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Shin J, Kim ER, Jang HJ, Baek DH, Yang DH, Lee BI, Cho KB, Cho JW, Jung SA, Hong SJ, Ko BM, Jeon JW, Ko WJ, Kim SM, Kim YD, Gyoo KC, Baik GH, Yoo IK, Nyeong LK, Lee SH, Lim CH, Jeon SW. Long-term prognosis of curative endoscopic submucosal dissection for early colorectal cancer according to submucosal invasion: a multicenter cohort study. BMC Gastroenterol 2022; 22:417. [PMID: 36100888 PMCID: PMC9469604 DOI: 10.1186/s12876-022-02499-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Endoscopic submucosal dissection (ESD) can provide a high en bloc resection rate and has been widely applied as curative treatment for early colorectal cancer (ECC). However, surgical treatment is occasionally required, and reports on the long-term prognosis of ESD are insufficient. This study aimed to investigate the long-term outcomes of ECC removal by ESD, including local recurrence and metastasis. Methods This multicenter study was conducted retrospectively on 450 consecutive patients with ECC who were treated with ESD between November 2003 and December 2013. Clinical, pathological, and endoscopic data were collected to determine tumor depth, resection margin, lymphovascular invasion, and recurrence. Results The median follow-up period was 53.8 (12–138 months). The en bloc resection rate was 85.3% (384) and in intramucosal cancer being 84.1% and in superficial submucosal invasion (SM1) cancer being 89.8% (p = 0.158). The curative resection rate was 76.0% (n = 342), and there was no statistical difference between the two groups (77.3% vs. 71.4%, p = 0.231). The overall recurrence free survival rate (RFS) was 98.7% (444/450). In patients with curative resection, there was no statistically significant difference in RFS according to invasion depth (intramucosal: 99.3% vs. SM1: 97.1%, p = 0.248). Conclusions Patients with curatively resected ECC treated with ESD showed favorable long-term outcomes. Curatively resected SM1 cancer has a RFS similar to that of intramucosal cancer.
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Cha B, Shin J, Ko WJ, Kwon KS, Kim H. Prognosis of incompletely resected small rectal neuroendocrine tumor using endoscope without additional treatment. BMC Gastroenterol 2022; 22:293. [PMID: 35681149 PMCID: PMC9185951 DOI: 10.1186/s12876-022-02365-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/28/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In recent years, the incidence of rectal neuroendocrine tumors (NET)s has markedly increased due to the widespread use of screening colonoscopy. However, many patients are referred from local clinics after undergoing conventional endoscopic mucosal resection (EMR) for polyps without perceived NET, with a pathological report of incomplete resection. We evaluated the prognosis of incompletely resected small rectal NET without additional endoscopic resection for small rectal NET less than 10 mm in diameter present within the submucosal layer showing good prognosis, due to its rare metastatic potential. METHODS We retrospectively reviewed patients from 2008 to 2018 at a single center who had had small rectal NET (located in the rectum from the anal verge to 20 cm in proximity) and had undergone 'incomplete resection' using endoscopy with a positive deep margin or with a very small safe deep margin (< 100 um). A small rectal NET was defined as a tumor ≤ 10 mm in diameter, without lymph node nor distant metastasis, and with low grade (G1) according to the WHO grading system. RESULTS Of 267 patients who were diagnosed with small rectal NET, 77 were diagnosed with incomplete resection or possible remnant NET. Of those, 55 patients (55/77, 71.4%) were referred from local clinics post EMR diagnosed as polyps. The rate of histologically incomplete resection was highest in endoscopic submucosal dissection (11/21, 52.4%) and lowest in surgical resection (0/9, 0%), while endoscopic submucosal resection with band ligation showed an incomplete resection rate of 4.4% (5/113). After exclusion of 36 patients, namely 21 patients had undergone additional surgical (n = 6) or endoscopic (n = 15) resection and 25 patients who were lost during the follow-up period of 2 years, 31 patients had undergone surveillance with endoscopic evaluation or either a biopsy or radiological evaluation for distant metastasis during a median follow-up duration of 2 years. None of the incompletely resected small rectal NET patients showed local or distant metastasis. CONCLUSION Incomplete resection of small rectal NET with G1 grade has a good prognosis without additional treatment.
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Affiliation(s)
- Boram Cha
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Jongbeom Shin
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Weon Jin Ko
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Kye Sook Kwon
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea
| | - Hyungkil Kim
- Department of Internal Medicine, Digestive Disease Center, Inha University School of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea.
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Jung Y, Baik GH, Ko WJ, Ko BM, Kim SH, Jang JS, Jang JY, Lee WS, Cho YK, Lim SG, Moon HS, Yoo IK, Cho JY. Diode Laser-Can It Replace the Electrical Current Used in Endoscopic Submucosal Dissection? Clin Endosc 2021; 54:555-562. [PMID: 33435658 PMCID: PMC8357600 DOI: 10.5946/ce.2020.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/19/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Aims A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model.
Methods In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed.
Results The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group.
Conclusions The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.
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Affiliation(s)
- Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Weon Jin Ko
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Bong Min Ko
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seong Hwan Kim
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Jin Seok Jang
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jae-Young Jang
- Department of Gastroenterology and Hepatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Wan-Sik Lee
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Young Kwan Cho
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - In Kyung Yoo
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Korea
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Kim HS, Kim HK, Ko WJ. Two-Stage Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia. Clin Endosc 2020; 53:232-235. [PMID: 31309765 PMCID: PMC7137558 DOI: 10.5946/ce.2019.067] [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: 03/15/2019] [Accepted: 04/16/2019] [Indexed: 11/14/2022] Open
Abstract
Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEM procedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique that is divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10 years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtype achalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method "two-stage POEM", which was successfully performed without any complications. This new POEM method can also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change of treatment failure.
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Affiliation(s)
- Hak Su Kim
- Department of Gastroenterology and Hepatology, Incheon Sarang Hospital, Incheon, Korea
| | - Hee Kyung Kim
- Department of Gastroenterology and Hepatology, Cheonggu Sungsim Hospital, Seoul, Korea
| | - Weon Jin Ko
- Department of Gastroenterology, CHA Kumi Medical Center, Gumi, Korea
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Chang YW, Ko WJ, Oh CH, Park YM, Oh SJ, Moon JR, Cho JH, Kim JW, Jang JY. Clarithromycin resistance and female gender affect Helicobacter pylori eradication failure in chronic gastritis. Korean J Intern Med 2019; 34:1022-1029. [PMID: 29898576 PMCID: PMC6718756 DOI: 10.3904/kjim.2018.054] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/08/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS The eradication rate of the first-line triple therapy (a proton pump inhibitor, clarithromycin, and amoxicillin) for Helicobacter pylori infection has gradually decreased in Korea. We evaluated whether clinical parameters, clarithromycin resistance, and CYP2C19 genotype can affect the eradication failure. METHODS A total of 203 patients with H. pylori-positive chronic gastritis were consecutively enrolled. They received clarithromycin-based triple therapy for 7 days. A clarithromycin resistance test was performed by detection of A2142G and A2143G point mutations in H. pylori 23S rRNA. The CYP2C19 genotype was examined for polymorphism G681A of exon 5 and G636A of exon 4 by polymerase chain reaction with restriction fragment length polymorphism. Eradication was assessed by a 13C-urea breath test 4 weeks after treatment. RESULTS Of 203 patients, 190 completed the study. The eradication rate was 64.0% according to intention-to-treat analysis and 68.4% by per-protocol analysis. CY-P2C19 genotypes were identified as follows: 75 poor metabolizers, 75 intermediate metabolizers, and 40 rapid metabolizers. Nonetheless, this polymorphism was not significantly associated with eradication failure (p = 0.682). Clarithromycin resistance was detected in 33/190 patients (17.4%), and their eradication rate was zero. Clarithromycin resistance (odds ratio [OR], 19.13; 95% confidence interval [CI], 9.35 to 35.09) and female gender (OR, 1.73; 95% CI, 1.15 to 4.25) were significantly associated with eradication failure. The other clinical parameters such as age, cigarette smoking, alcohol intake, the body mass index, hypertension, and diabetes were not significantly associated with eradication. CONCLUSION Clarithromycin resistance and female gender are factors affecting H. pylori eradication failure in patients with chronic gastritis.
