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Background Endoscopic ultrasound-elastography (EUS-EG) is a non-invasive complementary diagnostic method for the differential diagnosis of solid pancreatic lesions (SPL). However, the optimal strain ratio (SR) value and diagnostic performance of EUS-EG have not yet been determined in pancreatic neuroendocrine neoplasm (PNEN), mass-forming pancreatitis (MFP), and pancreatic ductal adenocarcinoma (PDAC). We aimed to determine the optimal SR value in EUS-EG for differential diagnosis of SPLs. Methods A total 134 patients who underwent EUS-EG to evaluate SPL were retrospectively investigated. Patients were divided into 3 groups – PNEN (n=10), MFP (n=37), and PDAC (n=87). Baseline characteristics and results of EUS-EG were compared between groups and statistical analyses were performed for differential diagnosis. Results The mean SR values of each group were 11.85±7.56 (PNEN), 11.45±5.97 (MFP), and 22.50 ± 13.19 (PDAC), respectively. There was significant association between SR value increase and PDAC diagnosis (PNEN versus PDAC, p=0.0216; MFP versus PDAC, p=0.0006) in multinomial logistic regression analysis. SR value of 17.14 was confirmed as the optimal cut-off value for differential diagnosis between MFP and PDAC. Conclusions Differential diagnosis of SPL could be performed using EUS-EG. The cut-off SR value presented in this study is expected to be useful in differential diagnosis. Clinical trial registration number: https://cris.nih.go.kr/cris : KCT0002082

Background and Aims Contrast-enhanced harmonic EUS (CEH-EUS) is useful in the differential diagnosis of solid pancreatic lesions (SPLs). However, there is lack of verification about the usefulness of CEH-EUS–guided FNA/fine-needle biopsy (FNB) sampling. This study aimed to investigate the usefulness of CEH-EUS–guided FNA/FNB sampling without on-site cytopathology. Methods Patients with SPLs were prospectively enrolled and randomly assigned (1:1) to 2 parallel groups, the interventional group (CEH-EUS) or the control group (conventional EUS). The diagnostic sensitivity and optimal number of needle passes for pathologic diagnosis were investigated and compared between groups. Results Two hundred forty patients were enrolled from March 2016 to September 2019, with 120 patients assigned to each group. Pancreatic malignancies and neuroendocrine tumors were found in 202 (90.83%) and 9 (3.75%) patients, respectively. There was no statistically significant difference between the groups in terms of age, sex, lesion size (30.96 ± 12.09 mm in the CEH-EUS group vs 33.09 ± 16.39 mm in the conventional EUS group; P = .252), lesion location, adverse event rate, and disease distribution. The diagnostic sensitivity values in the CEH-EUS and conventional EUS groups were 85.8% and 88.3%, respectively (P = .564). All patients in the conventional EUS group and most in the CEH-EUS group received a pathologic diagnosis within 3 needle passes. Conclusions Diagnostic sensitivity for SPLs was not different between the CEH-EUS and conventional EUS groups, and no independent factors were found that could improve diagnostic sensitivity. CEH-EUS–guided FNA/FNB sampling does not need to be used routinely and may be selectively considered for small, indeterminate lesions. (Clinical trial registration number: KCT 0001840.)

Hypertriglyceridemia (HTG) is a well-known cause of acute pancreatitis (AP) and elevation of serum triglycerides (TG) to ≥1000 mg/dl is strongly indicative of HTG-induced AP (HTG-AP). HTG-AP is potentially associated with persistent organ failure and poor prognosis. Here, we compared differences in clinical features and outcomes between patients with HTG-AP and patients with AP due to other causes.A prospective AP registry was constructed in Gil Medical Center between June 2014 and May 2018. In total, 499 patients with AP were included for whom serum TG data at admission were available.HTG-AP was present in 52 patients (10.4%); these patients were younger than patients with AP due to other causes (39.62 ± 10.12 vs. 51.62 ± 17.41, p 0.001). After propensity score matching adjusted by age, the factors associated with severity were more common in the HTG-AP group; these factors included the presence of systemic inflammatory response syndrome, Ranson's score ≥3, acute physiology, age, chronic health evaluation (APACHE) II score ≥8 at admission, and C-reactive protein level10 mg/dl after 24 h of hospitalization. There were no significant differences in complications or severity based on the revised Atlanta classification 2012. In addition, recurrence was more frequent in the HTG-AP group (25.0% vs. 6.4%, p 0.001).HTG-AP occurred in younger patients and showed more frequent recurrences than AP with other causes. Although factors related to severe feature were more common in HTG-AP during early phase, overall severity and prognosis were not different between the two groups.

