A Case of Percutaneous Transhepatic Gallbladder Papillary Balloon Dilatation / 대한내과학회지

Endoscopic retrograde cholangiopancreatography (ERCP) fails occasionally due to a surgically altered anatomy, periampullary diverticulum, difficult cannulation, or poor general condition of the patient. In these cases, alternative treatment options are necessary, including percutaneous transhepatic biliary drainage (PTBD) or percutaneous transhepatic gallbladder biliary drainage (PTGBD). Here, we report a case of cholangitis treated with percutaneous transhepatic gallbladder papillary balloon dilatation (PTGBPBD). A 61-year-old male was admitted for cholangitis associated with biliary sludge. ERCP cannulation had failed due to the position of the papilla within a large periampullary diverticulum, and PTBD had failed due to a non-dilated intrahepatic bile duct. Following PTGBD, papillary balloon dilatation was completed successfully through the PTGBD tract. The patient tolerated the procedure and was discharged without complications. We conclude that PTGBPBD is an acceptable and safe procedure in a patient with cholangitis who underwent failed ERCP or PTBD procedures.

A Case of Percutaneous Transhepatic Gallbladder Papillary Balloon Dilatation / 대한내과학회지

Endoscopic retrograde cholangiopancreatography (ERCP) fails occasionally due to a surgically altered anatomy, periampullary diverticulum, difficult cannulation, or poor general condition of the patient. In these cases, alternative treatment options are necessary, including percutaneous transhepatic biliary drainage (PTBD) or percutaneous transhepatic gallbladder biliary drainage (PTGBD). Here, we report a case of cholangitis treated with percutaneous transhepatic gallbladder papillary balloon dilatation (PTGBPBD). A 61-year-old male was admitted for cholangitis associated with biliary sludge. ERCP cannulation had failed due to the position of the papilla within a large periampullary diverticulum, and PTBD had failed due to a non-dilated intrahepatic bile duct. Following PTGBD, papillary balloon dilatation was completed successfully through the PTGBD tract. The patient tolerated the procedure and was discharged without complications. We conclude that PTGBPBD is an acceptable and safe procedure in a patient with cholangitis who underwent failed ERCP or PTBD procedures.

Hepatitis B Core Antigen Expression in Hepatocytes Reflects Viral Response to Entecavir in Chronic Hepatitis B Patients

BACKGROUND/AIMS: Hepatitis B core antigen is known to be a major target for virus-specific T cells and also reflects the progression of liver dissease and viral replication. Hepatitis B core antigen expression in hepatocytes leads to altered histological activity, viral replication, and immune response. The purpose of this study is to evaluate whether the topographical distribution of hepatitis B core antigen expression can predict the viral response to entecavir in patients with chronic hepatitis B. METHODS: We enrolled 91 patients with treatment-naive chronic hepatitis B. All the patients underwent liver biopsy, and the existence and pattern of hepatitis B core antigen evaluated by immunohistochemistry. All patients received 0.5 mg of entecavir daily following a liver biopsy. We checked the viral response at 3, 6, and 12 months during antiviral therapy. RESULTS: Of the 91 patients, 64 (70.3%) had hepatitis B core antigen expression. Of the subcellular patterns, the mixed type was dominant (n=48, 75%). The viral response was significantly higher in the hepatitis B core antigen-negative group than in the hepatitis B core antigen-positive group (88.9% and 54.7%, respectively; p=0.001) after 12 months of entecavir therapy. CONCLUSIONS: Chronic hepatitis B patients who are hepatitis B core antigen-negative have a better response to entecavir therapy than do hepatitis B core antigen-positive patients.

Effects of Metabolic Syndrome on Fibrosis in Chronic Viral Hepatitis

BACKGROUND/AIMS: Metabolic syndrome, comprising diabetes, hypertension, central obesity, and dyslipidemia, is increasingly prevalent worldwide. We aimed to study the relationship between metabolic syndrome and the risk of liver fibrosis in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). METHODS: In total, 954 patients (CHB, 850; CHC, 104 patients) with liver biopsy were included in the retrospective analysis. Extensive clinical and histological data were available. Metabolic syndrome was defined using the International Diabetes Federation definition of metabolic syndrome, 2006 criteria. Histological lesions were evaluated according to the histology activity index system. RESULTS: Metabolic syndrome was present in 6% of patients and significantly more prevalent in patients with CHC than in patients with CHB (5% vs 13%, p<0.001). Patients with metabolic syndrome were older among patients with CHB and patients with CHC, and, as expected, were mainly overweight or obese. Fibrosis was significantly more severe in patients with metabolic syndrome than in those without, regardless of whether they had CHB and CHC (CHB, 3.3+/-2.1 vs 2.4+/-1.3, p=0.025; CHC, 2.6+/-1.5 vs 1.3+/-0.7, p=0.006). Liver fibrosis (stages 3 to 4) was independently associated with increased age, higher transaminase level and metabolic syndrome (odds ratio, 2.421; p=0.017). CONCLUSIONS: Metabolic syndrome is associated independently with severe fibrosis in patients with chronic viral hepatitis B and C.