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Affiliation(s)
- Young Woon Chang
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Weon Jin Ko
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
| | - Chi Hyuk Oh
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
- Correspondence to Chi Hyuk Oh, M.D. Division of Gastroenterology and Hepatology, Department of Internal medicine, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-958-8114 Fax: +82-2-958-8147 E-mail:
| | - Yoo Min Park
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Shin Ju Oh
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Rock Moon
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jun-Hyung Cho
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jung-Wook Kim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae-Young Jang
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Yoo IK, Ko WJ, Kim HS, Kim HK, Kim JH, Kim WH, Hong SP, Yeniova AÖ, Cho JY. Anti-reflux mucosectomy using a cap-assisted endoscopic mucosal resection method for refractory gastroesophageal disease: a prospective feasibility study. Surg Endosc 2019; 34:1124-1131. [DOI: 10.1007/s00464-019-06859-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 05/18/2019] [Indexed: 02/06/2023]
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Kim HK, Ko WJ, Kwon CI, Song GW, Yoo IK, Song JH, Kim HS, Cho JY. Endoscopic Submucosal Dissection Followed by Concurrent Chemoradiotherapy in Patients with Early Esophageal Cancer with a High Risk of Lymph Node Metastasis. Clin Endosc 2019; 52:502-505. [PMID: 31085965 PMCID: PMC6785410 DOI: 10.5946/ce.2018.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/10/2018] [Accepted: 01/19/2019] [Indexed: 12/29/2022] Open
Abstract
Endoscopic submucosal dissection is recommended as an alternative therapy for early esophageal cancer. However, achieving curative resection in this procedure remains controversial since precise prediction of lymph node metastasis can be difficult. Here, we present the preliminary results of endoscopic submucosal dissection followed by concurrent chemoradiotherapy for early esophageal cancer with a high risk of lymph node metastasis. From May 2006 to January 2014, six patients underwent concurrent chemoradiotherapy after endoscopic submucosal dissection with a median follow-up period of 63 months. No complications were encountered during concurrent chemoradiotherapy. Although local recurrence did not occur in all patients, two patients were diagnosed with metachronous cancer. Overall, the survival rate was 100%. Thus, endoscopic submucosal dissection followed by concurrent chemoradiotherapy may be a feasible treatment for early esophageal cancer in patients with a high risk of lymph node metastasis. Future prospective large-scale studies are warranted to confirm our results.
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Affiliation(s)
- Hee Kyung Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - In Kyun Yoo
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Hyun Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hak Su Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Kwon CI, Kim G, Moon JP, Yun H, Ko WJ, Cho JY, Hong SP. Performance of disposable endoscopic forceps according to the manufacturing techniques. Korean J Intern Med 2019; 34:530-538. [PMID: 29502363 PMCID: PMC6506737 DOI: 10.3904/kjim.2017.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/27/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Recently, to lower the production costs and risk of infection, new disposable biopsy forceps made using simple manufacturing techniques have been introduced. However, the effects of the manufacturing techniques are unclear. The aim of this study was to evaluate which types of biopsy forceps could obtain good-quality specimens according to the manufacturing techniques. METHODS By using an in vitro nitrile glove popping model, we compared the popping ability among eight different disposable biopsy forceps (one pair of biopsy forceps with cups made by a cutting method [cutting forceps], four pairs of biopsy forceps with cups made by a pressing method [pressing forceps], and three pairs of biopsy forceps with cups made using a injection molding method [molding forceps]). Using an in vivo swine model, we compared the penetration depth and quality of specimen among the biopsy forceps. RESULTS In the in vitro model, the molding forceps provided a significantly higher popping rate than the other forceps (cutting forceps, 25.0%; pressing forceps, 17.5%; and molding forceps, 41.7%; p = 0.006). In the in vivo model, the cutting and pressing forceps did not provide larger specimens, deeper biopsy specimen, and higher specimen adequacy than those obtained using the molding forceps (p = 0.2631, p = 0.5875, and p = 0.2147, respectively). However, the molding forceps showed significantly more common crush artifact than the others (cutting forceps, 0%; pressing forceps, 5.0%; and molding forceps, 43.3%; p = 0.0007). CONCLUSION The molding forceps provided lower performance than the cutting and pressing forceps in terms of crush artifact.
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Affiliation(s)
- Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Gwangil Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jong Pil Moon
- Interventional Research Center, M.I. Tech Co. Ltd., Pyeongtaek, Korea
| | - Ho Yun
- Interventional Research Center, M.I. Tech Co. Ltd., Pyeongtaek, Korea
| | - Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
- Correspondence to Joo Young Cho, M.D. Digestive Disease Center, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: +82-31-780-5641 Fax: +82-31-780-5219 E-mail:
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Abstract
Background/Aims We evaluated whether manometric subtype is associated with treatment outcome in patients with achalasia treated by peroral endoscopic myotomy (POEM). Methods High-resolution manometry data and Eckardt scores were collected from 83 cases at two tertiary referral centers where POEM is performed. Manometric tracings were classified according to the three Chicago subtypes. Results Among the 83 cases, 48 type I, 24 type II, and 11 type III achalasia cases were identified. No difference was found in pre-POEM Eckardt score, basal lower esophageal sphincter (LES) pressure, or integrated relaxation pressure (IRP) among the type I, type II, and type III groups. All three patient groups showed a significant improvement in post-POEM Eckardt score (6.1±2.1 to 1.5±1.5, p=0.001; 6.8±2.2 to 1.2±0.9, p=0.001; 6.6±2.0 to 1.6±1.4, p=0.011), LES pressure (26.1±13.8 to 15.4±6.8, p=0.018; 32.3±19.0 to 19.2±10.4, p=0.003; 36.8±19.2 to 17.5±9.7, p=0.041), and 4s IRP (21.5±11.7 to 12.0±8.7, p=0.007; 24.5±14.8 to 12.0±7.6, p=0.002; 24.0±15.7 to 11.8±7.1, p=0.019) at a median follow-up of 16 months. Conclusions POEM resulted in a good clinical outcome for all manometric subtypes.
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Affiliation(s)
- Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Tae Hee Lee
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Su Jin Hong
- Digestive Disease Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Abstract
The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.
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Affiliation(s)
- Weon Jin Ko
- Department of Gastroenterology, Cha Kumi Medical Center, Cha University College of Medicine, Gumi, Korea
| | - Joo Young Cho
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam, Korea
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Abstract
Submucosal tumors (SMTs) originate from tissues that constitute the submucosal layer and muscularis propria, and are covered by normal mucosa. Esophageal SMTs are rare, accounting for <1% of all esophageal tumors. However, the recent widespread use of endoscopy has led to a rapid increase in incidental detection of SMTs in Korea. Esophageal SMTs are benign in ≥90% of cases, but the possibility of malignancies such as gastrointestinal stromal tumor and malignant leiomyosarcoma still exists. Therefore, patients undergo resection in the presence of symptoms or the possibility of a malignant tumor. For resection of esophageal SMTs, surgical resection was the only option available in case of possible malignancy, but minimally invasive surgery by endoscopic resection is becoming more preferable to surgical resection with the development of endoscopic ultrasonography, endoscopic techniques, and other devices.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Ko WJ, Song GW, Hahm KB, Hong SP, Cho JY, Cho JH, Jin SY. Tissue diagnosis of GI subepithelial tumor only through Trucut biopsy under a forward-viewing endoscope: applicability as newer diagnostic modality. Surg Endosc 2016; 30:5009-5014. [PMID: 27194267 DOI: 10.1007/s00464-016-4846-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/27/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Trucut biopsy (TCB) has been proposed to overcome the limitations of endoscopic ultrasonography (EUS)-guided fine-needle aspiration for the pathologic diagnosis of upper gastrointestinal (GI) subepithelial tumor (SET); however, it can be difficult to perform because the Trucut biopsy needle is very stiff. Although technical failures have been reported with the use of TCB, recently the forward-viewing echoendoscope showed a high diagnostic accuracy. We hypothesized that TCB under a conventional forward-viewing endoscope can be applied with higher yield of tissue diagnosis. METHODS To evaluate the feasibility of TCB under a forward-looking endoscopy without cumbersome EUS guidance, we introduced a 19-gauge TCB needle into the working channel of a conventional upper endoscope in 27 patients with GI SET to make tissue diagnosis. Prospectively collected data were analyzed, including technical success rate, pathologic result, and adverse events. RESULTS Twenty-seven patients with GI SET (18 esophageal tumors and nine gastric tumors) underwent TCB under a forward-looking endoscope. All procedures were performed safely without any TCB-related complications. Subsequently, histopathology examination revealed gastrointestinal stromal tumors (GISTs) in three cases and leiomyomas in 21 cases. Histologic assessment was completed in 24 out of 27 patients (88.9 %) because tissue obtained from three patients, whose tumors were located in the stomach, was not sufficient for the pathologic diagnosis. CONCLUSIONS TCB using a conventional forward-viewing endoscope without EUS guidance provided an excellent pathologic diagnosis of upper GI SET.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, 59 Yatapro, Bundang-gu, Seongnam-si, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, 59 Yatapro, Bundang-gu, Seongnam-si, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, 59 Yatapro, Bundang-gu, Seongnam-si, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, 59 Yatapro, Bundang-gu, Seongnam-si, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, 59 Yatapro, Bundang-gu, Seongnam-si, Korea.
| | - Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - So Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Seoul, Korea
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Song JH, Ko WJ, Song GW, Hahm KB, Cho JY. Urgent hemostasis of active appendiceal bleeding by intra-appendiceal stent insertion and detachable snare wrapping. Gastrointest Endosc 2016; 84:740-1. [PMID: 27102833 DOI: 10.1016/j.gie.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/07/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Ji Hyun Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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14
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Cho NG, Kim HS, Song GW, Park JM, Ko WJ, Hahm KB. Surrounding break up after Helicobacter pylori eradication to prevent metachronous gastric cancer after endoscopic submucosal resection. Transl Cancer Res 2016. [DOI: 10.21037/tcr.2016.04.12] [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: 11/06/2022]
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15
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Ko WJ, Cho JY. Current Techniques for Treating Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract. Clin Endosc 2016; 49:226-8. [PMID: 27214386 PMCID: PMC4895942 DOI: 10.5946/ce.2016.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/20/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 02/06/2023] Open
Abstract
Most gastrointestinal stromal tumors (GISTs) arise from the proper muscle layer of the upper gastrointestinal (GI) tract and have a low malignant potential. They are sometimes accompanied by symptoms, but in most cases are detected by chance. Endoscopic surgery of subepithelial tumors in the upper GI tract has been actively performed, and its merits include the need for fewer medical devices compared with other surgical procedures and post-resection organ preservation. However, because endoscopic procedures are still limited to small or pilot studies, a multidisciplinary approach combining laparoscopy and endoscopy is needed for more effective and pathologically acceptable management of GISTs. Many new endoscopic surgeries have been developed, and this review describes the current status of and the new approaches for endoscopic surgery of GISTs in the upper GI tract.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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16
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Affiliation(s)
- Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
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17
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Ko WJ, Song GW, Kim WH, Hong SP, Cho JY. Endoscopic resection of early gastric cancer: current status and new approaches. Transl Gastroenterol Hepatol 2016; 1:24. [PMID: 28138591 DOI: 10.21037/tgh.2016.03.22] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/04/2016] [Indexed: 12/18/2022] Open
Abstract
Endoscopic resection (ER) of early gastric cancer (EGC) has been an optimal treatment for selected patients. As endoscopic submucosal dissection (ESD) has been widely used for treatment of EGC, concerns have been asked to achieve curative resection for EGC while guaranteeing precise prediction of lymph node metastasis (LNM). Moreover, a new microscopic imaging for precise endoscopic diagnosis of EGC is introduced. This review covers the current status and new approaches of ER of EGC.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
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18
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Ko WJ, Lee BM, Park WY, Kim JN, Cho JH, Lee TH, Hong SJ, Cho JY. Jackhammer esophagus treated by a peroral endoscopic myotomy. Korean J Gastroenterol 2016; 64:370-4. [PMID: 25530589 DOI: 10.4166/kjg.2014.64.6.370] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A 49-year-old woman visited our hospital with dysphagia and chest pain. In another hospital, she was diagnosed as reflux esophagitis. Although she had taken proton pump inhibitor and prokinetics drugs for a long time, she was not relieved of any symptoms. On the basis of high resolution manometry and endoscopic ultrasonography findings, Jackhammer esophagus was diagnosed. In this patient, peroral endoscopic myotomy (POEM) was performed for long myotomy of thickened circular muscle. During the procedure, there were no significant complications and she was discharged uneventfully. Symptoms were completely improved during three months after POEM. Here, we report on a case of Jackhammer esophagus treated by POEM.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, Soonchunhyang University Hospital Seoul, Korea
| | - Byoung Moo Lee
- Digestive Disease Center, Soonchunhyang University Hospital Seoul, Korea
| | - Won Young Park
- Digestive Disease Center, Soonchunhyang University Hospital Seoul, Korea
| | - Jin Nyoung Kim
- Digestive Disease Center, Soonchunhyang University Hospital Seoul, Korea
| | - Jun Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital Seoul, Korea
| | - Tae Hee Lee
- Digestive Disease Center, Soonchunhyang University Hospital Seoul, Korea
| | - Su Jin Hong
- Digestive Disease Center, Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Joo Young Cho
- Digestive Disease Center, Soonchunhyang University Hospital Seoul, Korea
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19
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Hong HJ, Song GW, Ko WJ, Kim WH, Hahm KB, Hong SP, Cho JY. Double-Scope Peroral Endoscopic Myotomy (POEM) for Esophageal Achalasia: The First Trial of a New Double-Scope POEM. Clin Endosc 2016; 49:383-6. [PMID: 26975862 PMCID: PMC4977742 DOI: 10.5946/ce.2015.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 08/29/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022] Open
Abstract
With the accumulation of clinical trials demonstrating its efficacy and safety, peroral endoscopic myotomy (POEM) has emerged as a less invasive treatment option for esophageal achalasia compared with laparoscopic Heller myotomy. However, the difficulty in determining the exact extent of myotomy, a critical factor associated with the success and safety of the procedure, remains a limitation. Although the various endoscopic landmarks and ancillary techniques have been applied, none of these has been proven sufficient. As a solution for this limitation, the double-scope POEM technique with a second endoscope to assure the exact length of the submucosal tunnel has been applied since 2014. Before double-scope POEM was introduced, the second endoscope was applied only to confirm the accuracy of the procedure. In the present study, we performed double-scope POEM in the treatment of esophageal achalasia through a novel procedure of simultaneous application of the second endoscope to assist in the conventional POEM procedure.
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Affiliation(s)
- Hee Jin Hong
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ga Won Song
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Weon Jin Ko
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won Hee Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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20
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Ko WJ, Song GW, Hong SP, Kwon CI, Hahm KB, Cho JY. Novel 3D-printing technique for caps to enable tailored therapeutic endoscopy. Dig Endosc 2016; 28:131-8. [PMID: 26347022 DOI: 10.1111/den.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/19/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM To evaluate the feasibility of a tailored endoscopic cap created using 3D-printing technology that is customized according to esophagogastric lesions of each patient. METHODS Tailored endoscopic caps, which were designed and fabricated with a 3D printer, were inserted in 35 patients. The types of cap were side-hole cap made for cap-assisted endoscopic mucosal resection (EMRC), oblique-head cap designed for endoscopic submucosal dissection (ESD), wide-head cap used for Trucut biopsy (TCB), and narrow-tip cap to facilitate peroral endoscopic myotomy (POEM). RESULTS EMRC in the esophagus and gastroesophageal junction was carried out using a side-hole cap in seven patients. Median total procedure time for successful removal of lesions was 14 min (range 8-50 min). Gastric ESD was carried out using with an oblique-head cap in 16 patients, for which the median total procedure time was 53 min. TCB in the esophagus was done using a wide-head cap in eight patients. While carrying out POEM for tunneling, a narrow-tip cap was used in four patients with achalasia. CONCLUSION Based on the current proof-of-concept study, we anticipate that creating a tailored endoscopic cap is feasible for therapeutic endoscopy.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ga Won Song
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang-il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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21
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Lee SH, Park JM, Han YM, Ko WJ, Hahm KB. [Unpleasant Journey from Helicobacter pylori-associated Gastritis to Gastric Cancer: Cancer Prevention by Taking a Detour]. Korean J Gastroenterol 2015; 66:303-11. [PMID: 26691187 DOI: 10.4166/kjg.2015.66.6.303] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As a commensal or a pathogen, Helicobacter pylori can change the balance of a complex interaction that exists among gastric epithelial cells, microbes, and their environment. Therefore, unraveling this complex relationship of these mixtures can be expected to help prevent cancer as well as troublesome unmet medical needs of H. pylori infection. Though gastric carcinogenesis is a multi-step process, precancerous lesion can be reversible in the early phase of mucosal damage before reaching the stage of no return. However, biomarkers to predict rejuvenation of precancerous atrophic gastritis have not been identified yet and gastric cancer prevention is still regarded as an impregnable fortress. However, when we take the journey from H. pylori-associated gastritis to gastric cancer, it provides us with the clue for prevention since there are two main preventive strategies: eradication and anti-inflammation. The evidence supporting the former strategy is now ongoing in Japan through a nation-wide effort to eradicate H. pylori in patients with chronic gastritis, but suboptimal apprehension to increasing H. pylori resistance to antibiotics and patient non-compliance still exists. The latter strategy has been continued in the author'sresearch center under siTRP (short-term intervention to revert premalignant lesion) strategy. By focusing on the role of inflammation in the development of H. pylori-associated gastric carcinogenesis, this review is intended to explain the connection between inflammation and gastric cancer. Strategies on H. pylori eradication, removal of inflammation, and reverting preneoplastic lesion will also be introduced. In the end, we expect to be able to prevent gastric cancer by take a detour from the unpleasant journey, i.e. from H. pylori-associated gastritis to gastric cancer.
