonists (H2RAs), 12 patients (11.4%) with occasional symptoms requiring treatment with proton pump inhibitors (PPIs), as needed, and 33 patients (31.3%) with sustained symptoms needing daily maintenance with PPIs. CONCLUSION Nearly 50% of patients in Taiwan with endoscopic esophagitis still required treatment 7 years after diagnosis. Approximately 31% of patients still required daily acid suppression therapy. Presence of hiatal hernia and the severity of esophagitis at initial endoscopy independently were predictive of those who would require long-term acid suppression therapy.
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Affiliation(s)
- C S Chang
- Division of Gastroenterology, Taichung Veterans' General Hospital, Taichung, Taiwan, ROC.
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Poon CM, Chan KW, Lee DWH, Chan KC, Ko CW, Cheung HY, Lee KW. Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc 2003; 17:1624-7. [PMID: 12874694 DOI: 10.1007/s00464-002-8718-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2002] [Accepted: 10/01/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. METHODS One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to receive either the two-port or the four-port technique. All patients were blinded to the type of operation they underwent. Four surgical tapes were applied to standard four-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unscaled visual analog scale (VAS). Other outcome measures included analgesia requirements, length and difficulty of the operation, postoperative stay, and patient satisfaction score on surgery and scars. RESULTS Demographic data were comparable for both groups. Patients in the two-port group had shorter mean operative time (54.6 +/- 24.7 min vs 66.9 +/- 33.1 min for the four-post group; p = 0.03) and less pain at individual subcostal port sites [mean score using 10-cm unscaled VAS: 1.5 vs 2.8 ( p = 0.01) at the midsubcostal port site and 1.3 vs 2.3 ( p = 0.02) at the lateral subcostal port site]. Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score on surgery and scars were similar between the two groups. CONCLUSION Two-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy.
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Affiliation(s)
- C M Poon
- Department of Surgery, North District Hospital, Sheung Shui, N. T., Hong Kong SAR, China
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Huang SF, Ko CW, Chang CS, Chen GH. Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor. Hepatogastroenterology 2003; 50:1115-8. [PMID: 12845993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND/AIMS To study and review the clinical manifestations, microbiology, comorbidity, and diagnosis of liver abscess after transarterial chemoembolization for malignant hepatic tumor. METHODOLOGY We retrospectively reviewed 1374 patients who underwent 2581 transarterial chemoembolization procedures due to malignant hepatic tumors over an 8-year period. RESULTS 7 patients had liver abscess after transarterial chemoembolization. The incidence was 0.27% (7/2581). Hepatocellular carcinoma was diagnosed in all 7 patients, whose liver function was classified as stage A by the Child-Pugh criteria. The clinical manifestations were intermittent fever, abdominal pain, and leukocystosis. All the patients had hyperechoic spots with reverberative shadows on sonograms or low attenuation areas with different Hounsfield units on computed tomography scan, which expressed the 100% incidence (7 of 7) of gas-forming abscesses. Percutaneous drainage or aspiration was done in 6 patients. One received laparotomy with local debridement due to suspicious organ rupture. The pus culture showed Gram-negative bacteria in all patients. Blood cultures were positive in only 3 of 7 patients (43%). No patients died of liver abscess after aspiration, drainage, or debridement of abscess combined with parenteral antibiotic treatment. Biliary tract diseases, found in 4 patients, were the most common comorbidity. CONCLUSIONS Liver abscess after transarterial chemoembolization is a very rare complication, which usually develops in patients with biliary tract disease. Gram-negative bacteria are the main pathogens. The incidence of gas formation is higher after transarterial chemoembolization than in the general population. However, the prognosis is good after adequate clearance of pus and antibiotic treatment.
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Affiliation(s)
- Shao-Feng Huang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 160, Sec. 3, Chung-Kang Rd., Taichung, 40705, Taiwan
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Abstract
BACKGROUND/AIM Cutaneous electrical stimulation has been reported to be as effective as electroacupuncture. The aim of this study was to test whether cutaneous electrical stimulation had the same effect as electroacupuncture to enhance the regularity of myoelectrical activity. METHODS Fifteen healthy male volunteers were enrolled for this study. Electrogastrography (EGG) was performed for 30 min at the baseline, 30 min during electroacupuncture or cutaneous electrical stimulation, and for an additional 30 min thereafter. RESULTS During 3 Hz of electroacupuncture on the Zusanli point, there was a significant increase in the percentage of normal frequency. The percentage of normal frequency in the post-acupuncture period was also increased, but it was not statistically significant when compared to the baseline. There was a significant decrease in the tachygastric and bradygastric rhythm during electroacupuncture on the Zusanli points. There were similar changes of EGG parameters with cutaneous electrical stimulation on the Zusanli points. The percentage of normal frequency during cutaneous electrical stimulation increased significantly. However, the percentage of normal frequency in the post-cutaneous electrical stimulation period was similar to the baseline. There was a significant decrease in the percentage of tachygastric rhythm during cutaneous electrical stimulation on the Zusanli points. However, there was no significant change in the percentage of bradygastric rhythm during and after the cutaneous electrical stimulation periods. CONCLUSIONS The effect of cutaneous electrical stimulation on the percentage of normal frequency and tachygastria is similar to electroacupuncture. Nonetheless, the changes of the percentage in bradygastria are not significant.
