Incidence of Cholangiocarcinoma with or without Previous Resection of Liver for Hepatolithiasis

BACKGROUND/AIMS: To investigate the incidence of cholangiocarcinoma in patients with hepatolithiasis with or without previous resection of liver. METHODS: From 2002 to 2009, we retrospectively reviewed 117 patients who were diagnosed and treated for hepatolithiasis in Korea University Guro Hospital. Among the 117 patients, 55 patients who were lost during follow-up were excluded, and 62 patients were eligible for analysis. The hepatic resection group (n=25) included patients who underwent left hemihepatectomy (n=2); left lateral segmentectomy (n=10); left lobectomy (n=9); right lobectomy (n=3); or wedge resection (n=1). The nonhepatic resection group (n=37) included transhepatic cholangiographic lithotomy and endoscopic retrograde cholangiopancreatography-treated patients. The mean follow-up period was 47 months. RESULTS: The incidence of cholangiocarcinoma while patients were followed for hepatolithiasis was 12.9% (8/62) (hepatic resection group, three cases [12%] vs nonhepatic resection group, five cases [13.5%]; p=1.000). The mean follow-up period was 53 months (47+/-11 months) until the diagnosis of cholangiocarcinoma. CONCLUSIONS: There was no difference in the incidence of cholangiocarcinoma according to previous liver resections. Patients with hepatolithiasis should be carefully followed up for detection of cholangiocarcinoma even after a previous liver resection.

Anticancer Effects of Astaxanthin and alpha-tocopherol in Esophageal Cancer Cell Lines

BACKGROUND/AIMS: Astaxanthin (AX) has been attributed with potential for protecting the organism against different types of cancer due to its anti-oxidant activity. Also several in vivo and in vitro studies suggest certain naturally occurring vitamin E (i.e. alpha-tocopherol) as promising anticancer agents. We assessed the effect of AX and alpha-tocopherol (AT) respectively and their combination on human esophageal cancer cell lines to investigate the mechanism of anticancer effect and their therapeutic potential. MATERIALS AND METHODS: Two human esophageal cancer cell lines (TE-1, TE-4) were exposed to AX (6 to 10 microg/mL) and AT (20 to 100 microM) for 24 hours. Quantification of proliferation was performed by MTT assay. Cell cycle machinery proteins such as p-AKT, p-p38, cyclin D1, p27 and caspase-3 were investigated by Western blot. RESULTS: Significant inhibition of cell proliferation of AX and AT was observed in TE-4 cell line by a dose-dependent manner. Furthermore, AX and AT as single agents increased the protein expression of p27 and cleaved caspase-3 in TE-4 cell line. The combination of the two agents decreased the expression of cyclin D1, however they did not demonstrate pro-apoptotic effect. CONCLUSIONS: AX and AT as single agents are effective at inhibition of cell proliferation and induce apoptosis by the modulation of cell cycle machinery proteins in esophageal cancer cell lines. However, our data could not suggest that their combination has any cooperative apoptotic effect.

Factors Affecting Complete Small Bowel Study and Diagnostic Yield in MiroCam(R) Capsule Endoscopy

BACKGROUND/AIMS: Mirocam(R) capsule endoscopy has been widely used in Korea; however, data with respect to Mirocam(R) capsule endoscopy is lacking. We have assessed the factors affecting complete small bowel studies and diagnostic yield in Mirocam(R) capsule endoscopic studies. METHODS: We retrospectively analyzed 103 cases that were assessed with Mirocam(R) capsule endoscopy between June 2007 and February 2010 at Guro Korea University Hospital. RESULTS: The mean age of the 103 cases was 55.47 years (range, 16-99 years) and 67 cases (65%) were male. The indications for capsule endoscopy were hematochezia/melena (77 cases, 74.8%), anemia (8 cases, 7.8%), abdominal pain (12 cases, 11.7%), and miscellaneous (weight loss and chronic diarrhea; 6 cases, 5.8%). The mean stomach transit time was 59.9+/-88.3 minutes (range, 1-630 minutes) and the mean small bowel transit time was 396.0+/-131.7 minutes (range, 117-708 minutes). The rate of successfully performing a complete small bowel study was 82.5% (85 cases), and the stomach transit time was a significant factor for a complete small bowel study (OR=0.991, 95% CI=0.984-0.998, P=0.012). The diagnostic yield was 51.5% (53 cases); visual quality was a significant factor in determining the diagnostic yield (OR=6.776, 95% CI=1.32-34.70, P=0.022). CONCLUSIONS: In a Mirocam(R) capsule endoscopic study, short stomach transit time was a significant factor affecting completion of the small bowel study. Achieving excellent visual quality by good bowel preparation was a significant factor for improving the diagnostic yield.