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Affiliation(s)
- Sang Hwan Lee
- Digestive Disease Center, CHA University Bundang Medical Center, Seongnam, Korea
| | - Jong Min Park
- CHA Bio Complex, CHA Cancer Prevention Research Center, Seongnam, Korea
| | - Young Min Han
- CHA Bio Complex, CHA Cancer Prevention Research Center, Seongnam, Korea
| | - Weon Jin Ko
- Digestive Disease Center, CHA University Bundang Medical Center, Seongnam, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA University Bundang Medical Center, Seongnam, Korea.,CHA Bio Complex, CHA Cancer Prevention Research Center, Seongnam, Korea
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22
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Park JM, Lee HJ, Yoo JH, Ko WJ, Cho JY, Hahm KB. Overview of gastrointestinal cancer prevention in Asia. Best Pract Res Clin Gastroenterol 2015; 29:855-67. [PMID: 26651248 DOI: 10.1016/j.bpg.2015.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/11/2015] [Accepted: 09/02/2015] [Indexed: 01/31/2023]
Abstract
"War on cancer" was declared through the National Cancer Act by President Richard Nixon in 1971, but cancer statistics from the American Cancer Society and other sources indicated the failure of this war, suggesting instead focus on the message that a "prevention strategy" might be much more effective than cancer treatment. While cancer statistics notoriously showed sharp increases in incidence as well as in mortality concurrent with economic growth in Asia, fortunately Asian countries benefit from plentiful resources of natural compounds, which can prevent cancer. Just like cancer chemotherapeutics targeted to kill cancer cells in Western countries, natural agents activating molecular mechanisms for cancer prevention, reversion of premalignant tumors, and even ablation of cancer stem cells, are very abundant in Asia. Currently, these natural agents are under very active investigations targeting the hallmarks of cancer prevention, including selective induction of apoptosis in cancer cells, suppression of growth factors or their signaling, suppression of cell proliferation and of cancer-promoting angiogenesis, induction of mesenchymal-epithelial transition, and disruption of the tumor microenvironment, developing promising cancer preventive agents. However, Asia is the most populous continent in the world and some Asian countries do not have the resources to implement cancer screening programs for early detection or treatment. In addition, despite the excellent cancer preventive screening strategies in some Asian countries, well-designed clinical trials for cancer prevention are somewhat delayed compared to Western countries. In this review article, several phytochemicals/phytoceuticals produced and studied in different Asian countries will be introduced, including Korean red ginseng (pride of Korea), curcumin (Indian spice for life), black or green tea (popular in Japan/Sri Lanka), genistein from tofu (famous Chinese food), diallylsulfide or S-allylcysteine (garlic, popularly consumed as a food ingredient in many Asian countries), capsaicin, 6-gingerol, flavopiridol, and silymarin (abundant in various Asian foods). Whereas in Western countries cancer chemotherapeutics involve strategies not only to block the growth of the primary tumor, but also to inhibit its progression to metastatic disease, the endless pursuit of effective agents for cancer prevention may be a unique and featured strategy in Asia. More active efforts for clinical application of these principles should be supported.
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Affiliation(s)
- Jong-Min Park
- CHA Cancer Prevention Research Center, CHA University, CHA Bio Complex, Seongnam, Republic of Korea.
| | - Ho-Jae Lee
- Laboratory of Cancer Prevention, Gachon University, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Republic of Korea.
| | - Jun Hwan Yoo
- CHA Cancer Prevention Research Center, CHA University, CHA Bio Complex, Seongnam, Republic of Korea.
| | - Weon Jin Ko
- Digestive Disease Center, CHA University Bundang Medical Center, Seongnam, Republic of Korea.
| | - Joo Young Cho
- Digestive Disease Center, CHA University Bundang Medical Center, Seongnam, Republic of Korea.
| | - Ki Baik Hahm
- CHA Cancer Prevention Research Center, CHA University, CHA Bio Complex, Seongnam, Republic of Korea; Digestive Disease Center, CHA University Bundang Medical Center, Seongnam, Republic of Korea.
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23
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Ko WJ, An P, Ko KH, Hahm KB, Hong SP, Cho JY. Image Quality Analysis of Various Gastrointestinal Endoscopes: Why Image Quality Is a Prerequisite for Proper Diagnostic and Therapeutic Endoscopy. Clin Endosc 2015; 48:374-9. [PMID: 26473119 PMCID: PMC4604274 DOI: 10.5946/ce.2015.48.5.374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/30/2015] [Accepted: 08/04/2015] [Indexed: 01/07/2023] Open
Abstract
Arising from human curiosity in terms of the desire to look within the human body, endoscopy has undergone significant advances in modern medicine. Direct visualization of the gastrointestinal (GI) tract by traditional endoscopy was first introduced over 50 years ago, after which fairly rapid advancement from rigid esophagogastric scopes to flexible scopes and high definition videoscopes has occurred. In an effort towards early detection of precancerous lesions in the GI tract, several high-technology imaging scopes have been developed, including narrow band imaging, autofocus imaging, magnified endoscopy, and confocal microendoscopy. However, these modern developments have resulted in fundamental imaging technology being skewed towards red-green-blue and this technology has obscured the advantages of other endoscope techniques. In this review article, we have described the importance of image quality analysis using a survey to consider the diversity of endoscope system selection in order to better achieve diagnostic and therapeutic goals. The ultimate aims can be achieved through the adoption of modern endoscopy systems that obtain high image quality.
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Affiliation(s)
- Weon Jin Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Pyeong An
- Digestive Disease Center, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kwang Hyun Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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24
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Han YM, Park JM, Kangwan N, Jeong M, Lee S, Cho JY, Ko WJ, Hahm KB. Role of proton pump inhibitors in preventing hypergastrinemia-associated carcinogenesis and in antagonizing the trophic effect of gastrin. J Physiol Pharmacol 2015; 66:159-167. [PMID: 25903947] [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] [Received: 12/26/2013] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
Gastrin is the main hormone stimulating gastric acid secretion, but it exerts proliferative and anti-apoptotic actions on various cancer cell types, in addition to its well-known trophic effect on enterochromaffin-like cells. As treatment with proton pump inhibitors (PPIs) increases the biosynthesis and secretion of gastrin, it has been postulated that treatment with PPIs could increase the risk of cancer, especially in Barrett's esophagus, gastric carcinoids, and colorectal cancer (CRC). Some tumors produce gastrin of their own, which can act in an autocrine manner to promote tumor growth. In addition, gastrin is known to foster the tumor microenvironment. However, in spite of these potentially increased cancer risks due to PPI-induced hypergastrinemia, prospective, large-scale cohort studies did not show an increase in CRC prevalence. The question as to why the long-term use of PPIs was not associated with an increased cancer risk of CRC might be answered by the fact that the PPIs antagonized the trophic effects of hypergastrinemia. Furthermore, the blockade of proton pumps or potassium channels in cancer cells could limit the abnormal glycolytic energy metabolism of cancer cells. Apart from their suppressive effect on gastric acids, PPIs exert an anti-tumor effect through the selective induction of apoptosis as well as an anti-inflammatory effect, and they protect cells from developing chemo- or radiotherapeutic resistance. Moreover, the anti-carcinogenic actions of PPIs were augmented with PPI-induced hypergastrinemia. Together with their potential targeted killing of cancer stem cells, these effects demonstrate their potential anti-cancer actions.
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Affiliation(s)
- Y-M Han
- CHA Cancer Prevention Research Center, CHA Bio Complex, Seongnam, Korea.
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25
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Lee WC, Ko WJ, Cho JH, Lee TH, Jeon SR, Kim HG, Cho JY. Endoscopic Treatment of Various Gastrointestinal Tract Defects with an Over-the-Scope Clip: Case Series from a Tertiary Referral Hospital. Clin Endosc 2014; 47:178-82. [PMID: 24765601 PMCID: PMC3994261 DOI: 10.5946/ce.2014.47.2.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 02/05/2013] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 12/12/2022] Open
Abstract
Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.