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Affiliation(s)
- Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
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Abstract
Acupuncture has been shown to improve the regularity of gastric myoelectric activity. The aim of this study was to evaluate whether atropine-induced gastric dysrhythmia can be normalized by electroacupuncture. Fifteen healthy male volunteers were enrolled for this study. Each subject was studied for three sessions in a randomized sequence which included electroacupuncture on the Zusanli (St 36) points with or without premedication with atropine and a placebo stimulation on a nonacupoint. Cutaneous EGG was performed for 30 min at the baseline, 30 min during acupuncture, and for an additional 30 min after acupuncture. Serum gastrin, motilin, and human pancreatic polypeptide (hPP) levels were also measured. When applying 2 Hz of electrical stimulation on the Zusnali point, there was a significant increase in the percentage of normal frequency (2-4 cpm) during acupuncture (baseline versus acupuncture, 82.09 +/- 12.37% versus 93.08 +/- 8.17%, P < 0.01). There was a significant decrease in the percentage of bradygastria as well as tachygastria during 2 Hz of electrical stimulation on the Zusnali point. Using intravenous atropine immediately before electroacupuncture, the percentage of normal frequency during acupuncture and postacupuncture periods decreased significantly (baselines versus acupuncture and postacupuncture, 83.86 +/- 13.79% versus 55.07 +/- 29.44% and 56.76 +/- 33.44%, P < 0.01). There was a significant decrease in serum PP after intravenous atropine. This observation indicated that atropine-induced gastric dysrhythmia might be mediated partly via the vagal pathway. However, atropine-induced gastric dysrhythmia is not normalized by electroacupuncture.
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Affiliation(s)
- Chi-Sen Chang
- Division of Gastroenterology, Taichung Veterans General Hospital, Chung Shan Medical University, Taiwan
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Swanson SJ, Kirk AD, Ko CW, Jones CA, Agodoa LY, Abbott KC. Impact of HIV seropositivity on graft and patient survival after cadaveric renal transplantation in the United States in the pre highly active antiretroviral therapy (HAART) era: an historical cohort analysis of the United States Renal Data System. Transpl Infect Dis 2002; 4:144-7. [PMID: 12421459 DOI: 10.1034/j.1399-3062.2002.01009.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND National statistics are presented for patient survival and graft survival in patients seropositive for the human immunodeficiency virus (HIV+) at the time of renal transplantation in the era prior to highly active antiretroviral therapy (HAART). METHODS Historical cohort analysis of 63, 210 cadaveric solitary renal transplant recipients with valid HIV serology entries in the United States Renal Data System (USRDS) from 1 January 1987 to 30 June 1997. The medical evidence form was also used for additional variables but, because of fewer available values, was analyzed in a separate model. Outcomes were patient characteristics and survival associated with HIV+ status. RESULTS Thirty-two patients (0.05%) in the study period were HIV+ at transplant. HIV+ patients were comparable to the national renal transplant population in terms of gender and ethnic distribution but were younger and had younger donors and better HLA matching than the USRDS population. Patient and graft three-year survival were significantly reduced in HIV+ recipients (53% graft, 83% patient survival) relative to the USRDS population (73% and 88%, respectively). In multivariate analysis, HIV+ status was independently associated with patient mortality and decreased graft survival in recipients of cadaveric kidney transplants. CONCLUSIONS This analysis was retrospective and may underestimate the number of HIV+ patients transplanted in the United States. Although the clinical details of patient selection for transplant were unknown, these results show HIV+ patients can have successful outcomes after cadaveric renal transplantation, although outcomes are significantly different from HIV- recipients.