Regression of Hyperplastic Gastric Polyp after Helicobacter pylori Eradication / 대한소화기내시경학회지

BACKGROUND/AIMS: Recent studies have suggested that the eradication of Helicobacter pylori (Hp) may lead to the regression of hyperplastic polyps (HPPs) in the stomach. We evaluated the sizes of HPPs after Hp eradication and we also compared the clinical parameters between the regression and non-regression groups. METHODS: We enrolled 187 patients who had HPPs in the stomach. The polyps were measured by using biopsy forceps, and the endoscopically observed changes of the polyps were assessed by two endoscopists. RESULTS: Total regression was observed in 68 patients of the eradicated group and in 6 patients in the non-eradicated group (42.5% vs. 22.2%, respectively, p<0.05). The non regression rate was significantly higher for the non-eradicated group than that for the eradicated group (33% vs. 10%, respectively, p<0.05). Comparing between the regression and non-regression groups, the incidence of polyps that were smaller than 10 mm in size and sessile was significantly higher in the regression group. Hp eradication was the only significant predictor of regression. CONCLUSIONS: Hp eradication could be a therapeutic option for Hp positive-hyperplastic gastric polyps, and especially for those that are less than 10 mm in size and sessile.

Treatment Outcomes after Endoscopic Submucosal Dissection of Large Superficial Rectosigmoid Colon Tumors / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) of a colorectal tumor is technically difficult. This study aimed to analyze the clinical outcomes of superficial large rectosigmoid tumors after ESD. METHODS: Medical records of 15 patients with large rectosigmoid tumors (more than 30 mm), in which ESD performed, were reviewed retrospectively. RESULTS: The mean tumor size was 42.5+/-14.3 mm (range, 30~78 mm). A histological examination revealed a well-differentiated adenocarcinoma in five cases (33.3%), adenoma with high-grade dysplasia in six cases (40%), and low-grade dysplasia in four cases (26.7%). The mean procedural time was 90.5+/-60.7 min (range, 22~246 min). The en bloc resection rate was 86.7%, and the complete resection rate 100%. The lateral resection margin was positive in four cases (26.6%), but no cases with a positive vertical margin were observed. Bleeding occurred in three cases (20%), and all were treated successfully using endoscopic measures. Perforations occurred in three cases (20%); two cases were treated by clipping and the other by a laparotomy. CONCLUSIONS: ESD is a treatment option for superficial large rectosigmoid tumors. Further studies with larger cases and a longer term follow-up are needed to establish the efficacy and safety of ESD for colorectal tumors.