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Affiliation(s)
- Woong Cheul Lee
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Weon Jin Ko
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Tae Hee Lee
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Hyun Gun Kim
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Joo Young Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
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26
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Chang CJ, Tam HP, Ko WJ, Tsai PR. Predicting hospital mortality in adult patients with prolonged stay (>14 days) in surgical intensive care unit. Minerva Anestesiol 2013; 79:843-852. [PMID: 23698544] [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: 06/02/2023]
Abstract
BACKGROUND The aim of this paper was to identify the factors at surgical intensive care unit (SICU) admission and during the following SICU course that influence hospital mortality of patients with prolonged SICU stay (>14 days). METHODS This prospectively-planned study enrolled 1661 patients over 16 years old with prolonged SICU stay in a tertiary-care teaching hospital over a 4-year period. Data at SICU admission, physiologic factors on the 14th SICU day and the indications of prolonged ICU stay were collected. A multivariate logistic regression model with a least absolute shrinkage and selection operator technique was adopted to identify factors associated with hospital mortality in prolonged-stay patients at the 14th SICU day. RESULTS Prolonged-stay patients accounted for 9.7% of the total SICU admissions, but consumed 51.7% of total SICU days. The hospital mortality of these patients was 34%. For predicting the hospital mortality in prolonged SICU stay patients, the predictors at ICU admission included gender, longer pre-ICU days, higher Charlson comorbidity index, and not admitted from emergency. Predictors on the 14th SICU day included lower Glasgow coma scale, lower mean arterial pressure, higher dosage of inotropes required, higher serum lactate level, higher serum bilirubin level, lower platelet count, and the use of renal replacement therapy. Among the indications for prolonged SICU stay, predictors included the need for mechanical circulatory support, worsening acute encephalopathy with altered mental status, hemodynamic instability due to bleeding, and sepsis with unstable vital signs. CONCLUSION This validated predictive model reached clinically accurate discriminatory power, and may serve to improve patient care and resource utilization in the SICU.
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Affiliation(s)
- C J Chang
- Department of Education, National Taiwan University Hospital, Taiwan, Republic of China
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Abstract
PURPOSE Heart transplantation is indicated for children with end-stage heart failure or complex inoperable congenital defects. When the transplanted heart fails, retransplantation is suggested and herein we have presented the prognosis of these pediatric cases. MATERIALS AND METHODS From March 1987 to March 2011, we performed 404 heart transplantations including 45 pediatric patients, 6 (13.3%) of whom experienced graft failure requiring retransplantation. Only four of the six patients (66.7%) had a chance for retransplantation. RESULTS Six of 45 pediatric heart transplant patients (13.3%) experienced graft failure requiring retransplantation. Four of them (66.7%) underwent retransplantation. Only one of the four died due to severe postoperative sepsis with acute respiratory distress. The other three patients recovered well and remain alive with no neurological sequelae; all are in New York Heart Association functional classification I at present. CONCLUSION Pediatric post-heart graft failure require expectations retransplantation, which shows a good prognosis.
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Affiliation(s)
- J M Luo
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
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28
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Chen YC, Chou NK, Hsu RB, Chi NH, Wu IH, Chen YS, Yu HY, Huang SC, Wang CH, Tsao CI, Ko WJ, Wang SS. End-stage renal disease after orthotopic heart transplantation: a single-institute experience. Transplant Proc 2010; 42:948-51. [PMID: 20430213 DOI: 10.1016/j.transproceed.2010.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 11/18/2022]
Abstract
Orthotopic heart transplantation is the treatment of choice for end-stage heart failure, and calcineurin inhibitor agents allow for better allograft survival. However, pretransplantation low cardiac output status and posttransplantation immunosuppressants contribute toward deterioration of renal function. From 1987 to 2008, 350 patients underwent orthotopic heart transplantation in our hospital. Most of them received anti-thymocyte globulin (ATG) as the induction immunosuppressant. The introduction of mycophenolate mofetil (MMF) reduced the maintenance level of cyclosporine. The 26 patients who developed end-stage renal disease required dialysis. We reviewed the patient characteristics, including pretransplantation status, immunosuppressant regimens and drug levels, time and type of dialysis, and mortality rate. The mean age of these 26 patients was 53 years. Three patients underwent peritoneal dialysis. The overall 1-year survival rate was 96%, and the 5-year survival rate was 80%. The duration from heart transplantation to chronic dialysis correlated with the presence of a pretransplantation diagnosis of diabetes (P<.05) and an elevated pretransplantation blood creatinine level (P=.01), but there was no significant effect of the initial level of cyclosporine. In addition, the pretransplantation blood creatinine level was also related to the necessity of immediate postoperative hemodialysis (P=.01). There was no significant risk factor in relation to mortality. Regardless of modification of immunosuppressant regimens and initial drug levels, pretransplantation kidney function played an important inverse role in the duration from transplantation to dialysis: the higher the pretransplantation blood creatinine, the shorter the duration. While awaiting a heart transplant, more effort should be spent on protecting renal function to avoid early chronic dialysis.
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Affiliation(s)
- Y C Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
There is no generally accepted definition for a "prolonged surgical intensive care unit (SICU) stay". The aims of the current study were to: (1) define prolonged SICU stay; (2) identify risk factors of prolonged SICU stay; and (3) identify risk factors of hospital mortality in patients with a prolonged SICU stay. All SICU patients aged >16 years and with an intensive care unit (ICU) stay longer than three days without ICU readmission between 1 January 2004 and 30 November 2006 at the National Taiwan University Hospital were recruited to the study. A total of 2598 patients were recruited. ICU stay >16 days was defined as a prolonged SICU stay since rates of ICU mortality, hospital mortality and mortality one year after ICU discharge remained stationary after ICU stay was >16 days. A multivariate logistic regression model identified factors associated with a prolonged SICU stay, including age more than 70 years old, (odds ratio 1.587, 95% confidence interval 1.246 to 2.022), increasing pre-ICU hospital days (odds ratio 1.009, 95% confidence interval 1.003 to 1.015), admission from emergency (odds ratio 1.925, 95% confidence interval 1.455 to 2.548), use of mechanical circulation support (odds ratio 2.314, 95% confidence interval 1.458 to 3.674) and renal replacement therapy (odds ratio 5.140, 95% confidence interval 3.781 to 6.987). A multivariate logistic regression model identified factors associated with ICU mortality in patients with ICU stay >16 days, including renal replacement therapy (odds ratio 4.780, 95% confidence interval 2.687 to 8.504). An ICU stay >16 days could be used to define prolonged SICU stay when hospital and one-year mortality rates are considered. Prevention of organ failure requiring renal replacement therapy might prove a useful goal to avoid prolonged ICU stay and even hospital mortality.
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Affiliation(s)
- Y C Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Wang SS, Chou NK, Chi NH, Wu IH, Chen YS, Yu HY, Huang SC, Wang CH, Ko WJ, Tsao CI, Sun CD. Heart transplantation under cyclosporine or tacrolimus combined with mycophenolate mofetil or everolimus. Transplant Proc 2008; 40:2607-8. [PMID: 18929814 DOI: 10.1016/j.transproceed.2008.08.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In this study, we examined whether cyclosporine was effective when combined with everolimus in clinical heart transplantation (HT). PATIENTS AND METHODS From August 2004 to July 2007, 108 adult patients underwent primary HT. The main exclusion criteria were: donors > 60 years; cold ischemia times > 6 hours; recipients of multiorgan transplantation or a previous transplantation; and panel-reactive antibodies > or = 25%. The cyclosporine plus everolimus regimen (group CE, n = 32) was suggested first; upon refusal or if the recipient or donor was positive for hepatitis B surface antigen or PCR + hepatitis C infection, then patient was randomly assigned to success cyclosporine plus mycophenolate mofetil (MMF; group CM, n = 24) or tacrolimus plus MMF (group TM, n = 25). All patients underwent similar operative procedures and postoperative care with protocol endomyocardial biopsies. RESULTS No 30-day mortality was noted in any group. The efficacy failure rates were 3%, 25%, and 16% in groups CE, CM, and TM, respectively (P = .04 between groups CE and CM). The 1-year survivals were 96.7% +/- 18.1%, 89.7% +/- 29.8%, and 81.0% +/- 35.5% for groups CE, CM, and TM, respectively (P = .04 between groups CE and TM). The 3-year survival rates were 91.9% +/- 28.3%, 79.8% +/- 46.0%, and 81.0% +/- 35.5% in groups CE, CM, and TM, respectively. CONCLUSIONS The 3 immunosuppressive regimens offered good efficacy after HT. The cyclosporine plus everolimus regimen showed a significantly better result with less efficacy failure (compared with cyclosporine plus MMF: 3% vs 25%) and better 1-year survival compared with tacrolimus plus MMF: 96.7% vs 81.0%.