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Affiliation(s)
- S J Swanson
- Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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Batty DS, Swanson SJ, Kirk AD, Ko CW, Agodoa LY, Abbott KC. Hepatitis C virus seropositivity at the time of renal transplantation in the United States: associated factors and patient survival. Am J Transplant 2002. [PMID: 12099367 DOI: 10.1034/j.1600-6143.2001.10213.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
National statistics for patient characteristics and survival of renal transplant recipients positive for hepatitis C virus (HCV+) at the time of renal transplant are presented. A historical cohort analysis of 33479 renal transplant recipients in the United States Renal Data System from 1 July, 1994 to 30 June, 1997 has been carried out. The medical evidence form was also used for additional variables, but because of fewer available values, this was analyzed in a separate model. Outcomes were patient characteristics and survival associated with HCV+. Of 28692 recipients with valid HCV serologies, 1624 were HCV+ at transplant (5.7% prevalence). In logistic regression analysis, HCV+ was associated with African-American race, male gender, cadaveric donor type, increased duration of pre-transplant dialysis, previous transplant, donor HCV+, recipient (but not donor) age, serum albumin, alcohol use, and increased all-cause hospitalizations. Diabetes and IgA nephropathy were less associated with HCV+. Total all-cause, unadjusted mortality was 13.1% in HCV+ vs. 8.5% in HCV- patients (p <0.01 by log rank test). In Cox regression, mortality was higher for HCV+ (adjusted hazard ratio = 1.23, 95% confidence interval = 1.01-1.49, p = 0.04). HCV+ recipients were more likely to be African-American, male, older, and to have received repeat transplants and donor HCV+ transplants. HCV+ recipients also had substantially longer waiting times for transplant. In contrast to recent studies, diabetes did not have an increased association with HCV+, perhaps due to limitations of the database. HCV+ recipients had increased mortality and hospitalization rates compared with other transplant recipients.
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Affiliation(s)
- D S Batty
- Organ Transplantation Service, Walter Reed Army Medical Center, National Institutes of Health, Bethesda, MD, USA
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Poon CM, Lee DWH, Mak SK, Ko CW, Chan KC, Chan KW, Sin KS, Chan ACW. Two liters of polyethylene glycol-electrolyte lavage solution versus sodium phosphate as bowel cleansing regimen for colonoscopy: a prospective randomized controlled trial. Endoscopy 2002; 34:560-3. [PMID: 12170410 DOI: 10.1055/s-2002-33207] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND STUDY AIMS As a bowel cleansing agent for colonoscopy, sodium phosphate (NaP) has been reported to have equal effectiveness and better patient tolerance in comparison with 4 l polyethylene glycol-electrolyte lavage (PEG-EL) solution. Poor patient tolerance is frequently associated with a large amount of fluid consumed, and better patient tolerance might therefore be expected if the volume of PEG-EL solution could be reduced. This study aimed to compare 2 l PEG-EL solution with NaP in relation to patients' tolerance and its effectiveness as a bowel cleansing agent. PATIENTS AND METHODS Two hundred consecutive patients admitted to the day-procedure ward for elective colonoscopy were prospectively randomized to receive either a 2-l PEG-EL solution or a 90-ml oral NaP regimen. Patients with a history of congestive heart failure, impaired renal function (creatinine > 1.5 mg/dl), or previous colectomy were excluded from the study. The patients completed a questionnaire to assess their tolerance of bowel preparation before the colonoscopy. Endoscopists, who were blinded to the type of regimen that had been used, scored the adequacy of bowel preparation from the rectum to cecum using a defined endoscopic score. RESULTS Two hundred patients were included in this randomized trial. Nine patients were excluded, due to either an incomplete questionnaire (two in the PEG-EL group, one in the NaP group) or inability to complete the bowel preparation regimen (four in the PEG-EL group and two in the NaP group). The demographic data were comparable in the two groups. There were no differences between the two groups with regard to willingness to repeat the regimen, ease of consumption, acceptability of the bowel preparation regimen, or the endoscopists' satisfaction with the quality of bowel preparation. The NaP group had a better mean endoscopic score at the cecum compared with the PEG-EL group (1.47 +/- 1.15 vs. 1.05 +/- 0.76; P = 0.007). CONCLUSIONS The effectiveness and patient tolerance of the 2-l PEG-EL solution is comparable with that of oral NaP. The 2-l PEG-EL solution is therefore an effective alternative as a bowel-cleansing agent for colonoscopy.
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Affiliation(s)
- C M Poon
- Dept. of Surgery, North District Hospital, Sheung Shui, New Territories, Hong Kong Special Administrative Region, China
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