Usefulness of hydrocolonic sonograpy in the staging of colorectal cancer / 대한내과학회지

BACKGROUND: The purpose of this study was to evaluate the usefulness of hydrocolonic sonography (HUS) in local staging of colorectal cancer. METHODS: Thirty patients with colorectal cancer underwent HUS for clinical TNM staging before operation and then the preoperative staging was correlated with postoperative histological stage. RESULTS: All cases were correctly localized by HUS. The accuracy of depth of invasion (T staging) was 70% in overall cases. When divided into colon and rectal cancer, T staging was more accurate in colon cancer (88%), however, less accurate in rectal cancer (46.1%). The accuracy was higher especially in aspect of pericolic fat infiltration (93%). In N staging, the accuracy was 60% in overall cases, 71% in colon cancer and 46% in rectal cancer, respectively. The accuracy of N staging by HUS were somewhat poor on the whole due to technical properties. CONCLUSION: HUS is very valuable with respect to T staging, especially in colon cancer rather than in rectal cancer. N staging was somewhat doubtful in both. Because HUS is easy, noninvasive, and readily available at any place, it would be useful method for local staging colon cancer, especially T staging.

Colonic Metastasis from Gastric Carcinoma Presenting as Multiple Polyps / 대한소화기내시경학회지

Colonic metastasis from gastric carcinoma is very rare and usually originated from carcinomas of breast, kidney, prostate and ovary. They generally present as segmental stricture, mimicking granulomatous colitis, polyps, or advanced tumors. There were two cases of metastatic gastric carcinomas of colon reported as multiple polypoid colonic mass. Herein, we reported a case of multiple polypoid colonic metastasis from gastric carcinoma. A 46 year old man presented with symptoms of abdominal distension and hematochezia. After diagnosis of gastric carcinoma, the patient underwent radical total gastrectomy with extranodal radical dissection. One year later, colonoscopy revealed multiple colonic polyps showing metastatic deposits of signet ring cell carcinoma histologically. And it is identical to gastric carcinama histologically which had been resected one year ago.

A Case of Asymptomatic Cholecystogastric Fistula / 대한소화기내시경학회지

Biliary enteric fistulas which are caused by gallstone, peptic ulcer and carcinoma are an uncommon disease. Their incidence appears to increase recently with the advent of endoscopy. The usual types of the fistulas are choledochoduodenal, cholecystoduodenal and cholecystocolonic. But, cholecystogastric fistulas are very rare. Their symptoms are usually nonspecific and pneumobilia has been considered as a clue, but the diagnosis is difficult in most cases. At present, endoscopy is very helpful to the diagnosis. The treatment of asymptomatic fistulas is still in dispute. Endoscopic management is being used at times in recent days. We recently experienced a case of cholecystogastric fistula accidentally. During the evaluation for the cause of anemia, we suspected a fistula on endoscopy and confirmed it on endoscopic fistulography and managed it by endoscopic papillotomy and stone extraction.

Endoscopic snare resection for tumors of the ampulla of Vater

Though surgical resection has been the traditional treatment for tumors of the ampulla of Vater, endoscopic maneuvers such as snare resection, laser photodestruction and electrofulguration have recently been introduced to avoid operation-related morbidity and mortality. From 1994 to 1996, 6 patients with ampullary tumor were managed by endoscopic snare resection and regularly followed. Endoscopic snare resection of the ampullary tumor was technically feasible in all patients and each procedure was performed in a single session. Histologic diagnoses of the resected specimens were adenoma in 4 patients and adenoma with coexistent adenocarcinoma in 2 patients. Resection margins were negative in all patients except 1 with coexistent adenocarcinoma and a radical pancreaticoduodenectomy was performed in that case. For the other patient with adenocarcinoma foci, no further treatment was persued since he was 72-year-old and refused operation. Acute pancreatitis developed in 2 patients after endoscopic therapy, but was resolved with conservative management. There was no procedure-related death. Surveillance duodenoscopy performed at 1 and 6 months after endoscopic resection revealed no evidence of recurrent tumor in 4 patients with adenoma. Among them, 3 patients are alive without evidence of recurrence at 16-37 months after resection, but 1 patient was lost after 9 months of follow-up. The patient with adenocarcinoma in whom a pancreaticoduodenectomy was performed, has been alive without recurrence for 12 months. Oral 5-fluorouracil was administered for the other patient with adenocarcinoma foci. Though he experienced local recurrence at 13 months after the procedure, he has been alive for 28 months after resection. In conclusion, endoscopic snare resection may be applied as a viable alternative to surgery in selected patients with small ampullary tumors.