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Affiliation(s)
- S S Wang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Wang CH, Chou NK, Ko WJ, Chi NH, Tsao CI, Wang SS. The impact on biochemical profiles and allograft function for patients converted from cyclosporine to tacrolimus after clinical heart transplantation. Transplant Proc 2008; 40:2600-2. [PMID: 18929812 DOI: 10.1016/j.transproceed.2008.08.078] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tacrolimus, a potent calcineurin inhibitor, is a widely used immunosuppressant. This study sought to determine whether conversion from cyclosporine to tacrolimus afforded benefits on biochemical profiles and graft function among Chinese heart transplantation recipients. METHODS Forty-nine patients (44 men and 5 women) among 252 heart transplantations performed from 1995 to 2005 were converted from cyclosporine to tacrolimus due to rejection (69%) or to cyclosporine intolerance (31%). The median age of these recipients at transplantation was 46.4 years (range, 5 months to 68 years). Their median body weight was 60 kg (range, 4-84 kg). The allograft median ischemic time was 145 minutes (range, 52-300 minutes). We compared the biochemical markers, rejection episodes and allograft function. RESULTS The mean duration from heart transplantation to conversion was 419 days. After conversion, the serum bilirubin and alanine transaminase levels were significantly improved at 1 year. The lipid profiles, including triglycerides, total cholesterol, and low-density lipoprotein were nonsignificantly changed. The rejection episodes significantly decreased from 1.53 to 0.15 per patient per year (P < .001). The left ventricular ejection fraction significantly improved from 54.3 +/- 17.9% to 63.2 +/- 10.9% (P < .01). The right atrial pressure significantly decreased from 9.1 +/- 5.8 mmHg to 6.3 +/- 4.3 mm Hg (P < .01). The pulmonary capillary wedge pressure significantly decreased from 15.3 +/- 9.5 mm Hg to 10.8 +/- 5.3 mm Hg (P = .04). CONCLUSION In heart transplantation, conversion to tacrolimus owing to rejection or cyclosporine intolerance showed better liver profiles with fewer rejection episodes and improved graft function.
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Affiliation(s)
- C H Wang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Lee ML, Chou NK, Ko WJ, Chi NH, Chen YS, Yu HY, Wu IH, Huang SC, Wang CH, Chang CI, Wang SS. Cardiac Arrest After Methylprednisolone Pulse Therapy Rescued Using Extracorporeal Membrane Oxygenation in Patients With Acute Cardiac Rejection: Two Case Reports. Transplant Proc 2008; 40:2611-3. [PMID: 18929816 DOI: 10.1016/j.transproceed.2008.08.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M L Lee
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Chou NK, Chang CH, Chi NH, Chang CI, Chen YS, Wu ET, Wu MH, Wang JK, Hsu RB, Huang SC, Ko WJ, Chu SH, Lin FY, Wang SS. Single-center experience of pediatric heart transplantation in taiwan. Transplant Proc 2006; 38:2130-1. [PMID: 16980021 DOI: 10.1016/j.transproceed.2006.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/26/2022]
Abstract
Heart transplantation (HTx) is a treatment for end-stage heart failure or a complex or inoperable congenital defect. The long-term survival and the adequate donor to recipient body weight (D/R BW) ratio remain to be determined. From March 1995 to May 2004, 14 children (6 months-16 years of age) underwent HTx due to underlying diseases of idiopathic dilated cardiomyopathy (n = 10; 71.4%), congenital heart disease (n = 3; 21.4%), and Kawasaki disease (n = 1; 7.1%). Donor-recipient body weight ratio ranged from 0.89 to 3.9. Big heart syndrome was present in one patient when D/R BW ratio was more than 3. Actuarial survival was 92.9% at 5 years after transplantation. Only the one patient who had Kawasaki disease died due to early primary graft failure. HTx is a feasible method with good long-term survival rates for end-stage heart failure or for complex or inoperable congenital defects. After careful pretransplant evaluation, a high D/R BW ratio (more than 3) is acceptable.
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Affiliation(s)
- N K Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
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Chou NK, Chi NH, Chen YS, Yu HY, Lee CM, Huang SC, Hsu RB, Ko WJ, Lin FY, Chu SH, Wang SS. Heart retransplantation for heart allograft failure in Chinese heart transplant recipients: NTUH experience. Transplant Proc 2006; 38:2147-8. [PMID: 16980027 DOI: 10.1016/j.transproceed.2006.06.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/21/2022]
Abstract
We investigated the short- and long-term results after heart retransplantation in terms of different causes of heart allograft failure. We sought to establish the data of heart retransplantation in Chinese compared with Western counterparts due to differences in heart allograft vasculopathy. From March 1995 to May 2005, eight heart transplantation recipients with allograft failure underwent retransplantation. Heart allograft failure was due to coronary vasculopathy (CAV) in six patients (75%) and acute rejection in two patients (25%). The mean interval to retransplantation was 32 to 84 months (mean 54.3 months). There were five patients who survived after heart retransplantation for CAV and no patient survived after an earlier diagnosis of acute rejection. Heart retransplantation is a feasible method with acceptable long-term survival rate for heart allograft failure. After careful pretransplant evaluation, retransplantation is acceptable. The survival after retransplantation for CAV is notably great than that after acute rejection. Heart retransplantation is the only way for patients who have cardiac allograft failure to achieve long-term survival.
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Affiliation(s)
- N K Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung-shan South Road, Taipei, Taiwan
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Chou NK, Chen YS, Chi NH, Hsu RB, Ko WJ, Yu HY, Lin FY, Wang SS. Extracorporeal Membrane Oxygenation Hybrid With Various Ventricular Assist Devices as Double Bridge to Heart Transplantation. Transplant Proc 2006; 38:2127-9. [PMID: 16980020 DOI: 10.1016/j.transproceed.2006.06.052] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Ventricular assist devices (VAD) have benefitted patients with end-stage heart failure as a bridge to heart transplantation (HTx). We present our experience with HTx after an extracorporeal membrane oxygenation (ECMO) hybrid with various ventricular assist devices (VAD). From May 1996 to December 2003, mechanical circulatory support with a Biopump VAD was performed in eight patients, HeartMate left VAD in eight patients, and Thoratec VAD in eight patients. Before VAD implantation, 19 patients maintained their circulation with ECMO. Half of the 24 patients were implanted with VAD to await a suitable donor for HTx. We observed that half of the patients supported by ECMO hybrid with various VAD awaited a suitable donor for HTx. In our experience, we recommend the application of ECMO for short-term support within 1 week and the Biopump VAD, Thoractec VAD, or HeartMate VAD for medium-term or long-term support as a bridge to HTx.
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Affiliation(s)
- N K Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
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Wang SS, Chou NK, Chi NH, Hsu RB, Huang SC, Chen YS, Yu HY, Tsao CI, Ko WJ, Lai MY, Chu SH. Successful Treatment of Hepatitis B Virus Infection With Lamivudine After Heart Transplantation. Transplant Proc 2006; 38:2138-40. [PMID: 16980024 DOI: 10.1016/j.transproceed.2006.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
Patients with hepatitis B virus (HBV) infection have a higher morbidity and mortality after heart transplantation (HT). HBV infection is endemic in Taiwan. We studied the effect of lamivudine treatment of HBV infection after HT. From July 1987 to July 2005, 252 patients underwent HT. All recipients and donors underwent routine screening of hepatitis B surface antigen (HBsAg), hepatitis B e antigen, antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, antibody to hepatitis B e antigen, and an alanine aminotransferase (ALT) level before HT. When ALT was two times greater than the upper limit of normal or serum bilirubin was higher than 3 mg/dL in HBsAg-positive patients, HBV-DNA were checked by a branched DNA assay or polymerase chain reaction. When HVB-DNA was greater than 100,000 copies/mL, lamivudine (100 mg per day) was prescribed indefinitely. There were 14 patients under lamivudine treatment after HT, among whom, none suffered severe adverse reactions from lamivudine. Four patients died: one due to end-stage cirrhosis while awaiting liver transplantation at 14 months after HT. Two died of sudden death at 54 months and 138 months after HT. Another died of diffuse B cell lymphoma at 62 months after HT. All the survivors have normal ALT and undetectable HBV-DNA after lamivudine treatment. But the YMDD mutant was detected in two patients. With successful treatment of HBV infection in HT, it is not necessary to exclude HBV infection patients from HT.
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Affiliation(s)
- S S Wang
- Department of Surgery, National Taiwan University Hospital, No. 7 Chung-shan South Road, Taipei, Taiwan.