The Effect of Pantoprazole on Bone Turnover in Ovariectomized ICR Mice / 대한내과학회지

BACKGROUND/AIMS: Long-term exposure to proton pump inhibitors is associated with osteoporosis-related fractures; however, the mechanism is unknown. The purpose of this study was to evaluate the effect of pantoprazole on osteoporosis and bone turnover in ovariectomized ICR mice fed a calcium-free diet. METHODS: Ovariectomized female ICR mice were divided into a pantoprazole group (n=10) and a control group (n=10). The mice in the pantoprazole group were given an intraperitoneal injection of pantoprazole at 20 mg/kg twice daily. After 4 weeks, the mice were humanely euthanized, and bone mineral density (BMD) and dry tibia weight were measured. Serum osteocalcin and CTX-1 levels were measured by enzyme-linked immunosorbent assay. The mRNA expression levels of cytokines that stimulate osteoclast differentiation were determined using RT-PCR. Serum calcium, phosphorus, and alkaline phosphatase (ALP) levels were also analyzed. RESULTS: Serum osteocalcin concentration was significantly lower in the pantoprazole group compared with the control group (p=0.023). There was no difference in BMD, dry tibia weight, or serum ALP, calcium, phosphorus, or CTX-1 between the two groups. The expression of interleukin (IL)-1beta was lower in the pantoprazole group compared with the control group, but not significantly lower (p=0.058). The levels of tumor necrosis factor-alpha and IL-6 did not differ between the two groups. CONCLUSIONS: Pantoprazole, a proton pump inhibitor, decreased serum osteocalcin and suppressed IL-1beta expression, suggesting that pantoprazole affects bone formation and resorption in ovariectomized ICR mice. Further studies using larger sample sizes are needed.

Treatment Outcomes after Endoscopic Band Ligation of Symptomatic Internal Hemorrhoids / 대한내과학회지

BACKGROUND/AIMS: Elastic band ligation is a well-established method for the treatment of internal hemorrhoids. The aim of this study was to assess the treatment outcomes of flexible endoscopic rubber band ligation of internal hemorrhoids. METHODS: Using a flexible endoscope, 30 patients with symptomatic internal hemorrhoids were evaluated based on change in clinical symptoms (Goligher grade, bleeding score) and endoscopic classifications (range, size) before and after the procedure. RESULTS: Goligher grade and bleeding score showed significant improvement after the procedure (Goligher grade from 2.12 to 0.54, p<0.01, and bleeding score from 1.80 to 0.40, p<0.01). Endoscopic classification scores improved significantly after the procedure (range 3.03 to 1.55, p<0.01, and size from 1.80 to 0.85, p<0.01). As a complication, mild pain developed in 19 patients (90.5%) and severe pain in two patients (9.5%). Most (90.5%) were well controlled by conservative management, but one patient was operated on for hemorrhoidal thrombosis and in another patient the ligated rubber band had to be released promptly for pain relief. One patient (3.3%) experienced mild infection, which was relieved by medical treatment. During the 16.7+/-3.2-month period of follow-up, two patients relapsed, one was treated with additional endoscopic band ligation, and one underwent surgery. CONCLUSIONS: Flexible endoscopic band ligation is an effective and safe method of treatment in patients with symptomatic internal hemorrhoids.

The clinical significance of interferon inducible protein-10 in patients having chronic hepatitis C with genotype I / 대한내과학회지

BACKGROUND/AIMS: Recent studies have shown that serum interferon gamma-inducible protein-10 (IP-10) concentration decreased after pegylated interferon and ribavirin therapy, and was associated with a sustained virologic response (SVR). The aim of this study was to investigate the clinical significance of the pretreatment IP-10 level and change in serum IP-10 level between 1 month before and after treatment and its association with various virologic responses in patients having chronic hepatitis C (CHC) with genotype 1 undergoing pegylated interferon and ribavirin therapy. METHODS: Thirty-six patients having CHC with genotype I undergoing pegylated interferon and ribavirin therapy who had available stored sera 1 month before and after treatment were enrolled retrospectively. Serum IP-10 levels were measured by ELISA. Serum HCV RNA was measured by RT-PCR (detection limit0.05). The change in serum IP-10 between 1 month before and after treatment had no clinical meaning based on various virologic responses (p>0.05). CONCLUSIONS: The level of pretreatment IP-10 and change in IP-10 level between 1 month before and after treatment were not predictive factors of a SVR. Additional large-scale studies to determine the SVR-predicting role of serum IP-10 levels in patients with CHC are needed.