A Case of Hypertrophic Gastropathy and Early Gastric Cancer Associated with Pachydermoperiostosis / 대한소화기내시경학회지

Pachydermoperiostosis is a rare hereditary syndrome characterized by finger clubbing, periosteal new bone formation of tubular bones, and hypertrophic skin changes (pachydermia). This syndrome is known to be associated with a variety of diseases such as cranial suture defect, female escuchen, bone marrow failure and autonomic nervous system symptoms such as facial flushing and hyperhidrosis. There are just a few reports documenting gastric ulcer, hypertrophic gastropathy and Crohn's disease as associated diseases. A case is herein reported of pachydermoperiostosis accompanied by hypertrophic gastropathy and early gastric cancer.

The Role of Endoscopic Ultrasonography in Primary Gastric Lymphoma of MALT / 대한소화기내시경학회지

BACKGROUND AND AIMS: Endoscopic ultrasonography (EUS) is a useful diagnostic method for diagnosing local invasion and lymph node metastasis of primary gastric lymphoma including mucosa-associated lymphoid tissue (MALT) lymphoma, but the role of follow-up EUS after histologic regression of MALT lymphoma has not been well established until now. Therefore the usefulness of EUS in initial and follow up studies after Helicobacter pylori eradication therapy was investigated. METHODS: From January 1995 to October 1998, nineteen MALT lymphoma patients were investigated. All but four patients underwent EUS exam at diagnosis and 3~23 months thereafter. 17 patients recieved H. pylori eradication therapy and 2 patients recieved operations without medical treatment. RESULTS: 16 of the 17 patients (94%) were cured of H. pylori infection after antimicrobial therapy. but on the histologic criteria, 13 of the 16 cases (81%) who were cured of H. pylori infection showed complete regression of MALT lymphoma. Histologic regression of MALT lymphoma was observed 6 weeks to 23 months after H. pylori eradication. In follow up EUS exam, gastric wall abnormalities returned to normal in 9 cases (69%) and remained abnormal in 4 cases (31%) among the completely regressed 13 cases. CONCLUSIONS: Considerable portion (31%) of follow up EUS exam showed persistent abnormalities of gastric wall such as thickening of mucosa and/or submucosa after histologic regression of MALT lymphoma. To evaluate the usefulness of EUS, follow up EUS exam with regular interval for longer periods after histologic regression is needed.

A Comparison of Endoscopic Ultrasonography with Transabdominal Ultrasonography of Water-Filled Stomach in the Accuracy of Staging of Gastric Cancer / 대한소화기내시경학회지

BACKGROUND AND AIMS: There was no single method satisfying accuracy, patient compliance and cost in preoperative staging of gastric cancer. A transabdominal ultrasonography of water-filled stomach (TUS) was compared with endoscopic ultrasonography (EUS) for TN staging in operated gastric cancer. METHODS: We performed EUS conventionally and TUS immediately after 600 mL deaerated water ingested in 40 patients with gastric cancer prior to operation. All the cases were operated and the histological findings were compared with the results of preoperative TN staging. RESULTS: The overall T-staging accuracy rate of TUS was 62.5% and 55.0% for EUS. Both TUS and EUS could differentiate EGC from AGC in 85.0%. There was no statistical difference in the accuracy for the depth of cancer invasion between EUS and TUS. Differentiation of the cancer defined within the gastric wall (T3) from the cancer invading adjacent organs (T4) was possible in 92.5% for TUS and 87.5% for EUS. The accuracy of determining the depth of invasion was tent to be lower in fundus than in antrum and body. Lymph node metastasis was correctly diagnosed in 67.5% for TUS and in 70.0% for EUS. CONCLUSIONS: TUS may be a considered to be a relatively accurate and simple method for preoperative staging of gastric cancer in the absence of available EUS.