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Chou NK, Ko WJ, Chi NH, Chen YS, Yu HY, Hsu RB, Fang CT, Chang SC, Lin FY, Chu SH, Wang SS. Sparing Immunosuppression in Heart Transplant Recipients With Severe Sepsis. Transplant Proc 2006; 38:2145-6. [PMID: 16980026 DOI: 10.1016/j.transproceed.2006.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/20/2022]
Abstract
This study described an analysis of severe sepsis among heart transplantation recipients who were treated by sparing all immunosuppressants. Sepsis leading to multiple organ failure (MOF) in heart transplantation has a high mortality. This retrospective study of 190 patients who underwent heart transplantation from 1993 to 2004 included 12 who had severe sepsis with MOF who were treated by sparing all immunosuppressants. Half of them survived after sparing all immunosuppressants with intensive endomyocardial biopsy. Only one case needed pulse therapy for an acute rejection episode. The most common bacterial infectious episodes were caused by methicillin-resistant Staphylococcus aureus (n = 3). All sepsis episodes occurred in the first month after heart transplantation except in one case, which occurred 6 years after heart transplantation. There was a 50% survival rate of heart transplantation recipients who experienced MOF due to severe sepsis and were treated by sparing all immunosuppressants under a program of intensive endomyocardial biopsy.
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Affiliation(s)
- N K Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung-shan South Road, Taipei, Taiwan
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Wang SS, Chou NK, Chi NH, Hsu RB, Huang SC, Chen YS, Yu HY, Ko WJ, Chu SH, Tsai MK, Lee PH. Simultaneous Heart and Kidney Transplantation for Combined Cardiac and Renal Failure. Transplant Proc 2006; 38:2135-7. [PMID: 16980023 DOI: 10.1016/j.transproceed.2006.06.002] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Simultaneous heart and kidney transplantation (SHKT) is feasible for combined cardiac and renal failure. Herein we reviewed our 10-year experience in SHKT. Six patients underwent SHKT from June 1995 to December 2004. Their ages ranged from 13 to 63 years old with a mean of 45.5 +/- 15.8 years. They were all men except one girl, who was the youngest (aged 13) who suffered from dilated cardiomyopathy with congestive heart failure and chronic renal failure due to systemic lupus erythematosus. Because of aggravating heart failure, she changed from hemodialysis to peritoneal dialysis. Because of intractable heart failure, she underwent SHKT from a 24-year-old female donor. All received hemodialysis before SHKT. The indications for heart transplantation included dilated cardiomyopathy (n = 3), ischemic cardiomyopathy (n = 1), cardiac allograft vasculopathy (n = 1), and cardiac allograft failure (n = 1). The immunosuppressive protocol and rejection surveillance were these employed for heart transplantation. No operative mortality was noted in this study. The 1-year and 5-year survival rates were the same, 83%. The 10-year survival rate was 55%. No cardiac or renal allograft rejection was noted. No renal allograft loss was noted. There were two late mortalities: the one, who underwent redo heart transplantation for coronary artery vasculopathy died of cardiac allograft failure 1 year after SHKT. The other patient died of massive ischemic necrosis of the intestine at 6 years after SHKT. Our experience showed that SHKT had good short- and long-term results without increasing immunosuppressive doses. End-stage failure of either the heart or the kidney did not preclude heart plus kidney transplantation.
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Affiliation(s)
- S S Wang
- Department of Surgery, National Taiwan University Hospital, No. 7 Chung-shan South Road, Taipei, Taiwan.
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Abstract
UNLABELLED This study compares the pharmacokinetics of tacrolimus (TAC) and cyclosporine Neoral (CsA) in cardiac transplant recipients. METHODS Twenty-six de novo cardiac recipients were prospectively and randomly assigned to receive oral TAC- or CsA-based regimens after 5 to 6 days of rabbit antithymocyte globulin induction. Blood samples were collected at 0 (before the dose) and 0.5, 1, 2, 3, 4, 6, 8, 10, as well as 12 hours after drug administration. The pharmacokinetics of the first dose (PK-1) and at steady state (PK-S, 1 month after transplantation) were analyzed. RESULTS Comparing the AUC per milligram dose, there was no significant difference between PK-1 and PK-S among TAC (46.0 +/- 24.3 ng x h/mg x mL versus 69.0 +/- 43.9 ng x h/mg x mL, P = .15 by paired t-test), but a significant difference in CsA (25.2 +/- 11.4 ng x h/mg x mL versus 45.4 +/- 12.9 ng x h/mg x mL, P = .0005 by paired t-test). This means better TAC absorption in the early post-heart transplant period. Using a single-point blood level to predict AUC, TAC showed a significantly higher correlation than CsA at all corresponding sampling times. Besides, C12 in both PK-1 and PK-S of TAC displayed good correlations to the AUC (r2 = .895, P = .00 in PK-1 and r2 = .81, P = .00 in PK-S). The TAC trough level was accurate enough to predict the AUC. CONCLUSION The pharmacokinetic profile of TAC is more reliable than that of CsA in the early post-heart transplant period. A high correlation of trough blood levels with AUC omits the requirement for a multiple sampling strategy to more accurately measure AUC as is needed with CsA.
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Affiliation(s)
- C H Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Wang CH, Ko WJ, Chou NK, Wang SS. Efficacy and safety of tacrolimus versus cyclosporine microemulsion in primary cardiac transplant recipients: 6-month results in Taiwan. Transplant Proc 2005; 36:2384-5. [PMID: 15561256 DOI: 10.1016/j.transproceed.2004.08.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/17/2022]
Abstract
INTRODUCTION This study compared the efficacy and safety of a tacrolimus (TAC)-based with a cyclosporine (CsA)microemulsion-based immunosuppressive regimen in primary cardiac transplantation. METHODS Heart recipients were randomly assigned to receive either TAC or CsA regimen after sequential induction with rabbit anti-thymoglobulin. Endomyocardial biopsies were performed at weeks 1, 2, 3, and 4 and months 2, 3, and 6. RESULTS Among 21 adult patients (TAC, 11; CsA, 10) in this study, patient survival rates were 100% in both groups at the end of 6 months. One patient (9%) in the TAC group experienced acute rejection (ISHLT > or = 1B) versus 6 patients (60%) in the CsA group (P = .02). The effects on hematology, biochemistry, cytomegalovirus infection, and hemodynamics were similar in both groups except for better lipid profiles in the TAC group. There were no significant differences in severe adverse events. CONCLUSION The TAC-based regimen had a lower risk of acute rejection compared with CsA in heart transplant recipients. The safety profiles were similar in both groups. Therefore, TAC is an alternative to CsA as a primary maintenance immunosuppressant in heart transplantation.
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Affiliation(s)
- C H Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Tsao CI, Lin HY, Lin MH, Ko WJ, Hsu RB, Hwang SL, Chen SC, Chou NK, Tu HT, Chen YS, Wang SS. Influence of UNOS status on chance of heart transplantation and posttransplant survival. Transplant Proc 2004; 36:2369-70. [PMID: 15561251 DOI: 10.1016/j.transproceed.2004.08.101] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED This study was designed to compare the chance of heart transplantation (HTx) and survival among patients in different UNOS statuses in Taiwan. METHODS AND RESULTS From 1996 to 2002, among 203 patients on the heart transplant waiting list, 127 patients had undergone HTx up to December 2002 with 71 dead while waiting, and 5 still alive without transplantation. This study included those 198 patients who had either undergone HTx or who died. At the time of registry, 40 patients were at status IA, 57 at IB, and 101 at II. Nineteen (47.5%) of 40 status IA patients underwent HTx with a mean waiting time of 92 +/- 116 days and median waiting time of 35 days. The 1-month survival was 84%, and 1-year survival was 58%. Seven (64.9%) of 57 status IB patients underwent HTx with a mean waiting time of 85 +/- 100 days and a median waiting time of 40 days. Both 1-month and 1-year survivals were 92%. Seventy-one (70.3%) patients among 101 status II patients underwent HTx. Their mean waiting time was 134 +/- 135 days and median waiting time was 86 days. Their 1-month survival was 95%, and 1-year survival was 85%. CONCLUSION Although UNOS status IA patients had a shorter waiting time, their chance to undergo HTx was lower than those in either status IB or status II. The UNOS status IA heart-waiting patients showed lower posttransplant 1-month and 1-year survival rates.
