Factors Associated or Related to with Pathological Severity of Nonalcoholic Fatty Liver Disease

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been more and more often regarded as a serious disorder, because nonalcoholic steatohepatitis (NASH), a part of NAFLD, may progress to the end stage of liver disease. Though an advanced age, obesity, diabetes mellitus (DM) etc. being not infrequent conditions in Korea, are known to exacerbate the severity of this disease, there are only a few Korean reports on this subject. The purpose of this study is to identify possible factors that might add up to the pathological severity of this disorder in Korean patients. METHODS: Of 60 patients with steatosis found at liver biopsy, 43 NAFLD patients were reviewed retrospectively after exclusion of other liver diseases. RESULTS: The cases of steatosis were mild, moderate, and severe in 9, 10, and 24 patients, respectively. The degree of necroinflammatory activity was mild, moderate, and severe in 33, 9, and 1 patients, respectively. There were no established factors directly related to these classes. As to fibrosis, the cases were classified as none, mild, moderate, severe, and cirrhotic in 9, 11, 16, 7, and 0 patients, respectively. The stage of fibrosis correlated with the age (p< 0.001), BMI (body mass index) (p=0.032), and the platelet count (p=0.009), but the presence of NASH was associated only with BMI (p=0.002) and obesity (p=0.001). CONCLUSION: It seems that there are no factors that are directly related to the degree of steatosis or necroinflammatory activity. BMI seems to be a unique factor directly related to both the severity of fibrosis and the presence of NASH. The age and the platelet count are factors that are directly related to the degree of fibrosis but not to the presence of NASH.

The Difference in Success Rate of Endoscopic Stent Insertion with or without Fluoroscopic Guidance / 대한소화기내시경학회지

BACKGROUND/AIMS: Sometimes, the endoscopic stent insertion may be done without fluoroscopic guidance. This study was performed to evaluate the difference in success rate of endoscopic stent insertion with or without fluroscopic guidance. A total of hundred and sixty three patients with upper gastrointestinal obstruction were included. METHODS: The group I comprised 82 patients in which the stent insertion was done without fluoroscopy. The group II included 81 patients in which stent was inserted under the fluoroscopy. RESULTS: The locations of obstruction are at esophagus and cardia (group I /group II, 44/40 patients), at pylorus and duodenum (15/34 patients) and at post-operative stenosis of gastro-jejunal anastomosis (23/7 patients). The statistical difference of success rate were not found between the two groups [79/82 (96.3%) in group I, 80/81 (98.2%) in group II, p=0.620]. Among group I, three patients (3.7%) were failed due to incomplete guidewire insertion. These patients were the two cases of jejunal stenosis of esophago-jejunal anastomosis and one case of duodenal obstruction with carcinomatosis peritonei. However, in these cases, the stents were successfully inserted under the fluoroscopic guidance. CONCLUSION: The success rate of the endoscopic stent insertion with or without the fluoroscopic guidance is not different. But in cases of inaccurate guidewire insertion, especially in patients with pyloric obstruction, the endoscopic stent insertion under the fluoroscopic guidance may be more safe and successful.