Endoscopic Findings of Ectopic Pancreas in the Stomach / 대한소화기내시경학회지

BACKGROUND AND AIMS: Ectopic pancreas in the stomach is a relatively uncommon abnormality. Although its typical finding on endoscopy was described as a submucosal nodule with central umbilication, it is still difficult to differenciate ectopic pancreas from other pathologies. So we investigated the endoscopic findings of ectopic pancreas in the stomach. METHODS: Between Jan. 1987 and Aug. 1998, nineteen patients who underwent gastroendoscopy and were histologically diagnosed as ectopic pancreas by various methods, were encountered at the Department of Internal Medicine, Severance Hospital, Yonsei University. The clinicopathologic records of all the patients were reviewed. RESULTS: The mean age of the patients was 39.3 years old with a male to female ratio of 1:2.8. Endoscopically, seventeen cases (89.5%) were suggestive of submucosal tumors. Submucosal tumors combined with umbilication were in 4 cases (21.1%), with ulceration in 2 cases (10.5%), erosion in 5 cases (26.3%), ulceration and erosion in 1 case (5.3%), and normal mucosa in 5 cases (26.3%) respectively. The size of ectopic pancreas was in the range of 0.8-3.0 cm, except in one case which measured 6.0 cm. The location of ectopic pancreas was in the antrum in 18 cases (94.7%), and in the angle in 1 case (5.3%). The endoscopic diagnoses were ectopic pancreas in 5 cases (26.3%), submucosal tumor in 12 cases (63.1%), gastric polyp in 2 cases (10.5%). The methods of histologic diagnosis of ectopic pancreas in 3 cases (15.8%) was by endoscopic biopsy, by endoscopic submucosal resection in 10 cases (52.6%), and by operation in 6 cases (31.6%). CONCLUSIONS: Ectopic pancreas in the stomach is found in various morphology, presented as submucosal tumors in the antrum. Because histological diagnosis by endoscopic forcep biopsy is difficult in many cases, endoscopic submucosal resection or operation should be considered.

Randomised Trial of Coil (EndocoilTM) Stent Versus Plastic Stent in Malignant Biliary Tract Obstruction / 대한소화기내시경학회지

BACKGROUND AND AIMS: Endoscopic stent placement has become accepted palliative therapy for malignant biliary tract obstruction (MBTO). The main problem of plastic stent are the clogging or migration. The new self expandable super-elastic metallic coil stent (Endo-coilTM, Instent Inc.) is claimed to allow large lumen and prolong biliary-stent patency. In a prospective randomised trial, we compared the efficacy and frequency of stent dysfunction of EndocoilTMand plastic stent (PercuflexR, Microvasive Co.). METHOD: Between Aug. 1994 and Mar. 1995, we assigned 29 patients (21 males and 8 females, mean age 63 years) with unresectable MBTO due to cancer of bile duct (17), pancreas (6) periampullary (3), gallbladder (2) and perichoedochal LN (1). Thirteen of patients under-went EndocoilTMstents (24 Fr) and other 16 patients underwent plastic stents (12 Fr) insertion via transpapillary route. Successful insertion of stents was attained all cases and no serious complication occured. RESULTS: All patients with EndocoilTM stents and 11 (68%) patients with plastic stents were relieved completely from jaundice (T. bilirubon <3.0 mg/dl). There was no differences in decreasement of bilirubin between two groups after 7 days and 30 days after stents insertion. Median patency of the stents was significantly prolonged in patients with EndocoilTM stents compared with those with plastic stents(205 days vs 92 days). The stent dysfunction was noted 2 cases (15%) in EndocoilTM due to tumor ingrowth. In contrast, stent dysfunction was occured in 10 cases (62%) of plastic stents due to clogging (7 cases) and migration (3 cases). The patients' overall median survival was not different significantly between two groups (EndocoilTM250 days vs plastic 196 days). CONCLUSIONS: Both ndocoilTMand plastic stents offer effective bile drainage in MBTO. However EndocoilTM stents may be more effective for providing longer periods of drainage due to lower frequency of stent dysfuction than plastic stents.