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Affiliation(s)
- C I Tsao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Wang CH, Ko WJ, Chou NK, Wang SS. A limited sampling strategy for the estimation of 12-hour cyclosporine neoral area under the curve in Chinese cardiac transplant recipients. Transplant Proc 2004; 36:2390-2. [PMID: 15561259 DOI: 10.1016/j.transproceed.2004.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/28/2022]
Abstract
INTRODUCTION This study determined the accuracy of a limited sampling strategy to predict the 12-hour cyclosporine neoral (CsA) area-under-the-curve (AUC) to provide a practical method for more accurate therapeutic drug monitoring (TDM) of CsA in Chinese heart transplant recipients. METHODS Blood samples were collected at 0 (before the dose), and 0.5, 1, 2, 3, 4, 6, 8, 10, as well as 12 hours after CsA oral administration in 13 de novo heart recipients receiving oral CsA bid after rabbit antithymoglobulin sequential immuno-induction. Pharmacokinetics were analyzed for the first dose (PK-1) and the steady state dose (PK-2, 1 month after transplantation). The limited sampling strategies included single-point, 2-point, and 3-point prediction of AUC using multiple linear regression analyses. RESULTS Comparing the AUC/mg dose, PK-1 was much lower than PK-2 (25.2 +/- 11.4 ng x h/mg x mL vs 45.4 +/- 12.9 ng x h/mg x mL; P = .0005 using paired t test). The correlations of each single-point blood level of PK-1 with the AUC were lower than those of the corresponding sampling time in PK-2. In the PK-2 study, C4 had the best correlation (r2 = 0.732; P = .00) as a single-point to predict AUC, but the 2-point C2 + C12 had a higher correlation (r2 = 0.937; P = .00). Among the 3-point combinations, C2 + C4 + C12 showen the best prediction (r2 = 0.982; P = .00) of the AUC in PK-2. CONCLUSION The bioavailability of CsA was lower in PK-1 than in PK-2. At steady state, we recommend C2 + C12 to predict AUC because it is accurate and not labor-intensive.
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Affiliation(s)
- C H Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Liao WC, Hwang SL, Ko WJ, Wang SS. Analysis of heart donation for cardiac transplantation at the National Taiwan University Hospital: Fifteen-year cases review. Transplant Proc 2004; 36:2365-8. [PMID: 15561250 DOI: 10.1016/j.transproceed.2004.08.083] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The demand for organ transplantation is disparate to the supply of organ donors. The organ shortage is a limitation for transplantation. This study analyzed the status of heart donors at the National Taiwan University Hospital (NTUH) from July 1987 through November 2001 using registry records. One hundred ninety-four total heart donors yielded about 25 donors per year in the late era (years of 1995-2001). The majority of heart donors were men (78.4%) of O blood type (46.9%) with a mean age of 29.8 (SD = 11.9) years. Though head injury was the main source of heart donors (78.4%), cerebrovascular accident patients have increased (15%) since 1995. However, the number of donors from head injury decreased in the year of 1997, when Taiwan passed a law to force motorcycle drivers to wear safety helmets. The average interval from brain death to donation was 75.4 (SD = 71.2) hours. One hundred fifty-six (80.4%) of the 194 donor hearts came from outside hospitals. However, the majority of heart transplantations (166 cases, 85.6%) were done at the NTUH. Implementing a program for a smooth donation and organ procurement processes should provide better donor management in cardiac transplantation.
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Affiliation(s)
- W C Liao
- School of Nursing, Chun Shan Medical University, Taipei, Taiwan
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Lin MH, Lin HY, Tsao CI, Ko WJ, Hwang SL, Hu RH, Ho MC, Wu YM, Chen SC, Lee PH. Do patients with acute liver failure have a better chance to receive liver grafting? Transplant Proc 2004; 36:2232-3. [PMID: 15561202 DOI: 10.1016/j.transproceed.2004.08.100] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with acute hepatic failure (AHF) were always given first priority on the transplant waiting list. We investigated whether AHF patients will deprive other patients on the waiting list of the chance of liver transplantation (LTx). METHODS AND RESULTS From January 1999 to March 2003, a total of 423 patients were on the transplant waiting list at the National Taiwan University Hospital. Sixty-five of the patients had AHF caused by hepatitis-B-related disease (HBV, n = 52, 80%), Wilson disease (n = 3, 4.6%), drug-induced AHF (n = 3, 4.6%), and other causes (n = 7, 10.8%).Thirty-three patients died and 16 survived by medical treatment. Two received LTx abroad and 14 underwent LTx at our hospital (7 living-related; 7 cadaver). A total of 140 patients died while waiting for a transplant during the period studied. Of them, 107 were among 358 non-AHF patients (30%), and time-to-death interval was 133 +/- 175 days (median: 62); 33 were among 65 AHF patients (51%); time to death was 19 +/- 28 days (median: 8). There were 35 cadaver donor livers available during the period; 28 of 358 non-AHF patients (7.8%), and 7 of 65 AHF patients (10.7%) received cadaveric LTx. Their waiting time totaled 342 +/- 316 and 12 +/- 9 days, respectively (P < .0001). CONCLUSION Most AHF patients died unless they received liver grafts. Even with a higher priority assigned to them, AHF patients still have little chance to get a cadaver donor liver in Taiwan, and non-AHF patients have an even slimmer chance. Therefore, we need to encourage liver donation from living-related donors.
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Affiliation(s)
- M H Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Lee YC, Chang YL, Chen JS, Hsu HH, Ko WJ, Lee JM, Wu HD, Chang SC, Kuo SH. Lung transplantation-the surgical experience. Transplant Proc 2003; 35:445-6. [PMID: 12591481 DOI: 10.1016/s0041-1345(02)03961-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Y C Lee
- Department of Surgery, Pathology, National Taiwan University Hospital, Taipei, Taiwan
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Wang SH, Sheng WH, Chang YY, Wang LH, Lin HC, Chen ML, Pan HJ, Ko WJ, Chang SC, Lin FY. Healthcare-associated outbreak due to pan-drug resistant Acinetobacter baumannii in a surgical intensive care unit. J Hosp Infect 2003; 53:97-102. [PMID: 12586567 DOI: 10.1053/jhin.2002.1348] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [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: 11/11/2022]
Abstract
Acinetobacter baumannii is ubiquitous and has recently become one of the most important healthcare-associated (HA) pathogens in hospitals. Infection caused by this organism often leads to significant morbidity and mortality. Outbreaks of pan-drug resistant Acinetobacter baumannii (PDRAB) have rarely been reported. During a two-month period, an outbreak of PDRAB colonization and infection affecting 7 patients occurred in our surgical intensive care unit (SICU). The colonized sites were respiratory tract (N = 7) and central venous catheter (N = 2). One of the patients had a surgical wound infection. Extensive environmental contamination was identified, including sites such as bed rails, bedside tables, surface of ventilators and infusion pump, water for nasogastric feeding and ventilator rinsing and sinks. All of the isolates were analysed by pulsed-field gel electrophoresis (PFGE) and showed an identical pattern. After use of strict cohort nursing, hand hygiene environmental cleaning, and replacement of a dysfunctional high-efficiency particulate air filter (HEPA), the outbreak was controlled.
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Affiliation(s)
- S H Wang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Shih FJ, Tsao CI, Ko WJ, Chou NK, Hsu RB, Chen YS, Wang SS, Chu SH. Changes in health-related quality of life and working competence before and after heart transplantation: one-year follow-up in Taiwan. Transplant Proc 2003; 35:466-71. [PMID: 12591489 DOI: 10.1016/s0041-1345(02)04019-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- F J Shih
- College of Nursing, Taipei Medical University, Taipei, Taiwan
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Abstract
Eight acute liver failure patients, all in grade IV hepatic encephalopathy, were administered liver dialysis treatment with the Hemo Therapies Unit (Hemo Therapies Inc, San Diego, CA, USA). The patients were evaluated to determine whether the Glasgow Coma Scale score and cerebral blood flow improved with treatment. After the initial treatment, consciousness levels as measured by the Glasgow Coma Scale improved from a pre-treatment median of 5 (range 3 to 6) to a post-treatment median of 7 (range 5 to 9) (p=0.0005 by paired Wilcoxon test); mean blood flow velocity in the middle cerebral arteries as shown by transcranial Doppler sonography increased from a median of 37.85 cm/sec (range 20.3 to 114.0) to 57.90 (32.5 to 135.0) post-treatment (p=0.022); however, there was no significant change in the pulsatility index from a median of 1.18 (range 0.61 to 1.71) to 0.85 (range 0.70 to approximately 1.79) post-treatment (p=0.13). The 8 patients received 2 to 7 (median 5.5) times of daily 6-h liver dialysis treatments. Following the completion of all liver dialysis treatments, hepatic coma was fully resolved in 4 of 8 patients (50%) Three of 8 patients (37.5%) survived to hospital discharge, whereas 5 patients did not survive due to irreversible liver function and associated complications. In conclusion, liver dialysis treatment could improve hepatic encephalopathy, but the prognosis still depended on the underlying diseases.
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Affiliation(s)
- K W Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Affiliation(s)
- W J Ko
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Affiliation(s)
- N K Chou
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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