The predictors of sustained virological response with sofosbuvir and ribavirin in patients with chronic hepatitis C genotype 2

Background/Aims@#Real-world, clinical practice data are lacking about sofosbuvir/ ribavirin (SOF/RBV) treatment of Korean patients with hepatitis C virus genotype 2 (HCV GT2) infection. This study investigated the efficacy and safety of SOF/RBV in Korean patients with HCV GT2 infection and clinical factors predicting sustained virological response 12 weeks (SVR12) after the end of SOF/RBV treatment. @*Methods@#A total of 181 patients with HCV GT2 with/without cirrhosis were treated with SOF/RBV for 16/12 weeks. Rapid virological response (RVR) was defined as non-detectable HCV RNA at 4 weeks. @*Results@#The RVR rate was 80.7% (146/181), the end of treatment response rate was 97.8% (177/181) and the SVR12 rate was 92.8% (168/181). Of eight patients with relapse, four did not achieve RVR. Three patients had a history of hepatocellular carcinoma (HCC). Multivariable analysis showed that RVR (p = 0.015) and no previous history of HCC (p = 0.007) were associated with SVR12. Factors significantly contributing to RVR included cirrhosis, creatinine concentration, and pre-treatment HCV RNA level. SVR12 rate was significantly higher in RVR (+) than RVR (–) patients (95.2% vs. 82.9%, p = 0.011) and also significantly higher in patients without than with a history of HCC (94.1% vs. 72.7%, p = 0.008). During treatment, 80/181 patients (44.2%) experienced mild to moderate adverse events, with 32 (17.7%) requiring RBV dose reductions due to anemia. @*Conclusions@#SOF/RBV treatment was effective and tolerable in HCV GT2 patients. RVR and no previous history of HCC were positive predictors of SVR12.

The predictors of sustained virological response with sofosbuvir and ribavirin in patients with chronic hepatitis C genotype 2

Background/Aims@#Real-world, clinical practice data are lacking about sofosbuvir/ ribavirin (SOF/RBV) treatment of Korean patients with hepatitis C virus genotype 2 (HCV GT2) infection. This study investigated the efficacy and safety of SOF/RBV in Korean patients with HCV GT2 infection and clinical factors predicting sustained virological response 12 weeks (SVR12) after the end of SOF/RBV treatment. @*Methods@#A total of 181 patients with HCV GT2 with/without cirrhosis were treated with SOF/RBV for 16/12 weeks. Rapid virological response (RVR) was defined as non-detectable HCV RNA at 4 weeks. @*Results@#The RVR rate was 80.7% (146/181), the end of treatment response rate was 97.8% (177/181) and the SVR12 rate was 92.8% (168/181). Of eight patients with relapse, four did not achieve RVR. Three patients had a history of hepatocellular carcinoma (HCC). Multivariable analysis showed that RVR (p = 0.015) and no previous history of HCC (p = 0.007) were associated with SVR12. Factors significantly contributing to RVR included cirrhosis, creatinine concentration, and pre-treatment HCV RNA level. SVR12 rate was significantly higher in RVR (+) than RVR (–) patients (95.2% vs. 82.9%, p = 0.011) and also significantly higher in patients without than with a history of HCC (94.1% vs. 72.7%, p = 0.008). During treatment, 80/181 patients (44.2%) experienced mild to moderate adverse events, with 32 (17.7%) requiring RBV dose reductions due to anemia. @*Conclusions@#SOF/RBV treatment was effective and tolerable in HCV GT2 patients. RVR and no previous history of HCC were positive predictors of SVR12.

Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage without Fluoroscopy / 대한췌담도학회지

BACKGROUND/AIMS: Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Endoscopy ultrasound (EUS)-guided drainage includes multiple steps and requires many resources such as a linear echoendoscope and a fluoroscopy room, which may not be available at all medical centers. We aimed to evaluate the efficacy and safety of EUS-guided pancreatic pseudocyst drainage without fluoroscopy. METHODS: This retrospective study analyzed 10 patients who had undergone EUS-guided transmural drainage of pancreatic pseudocyst without use of fluoroscopy at the Pusan National University Hospital between January 2009 and December 2016. Drainage was performed via a transgastric approach and one or two 7 Fr double-pigtail stents were inserted. RESULTS: The technical success rate was 100% and the clinical success rate was 80%. In two patients, clinical success was not achieved and additional percutaneous catheter drainage was done. Therefore, pseudocysts in all the patients were treated successfully without surgical drainage. However, there were three adverse events in three patients: bleeding, infection, and stent migration in each respective patient. During the median follow-up period of 36.5 months, there was no recurrence of pseudocysts in any of the patients. CONCLUSIONS: EUS-guided transmural drainage of pseudocyst drainage without use of fluoroscopy is a technically feasible, safe, and effective procedure for the treatment of pancreatic pseudocyst.