Endoscopic Transpapillary Biopsy for the Diagnosis of Patients with Pancreaticobiliary Ductal Strictures / 대한소화기내시경학회지

BACKGROUND AND AIMS: Many diseases and conditions are responsible for pancreaticobiliary ductal strictures. In such patients, histologic diagnosis is crucial to determine therapeutic modalities and to predict their outcomes, as well as to avoid unnecessary operations for tissue diagnosis. To evaluate the diagnostic role of endoscopic transpapillary biopsys (ETPB), this technique was performed in patients with pancreaticobiliary ductal strictures suggestive of malignancy. METHODS: After visualization of the pancreaticobiliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), an ETPB of the lesion was conducted with or without an endoscopic sphincterotomy (EST) in sixty-four patients with pancreaticobiliary ductal strictures. The biopsy results were analysed according to the morphology of the lesion, site of the stricture, number of biopsys and whether or not an EST was done. RESULTS: The final diagnoses of the sixty-four patients included forty bile duct cancers (62.5%), nine pancreatic cancers (14.1%), four metastatic cancers (6.3%), and eleven benign ductal strictures (17.2%) such as biliary stones, cholangitis, etc. The sites of the strictures were located in the upper bile duct in thirty-two patients (50.0%), the middle bile duct in twenty-two (34.4%), the lower bile duct in three (4.7%), the pancreatic head in four (6.3%), and the pancreatic body in three (4.7%). Adequate tissue specimens for pathologic examination were obtained in fifty-four cases (84.4%). An ETPB was possible without an EST in nineteen cases (29.7%). The ETPB results revealed sensitivity of 60.4% (32/53), specificity of 100% (6/6), positive predictive value of 100% (32/32), and negative predictive value of 34.4% (11/32). The sensitivity of the ETPB was higher in the EST group than in group without an EST. There was no statistical significance however, according to tumor morphology, site, or number of biopsys. CONCLUSIONS: It is recommended that an ETPB, being a safe and effective method, should be performed as a diagnostic procedure during an ERCP for patients with pancreaticobiliary ductal strictures of unknown causes.

Dieulafoy's Disease of Upper Gastrointestinal Tract: Clinical Features and Endoscopic Treatment / 대한소화기내시경학회지

BACKGROUND AND AIMS: Dieulafoy' s disease is an uncommon cause of recurrent massive gastrointestinal bleeding. The bleeding results from abnormally large submucosal artery , usually located on proximal stomach. Endoscopic examination reveals a small mucosal defect with an isolated protruding vessel without associated ulcer. Endoscopic treatment had recently been attempted to control the bleeding from these lesions. METHODS: The clinical and endoscopic characteristics of 51 patients with gastrointestinal bleeding due to Dieulafoy' s disease were retrospectively analysed from January 1991 to July 1997 and the efficacy of endoscopic therapy of Dieulafoy' s disease was evaluated. RESULTS: The mean age was 51.2 +/-16.2 (Mean +/-SD, range: 19-80) years and male predominance (4.7 : 1) was observed. Symptoms included: melena (45.1%); hematochezia (31.4%); melena and hematochezia (23.5%). The mean hemoglobin value was 7.5 +/-2.1 g/dL. The mean transfusion requirement was 12.4 +/-13.2 blood units. The diagnosis was made at initial endoscopy in 72.5%. The lesion located in proximal stomach (49.0%), in mid/distal stomach (25.5%) and in duodenum (25.5%) in order. Endoscopic therapies included fibrin glue injection (FG) in 16 patients, hypertonic saline-epinephrine (1 : 1,000) injection (HSE) in 15 patients, HSE+FG in 14 patients and others in 6 patients. Overall, endo-scopic trreatment was successful in achieving hemostasis in 38 (74.5%) patients; FG in 14/16 (87.6%), HSE in 12/15 (80.0%), FG HSE in 9/14 (64.3%). There was no significant difference in success rate among the endoscopic treatment modalities. Nine patients had to be operated despite the endoscopic treatments, and four patients died due to the causes other than gastrointestinal bleeding. CONCLUSIONS: Endoscopic therapy of upper gastrointestinal Dieulafoy' s disease is effective and should be employed before the surgical intervention.