Angular Positioning of Stent Increases Bowel Perforation after Self-Expandable Metal Stent Placement for Malignant Colorectal Obstruction

BACKGROUND/AIMS: Some factors like stent wires, balloon dilatation and use of guide wires seems to increase perforation after self-expandable metal stent (SEMS) placement, but few studies mentioned about the relationship between angulation of malignant stricture and perforation. The present study aimed to confirm that more angular positioning of stents increases perforation. METHODS: This study was conducted with retrospectively evaluation at Digestive Disease Center, CHA Bundang Medical Center, CHA University. Between January 2002 and August 2011, SEMS was inserted in 130 patients with malignant colorectal obstruction. We studied the difference in the angle of stenosis between perforation and non-perforation groups using fluorography images. RESULTS: SEMS insertion was performed in 130 cases of obstruction due to colon cancer. Perforation occurred in eight patients (6.2%) of them. Thirteen cases were excluded from the analysis due to poor fluoroscopic images. Among the eight patients with perforation, the mean stenosis angle was 109.9degrees compared to 153.1degrees in the nonperforation group, indicating that the angle was more acute in the perforation group (p=0.016). CONCLUSIONS: This study shows that more angular positioning of stent increases bowel perforation after SEMS placement for malignant colorectal obstruction.

Acute Kidney Injury Associated with Disseminated Intravascular Coagulation that Developed after a Hysterectomy in a Patient with Probable Catastrophic Antiphospholipid Syndrome / 대한내과학회지

Acute kidney injury associated with disseminated intravascular coagulation (DIC) and a coagulation factor defect may develop with infection, malignancy, severe trauma, or obstetric complications. However, a gynecological etiology, such as hysterectomy, in a patient with adenomyosis has rarely been reported. We describe a case of a 42-year-old women who presented with DIC and acute kidney injury after a total hysterectomy. We thought that the cause for the acute kidney injury might be small vascular thrombosis and acute tubulointerstital nephritis due to probable catastrophic antiphospholipid syndrome with DIC. The patient was successfully treated with steroid therapy.

Acute Kidney Injury Associated with Disseminated Intravascular Coagulation that Developed after a Hysterectomy in a Patient with Probable Catastrophic Antiphospholipid Syndrome / 대한내과학회지

Acute kidney injury associated with disseminated intravascular coagulation (DIC) and a coagulation factor defect may develop with infection, malignancy, severe trauma, or obstetric complications. However, a gynecological etiology, such as hysterectomy, in a patient with adenomyosis has rarely been reported. We describe a case of a 42-year-old women who presented with DIC and acute kidney injury after a total hysterectomy. We thought that the cause for the acute kidney injury might be small vascular thrombosis and acute tubulointerstital nephritis due to probable catastrophic antiphospholipid syndrome with DIC. The patient was successfully treated with steroid therapy.

Intravesical Cidofovir in the Treatment of Hemorrhagic Cystitis after Unrelated Cord Blood Transplantation / 대한내과학회지

Hemorrhagic cystitis is a common complication in hematopoietic stem cell transplant recipients. We report a case of hemorrhagic cystitis after unrelated cord blood transplantation associated with adenovirus infection. Despite hydration, hematuria and large clots persisted. We instilled cidofovir into the bladder, which resulted in clearance of the adenovirus and significant clinical improvement. Our case emphasizes the effectiveness of intravesical cidofovir treatment for viral hemorrhagic cystitis.

Recurrent Gastric Cancer at the Duodenal Stump after Billroth II Subtotal Gastrectomy / 대한소화기내시경학회지

Many studies have shown that gastric stump cancer develops after distal gastrectomy, particularly after Billroth II reconstruction. But, recurrent cancer at the duodenal stump following Billroth II type distal gastrectomy for gastric cancer is extremely rare. We report a case of duodenal stump cancer in a 64-year-old man underwent Billroth II distal gastrectomy.