Clinicopathological Characteristics of Gastric Hepatoid Adenocarcinoma

BACKGROUND/AIMS: Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by a histology resembling hepatocellular carcinoma. Previous case studies reported that patients with GHA have a poor prognosis due to early lymph node or liver metastasis, but information concerning GHA is still limited. Therefore, we aimed to evaluate the clinicopathological features of GHA. MATERIALS AND METHODS: We reviewed the medical records of 9 patients who were diagnosed as having GHA between January 2011 and December 2016. The clinicopathological characteristics of these patients were retrospectively analyzed. RESULTS: The median age of the patients at diagnosis was 68.9 years. Seven of the 9 patients were male. Serum AFP levels were elevated in 3 of 4 patients. All the tumors were >4 cm (range, 4~12 cm), and 7 tumors were located at the lower third of the stomach. Five tumors were classified as Borrmann's type 3, with a purple, berry-like surface. Of the 6 patients without distant metastasis, 5 received curative-intent surgery and 3 received adjuvant chemotherapy. Three patients with distant metastasis received either palliative operation and/or chemotherapy. Their median survival time was 11.8 months (range, 1~36 months). Two patients with elevated serum CEA levels had poor outcomes. CONCLUSIONS: GHA is a rare subtype of gastric cancer that is prone to liver metastasis. All GHAs are advanced gastric cancer with a purple, berry-like surface at diagnosis. Although the prognosis of advanced-stage GHA is poor, active multimodality treatment might provide some benefit.

Clinical Significance of Extraluminal Compressions according to the Site of the Esophagus

BACKGROUND/AIMS: Differentiation of an extraluminal compression from a true subepithelial tumor (SET) in the esophagus by using endoscopy alone is often difficult. EUS is known as the best method for differentiating an extraluminal compression from a true SET. Extraluminal compression in the esophagus is occasionally observed, but its clinical significance has been rarely reported. Therefore, we aimed to evaluate the clinical significance of extraluminal compression in the esophagus according to the location of the lesion. MATERIALS AND METHODS: Sixty-one patients were diagnosed as having an extraluminal compression in the esophagus by using EUS between January 2006 and March 2014. Some patients underwent chest computed tomography for accurate diagnosis. RESULTS: The extraluminal compression was located at the mid-esophagus in 26 cases, lower esophagus in 22 cases, and upper esophagus in 13 cases. Of the 61 cases, 55 were caused by normal structures and 6 were caused by pathological lesions. The causes of the normal structures were the aorta, vertebra, trachea, left main bronchus, azygos vein, and diaphragm. The causes of the pathological lesions were engorged vessels and calcified lymph nodes. The posterior wall was the most frequent location of the extraluminal compression. However, the lesions in the anterior and right walls showed a higher frequency of pathological lesions than those in other sites. CONCLUSIONS: If the extraluminal compression is found in the anterior and right walls of the esophagus, more careful evaluation should be performed considering the high frequency of pathological lesions in the site.

Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy / 대한소화기학회지

The gastrointestinal tract is the most common site of extra-nodal non-Hodgkin lymphoma. However, the incidence of primary rectal lymphoma is extremely rare. Among the primary gastrointestinal lymphomas, follicular lymphoma has been described as a rare disease. It is difficult to diagnose rectal lymphoma due to its variable growth patterns and inadequate biopsies. Majority of patients with rectal lymphoma have non-specific symptoms or negative biopsies, often delaying the diagnosis. Our patient is a 62-year-old female. Two sessile and smooth subepithelial lesions with a yellowish normal mucosa were found on a screening colonoscopy. The initial mucosal biopsy finding was chronic inflammation, but we were highly suspicion of malignancy; we performed an endoscopic mucosal resection. Herein, we present a rare case of rectal follicular lymphoma diagnosed by endoscopic mucosal resection with a literature review.

A Case of Non ST Elevation Myocardial Infarction by Coronary Artery Focal Spasm in a Patient with Autosomal Dominant Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. The main causes of death in ADPKD are cardiovascular disease as well as infections and neurological reasons. ADPKD is causing vasculopathy including aortic root dilation, cerebral artery aneurysm, coronary aneurysm, and aortic dissection. In this case report, we describe a 37-year-old female ADPKD patient with non-ST elevation MI (NSTEMI) caused by coronary artery focal spasm.

Acute Pancreatitis Due to a Duodenal Ulcer

Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

Endoscopic Clip Closure of Duodenal Perforation Caused by Percutaneous Drainage Procedure

Acute cholecystitis is a disease commonly treated in health care institutions. Cholecystectomy is the standard treatment for acute cholecystitis, and emergent laparoscopic cholecystectomy is acceptable as an effective and safe treatment modality. One of the complications after laparoscopic cholecystectomy is intra-abdominal abscess. The standard treatment for postoperative intra-abdominal abscess is percutaneus transhepatic drainage and use of antibiotics. However, duodenal perforation can occur during insertion of the pigtail catheter for drainage. Operation is the treatment of choice for iatrogenic duodenal perforations. Recent reports describe nonsurgical treatments for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation due to pigtail catheter insertion for percutaneous transhepatic drainge that was succesfully treated by using endoclips.

Perforation of Gastrointestinal Stromal Tumor in Small Bowel on an Elderly Patient Presenting Acute Abdominal Pain

Acute abdominal pain as a common complaint in elderly patients may differ from that in younger patients. In elderly patients, the diagnostic accuracy of acute abdominal pain is lower compared to that in younger patients. On the other hand, the mortality in elderly patients with acute abdominal pain is far higher than that in the younger patients. Therefore, early and correct diagnosis of acute abdominal pain for the elderly patients could significantly influence the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor who presented at the Emergency Department with acute abdominal pain. Laparotomy was performed because perforation of a tumor in the jejunum was found by computed tomography. Diagnosis was confirmed by histopathology and immunohistochemistry. Therefore, small bowel disease should be considered when exploring the cause of acute abdominal pain in elderly patients.