Factors Affecting Insertion Time during Colonoscopy / 대한소화기내시경학회지

BACKGROUND AND AIMS: The goal of this study was to examine whether certain variables are associated with insertion time during colonoscopy. METHODS: A total of 703 consecutive subjects underwent colonoscopy by a single endoscopist from April of 1998 to August of 1998. The insertion time during colonoscopy was checked and the factors that may affect insertion time were analyzed. RESULTS: The indications for colonoscopy were bowel habit change (34.8%), the diagnosis of and follow up for colonic neoplastic disease (31.6%), abdominal pain (22.8%), thin stool caliber (19.2%), hematochezia (16.1%), routine examination (10.7%), inflammatory bowel disease (9.4%), tenesmus (8.8%) and a family history of colonic disease (3.1%). Of 703 subjects, complete colonoscopy was possible in 678 (96.4%). Reasons for incomplete insertion included inadequate bowel cleaning (n=11), pain (n=6), a history of operations (n=3), and others (n=5). Therefore, the adjusted completion rate was 97.9% (678/692). The mean insertion time in complete colonoscopy was 7.07 4.26 min (range; 2~35 min). Multivariable analysis revealed that inadequacy of bowel preparation was significantly associated with prolonged (>10 min) insertion time (p=0.005), whereas the history of colorectal resection was inversely associated with prolonged insertion time (p=0.010). CONCLUSIONS: Among the factors affecting insertion time during colonoscopy, cleanness of the bowels is the only correctable factor.

Endoscopic Ampullectomy for Tumors of the Ampulla of Vater: Long-term Follow-up Results / 대한소화기내시경학회지

BACKGROUND/AIMS: The resectability rate and prognosis of tumors of the ampulla of Vater are significantly better than for other periampullary tumors. Treatment for ampullary tumors has traditionally been surgical resection. However, endoscopic ampullectomy has been reported in patients with benign ampullary tumors. This study is being conducted to evaluate the availability of endoscopic ampullectomy. METHODS: Between 1994 and 1996, 6 cases (M: F=5: 1) with ampullary tumors were treated by endoscopic ampullectomy. Clinical presentations, complications, pathologic findings, and follow-up information were reviewed. RESULTS: Complete resection was perfomed in 5 cases. Pancreatitis after this procedure occurred in 2 cases, but were resolved by conservative care. Pathologic findings of resected specimens were adenama in 4 cases and adenocarcinoma in 2 cases. There was no recurrence in adenoma during the follow-up period (9-37 months) except in one case, which the patient was lost after 9 months. In one case with adenocarcinoma, the patient refused the operation, and consequently had the tumor recurrence 13 months later. CONCLUSIONS: Endoscopic ampullectomy was considered safe and effective treatment for removing benign ampullary tumors as well as malignant tumors, the latter of which are not considered suitable for operation.

A Case of Multiple Biliary Papillomatosis with Focal Adenocarcinoma / 대한소화기내시경학회지

Multiple biliary papillomatosis are extremely rare, fifty one cases have been reported in the literature. Clinical symptoms are associated with obsructive jaundice and cholangitis. Malignant transformation into adenocarcinoma had been described. We report a case of multiple papillomatosis in the entire biliary ductal system with malignant transformation, in which endoscopic retrograde cholangiopancreatography and peroral choledochoscopy showed multiple polypoid lesicons. The endoscopic sphincterotomy and the intraductal biopsy confirmed the histologic diagnosis of multiple papillomatosis and adenocarcinoma.

Endoscopic Balloon Sphincteroplasty without Sphincterotomy for Removal of Common Bile Duct Stones / 대한소화기내시경학회지

BACKGROUND: The complications associated with endoscopic stone removal arise from the sphincterotomy that is performed to facilitate stone extraction. Early complications such as bleeding, perforation, pancreatitis and sepsis occur in about 10% of all patients. Moreover late complications may emerge due to the loss of the sphincter function. So the endoscopic removal of the bile duct stones without a sphincterotomy seems preferable in order to avoid the early complications related to the sphincterotomy, and may also help to preserve the function of the sphincter of Cddi. AIM: To evaluate the efficacy and safety of endoscopic balloon sphinteroplasty(EBS), we attempted to remove common bile duct stones, less than 12 mm, without sphincterotomy in 11 patients. We also investigated the effects of sphincteroplasy on the motility of sphincter of Oddi before and after EBS. RESULTS: All patients were treated succesefully, with two patients administered sublingual nitroglycerine for the medical sphincter dilatation. Only one patient had mild abdominal pain, while the others experienced no complications. Follow-up manometric examinations showed the papillary function to be well preserved. CONCLUSION: This results suggested that the endoscopic balloon sphincteroplasy without sphincterotomy for the removal of small-sized stones is a useful and safe method, and its major advantage may lie in the preservation of the sphincter function. We recommend that prospective studies, preferably randomized, with clear objectives, are needed to clarify the success and safety of this technique compared to the standard sphincterotomy.