Background: Contrast‐enhanced harmonic endoscopic ultrasound (CEH‐EUS) is useful in the differential diagnosis of solid pancreatic lesions (SPLs). This study aimed to investigate the usefulness of CEH‐EUS-guided fine-needle aspiration/biopsy (FNA/B), without on-site cytopathology. Methods: This randomised controlled trial was conducted at two university hospitals in Korea. Patients with SPLs were prospectively enrolled and randomly assigned (1:1) using a table of random sampling numbers, to two parallel groups, the interventional group (CEH-EUS) or the control group (conventional EUS). The investigators, endoscopists, patients, and pathologists were unmasked to the group assigned. The diagnostic sensitivity and optimal number of needle passes for pathologic diagnosis were investigated and compared between groups. Clinical trial number: KCT0001840. Findings: In total, 252 patients with SPLs were screened and 240 were enrolled from March 2016 to September 2019, with 120 patients assigned to each group. Pancreatic malignancies and neuroendocrine tumours were found in 202 (90·83%) and nine (3·75%) patients, respectively. There was no statistically significant difference between the groups in terms of age, sex, lesion size (30·96±12·09 mm in the CEH-EUS group vs 33·09±16·39 mm in the conventional EUS group; p=0·252), location, adverse event rate (2·5% vs 2·5%; p=0·999), and disease distribution (malignancy, neuroendocrine tumour, and benign masses, p=0·395). The diagnostic sensitivity values in the CEH-EUS and conventional EUS groups were 85·8% and 88·3%, respectively (p=0·564). All the patients in the conventional EUS group and most of those in the CEH-EUS group received a pathological diagnosis within three needle passes. Interpretation: This prospective, randomised trial showed that the diagnostic sensitivity for SPLs was not different between the CEH‐EUS and conventional EUS groups, and there were no independent factors that could improve diagnostic sensitivity. CEH-EUS-guided FNA/B will not need to be used routinely for the diagnosis of SPLs. CEH-EUS may be selectively considered in small, indeterminate lesion. Trial Registration: (Clinical trial registration at https://cris.nih.go.kr/cris; KCT0001840) Funding Statement: None. Declaration of Interests: There are no conflicts of interest to declare. Ethics Approval Statement: This study was approved by the Institutional Review Board (GAIRB2016-026) and conducted in accordance with the principles set forth in the Declaration of Helsinki. Written informed consent was obtained from all patients.

Background: The incidence of colorectal cancer (CRC) is increasing, with metastasis of newly diagnosed CRC reported in a large proportion of patients. However, the effect of Korean Red Ginseng extracts (KRGE) on epithelial to mesenchymal transition (EMT) in CRC is unknown. Therefore, we examined the mechanisms by which KRGE regulates EMT of CRC in hypoxic conditions. Methods: Human CRC cell lines HT29 and HCT116 were incubated under hypoxic (1% oxygen) and normoxic (21% oxygen) conditions. Western blot analysis and real-time PCR were used to evaluate the expression of EMT markers in the presence of KRGE. Furthermore, we performed scratched wound healing, transwell migration, and invasion assays to monitor whether KRGE affects migratory and invasive abilities of CRC cells under hypoxic conditions. Results: KRGE-treated HT29 and HCT116 cells displayed attenuated vascular endothelial growth factor (VEGF) mRNA levels and hypoxia-inducible factor-1α (HIF-1α) protein expression under hypoxic conditions. KRGE repressed Snail, Slug, and Twist mRNA expression and integrin αVβ6 protein levels. Furthermore, hypoxia-repressed E-cadherin was restored in KRGE-treated cells; KRGE blocked the invasion and migration of colon cancer cells by repressing NF-κB and ERK1/2 pathways in hypoxia. Conclusions: KRGE inhibits hypoxia-induced EMT by repressing NF-κB and ERK1/2 pathways in colon cancer cells. Keywords: colon cancer, epithelial-mesenchymal transition, hypoxia-inducible factors, Korean Red Ginseng extract, Panax ginseng Meyer

Background and Aims Endobiliary radiofrequency ablation (EB-RFA) is a new adjunctive method for biliary drainage restoration. However, a concern remains about long-term adverse events of this procedure, such as biliary stricture, perforation, and hemorrhage. Therefore, we aimed to assess the long-term effects of in vivo EB-RFA in a swine model. Methods Six mini-pigs were divided into 2 groups: 10-W/33-mm EB-RFA and 7-W/18-mm EB-RFA. Endoscopic retrograde cholangiography–guided temperature controlled EB-RFA (80°C, 7-10 W, 120 seconds) was performed. After 28 days all mini-pigs underwent follow-up ERC and were killed to assess the long-term effects of EB-RFA. Results All mini-pigs developed biliary stricture (median length, 10.5 mm; range, 6-15) with jaundice (total bilirubin, 5.84 mg/dL; range, 4.3-9.2) and purulent bile at 1 month after EB-RFA. A significant difference was found in the length of stricture on cholangiogram between the 10 W/33-mm and 7 W/18-mm EB-RFA groups (median, 14 vs 6 mm; P = .034); however, no differences were found in the width of the stricture and laboratory findings. Histologic examination revealed marked thickening of bile duct with severe damage of whole layers replaced with reactive myofibroblastic proliferation, dense collagen laydown, chronic and acute inflammation, and fat necrosis. However, long-term adverse events, such as perforation or hemorrhage, were not found. Conclusions As a long-term result of EB-RFA, segmental biliary stricture with cholangitis develops in proportion to the power/length of the RFA electrode. Therefore, biliary stents should be placed to maintain biliary drainage after EB-RFA.

(LCX) coronary artery communicated with a branch of the bronchial artery (Fig. 1). The left ventricular ejection fraction was 60% based on echocardiography. We suspected that the stenosis of the LAD coronary artery contributed to the chest pain, and decided to treat with an anti-angina drug for this lesion. We reasoned that the coronary-to-bronchial artery fistula might be secondary to coronary artery stenosis inducing a steal phenomenon in patient with bronchiectasis. If the hemoptysis recurs at the coronary-to-left bronchial artery fistula, it may be accompanied by complications, such as myocardial infarction, and increase the risk of mortality during embolization. Therefore, we advised the patient to undergo prophylactic cardiac catheterization with embolization to close the