Comparative study of bentiromide test and endoscopic retrograde pancreatography in patients with chronic pancreatitis

We performed a bentiromide test in 25 patients with chronic pancreatitis and 7 normal controls to evaluate pancreatic exocrine function, and compared the test results of patients with their endoscopic retrograde pancreatography(ERP) findings. The cumulative 6-hour recovery rate of para-aminobenzoic acid(PABA) in the urine was significantly lower in patients with chronic pancreatitis(55.8 +/- 24.2%) than in controls(82.0 +/- 10.0%). Among 25 patients with chronic pancreatitis, however, 7 patients showed normal recovery rates of PABA. Pancreatograms of the patients represented 4 mild changes, 5 moderate changes, and 16 marked changes. The average 6-hour recovery rates of PABA of the groups were 56.9 +/- 21.6%, 78.4 +/- 10.5%, and 47.2 +/- 23.7%, respectively. Urinary PABA recovery rates were found subnormal as follows: 3(75%) in the mild changes group; 1(20%) in the moderate changes group; and 14(87.5%) in the marked changes group. We found hardly any correlation between the degree of functional impairment and the changes noted by ERP. These findings suggest that both the pancreatic function test and morphologic study are required to evaluate the degree of functional impairment in patients with chronic pancreatitis.

The Role of Endoscopic Ultrasonography in Differentiating Benign and Malignant Stromal Tumors of Upper Gastrointestinal Tract / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) has been useful in evaluating submucosal lesions of the upper gastrointestinal tract as well as providing guidelines for therapeutic plans. Large proportions of submucosal tumors are diagnosed as stromal tumors. Most are benign, but a significant proportion of them could be malignant. There are a few reports concerning EUS findings as being predictive of malignancy. The aim of this study was to evaluate specific EUS features favoring malignancy in stromal tumors of the UGI tract. METHODS: From January, 1992 to June, 1997, thirty-three cases appeared involving stromal tumors (18 benign, 15 malignant (including 8 STUMP)), and were either surgically (27 cases) or endoscopically (6 cases) resected. Videotapes and photographs were reviewed and EUS features that favored the malignancy were analyzed.

Lipid Peroxidation in Chronic Liver Diseases Type B / 대한간학회지

BACKGROUND/AIMS: Oxidative stress is known to play a role in the pathogenesis of a certain liver diseases such as alcoholic liver disease, metal storage disease, and ischemia/reperfusion injury. Recently oxidative stress(lipid peroxidation) has also been implicated in hepatic fibrosis, which is now regarded as a common response to chronic liver injury regardless of its nature. Development of fibrosis and cirrhosis are the major complications of chronic hepatitits B. So we aimed to detect lipid peroxidation in chronic hepatitis B and to investigate its potential role in the pathophysiology of the disease. METHODS: The subjects were histologically-proven 56 patients, including fatty liver(FL, n=8), healthy HBsAg carrier(n=6), chronic persistent hepatitis(CPH, n=8), mild chronic active hepatitis(CAH-m, n=10), severe CAH(CAH-s, n=16), and liver cirrhosis(LC, n=8). All patients were serologically HBsAg-positive except those with FL. Lipid peroxidation was detected in serum and liver specimen with TBARS(thiobarbituric acid-reacting substances) assay. Western blot and immunohistochemical stain of liver specimen were also performed, using polyclonal antibody against malondialdehyde (MDA). RESULTS: 1. There were no significant differences in serum TBARS levels among groups(p= 0.24). 2. The mean tissue TBARS level(nmol/g) was significantly higher in CAH-s group(175.4+ 41.5) than in other groups(FL 54.0+ 6.4, Carrier 51.1+ 15.9, CPH 63.9+ 2.9, CAH-m 68.9+ 7.9, LC 22.6+ 5.1) (p<0.05). 3. Tissue TBARS levels correlated with serum ALT levels(r=0.5934, p<0.05). 4. Western blot showed MDA bands only in CAH-s group. 5. Immunohistochemistry showed a strong MDA stain around portal and periportal area in CAH-s group, but weak or no stain in other groups. CONCLUSIONS: This study shows that lipid peroxidation can be detected in situ and commonly occurs in severe chronic hepatitis B. Oxidative stress may be related to active necroinflammatory change of the liver and contribute to the progression of the disease in chronic hepatitis B.

Peritoneoscopic liver biopsy findings in asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly

Asymptomatic chronic HBsAg carriers with normal liver function tests are, in general regarded as having no liver pathology. Most of the histologic findings in asymptomatic chronic carriers have been reported from areas with low incidence of Hepatitis B virus (HBV) infection, such as North America and Western Europe. It is well known that there are many differences in HBV infection between low and high endemic areas, but there have been few reports on the histologic findings of asymptomatic chronic HBsAg carriers from endemic areas. The present study was undertaken in Korea which is one of the endemic areas for HBV infection and was designed to assess the prevalence of chronic liver disease by peritoneoscopic liver biopsy among asymptomatic chronic HBsAg carriers and to make a basis for the follow-up of asymptomatic chronic HBsAg carriers according to the results obtained. One hundred and ten asymptomatic HBsAg-positive carriers with normal liver function tests and no hepatomegaly were included in the study. Final diagnosis by peritoneoscopic liver biopsy revealed that of the 110 asymptomatic carriers only 27 (24.5%) had a histologically normal liver, while 51 (46.4%) had chronic liver diseases, and the remaining 32 (29.1%) had nonspecific histologic abnormalities (nonspecific reactive changes in 18 cases, cholestasis in 6 cases, and fatty change in 8 cases). Of the 51 patients with chronic liver diseases, 3 had liver cirrhosis, 4 chronic active hepatitis with cirrhosis, 11 chronic active hepatitis and 33 chronic persistent hepatitis. The frequency of liver cirrhosis and chronic active hepatitis with cirrhosis was significantly high in the over 30 years of age group (12.1%) than in the under 30 years of age group (0%; p = 0.011 by Fisher's exact test). In conclusion, 46.4% of the Korean asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly had chronic liver disease. This finding contrasted with reports from low incidence areas of HBV infection. Our results suggest that in endemic areas, a liver biopsy should be considered to assess the status of liver disease in asymptomatic chronic HBsAg carriers even if liver function tests are normal and hepatomegaly is absent, and the result can be used as a basis for the follow-up of each asymptomatic chronic HBsAg carriers.

Treatment outcome of the patients with small hepatoma (5 cm in diameter) in relation to treatment modalities and underlying liver function / 대한간학회지

BACKGROUND/AIMS: To compare treatment outcome of hepatocellular carcinoma(HCC) under the size of 5 cm in relation to underlying liver function and treatment modalities, analysis of data from 145 patients was performed. METHODS: In this study, the records of 145 patients with small HCC (40 ng/mL) serum alpha-fetoprotein(AFP) level. Liver cirrhosis was associated in 109(75.2%) patients. Sixty five(44.8%) patients underwent surge, 63(43.5%) underwent transarterial therapy(TAT), 8(5.5%) underwent other modalities of therapy and the remaining 9(6.2% ) patients did not receive any specific treatment for HCC. In relation to the underlying liver function, 119(82.1% ) patients belonged to the non-cirrhotic or Child-Pugh class A, 20(13.8%) to class B and 6(4.1%) to class C. The median follow-up duration was 21 months. When analyzed with respect to treatment modalities alone, median survival was 43 months for all patients, 60 months for surgery, 29 months for TAT, 20 months for other treatment and 18 months for patients who received no specific treatment. Without considering liver function, cumulative 3 year survival rate was 68.6% for surgery, 43.9% for TAT, 29.2% for other treatment and 0% for no treatment. The survival rate for the patients who underwent surgery was significantly higher than for any other treatment modalities without considering the underlying liver function or in the non-cirrhotic/Child-Pugh class A(p0.05). But in patients classified as the non-cirrhotic/Child-Pugh class A, better survival was observed in the surgep group than the TAT group(p<0.05). The only factor influencing survival was the pre-treatment serum AFP level(p<0.05). The overall recurrence rate was 30.3%. For the entire patients, the factor significantly influencing the recurrence rate was the presence of underlying cirrhosis. When considering only the patients in the surgery group, the different types of surgical procedures significantly influenced the recurrence rate. CONCLUSION: Surgery is the treatment of choice for patients with HCC equal to or smaller than 5 cm. But for those patients whose tumor size is less than 3 cm, TAT may be a reasonable alternative to surgep when the liver function is not adequate for hepatic resection. Because overall recurrence rate exceeded 30% and median time of recurrence was only 9.5 months after definitive treatment, careful follow-up is required for all patients who undergo treatment for small HCC.