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Background/AimsAntibiotic usage and increasingly aging populations have led to increased incidence of Clostridium difficile infection (CDI) in worldwide. Recent studies in Korea have also reported increasing CDI incidence; however, there have been no reports on the long-term outcomes of CDI. We therefore investigated the long-term clinical outcomes of patients with CDI, including delayed recurrence, associated risk factors and mortality.MethodsHospitalized patients diagnosed with CDI at Seoul Paik Hospital between January 2007 and December 2008 were included. Their medical records were retrospectively investigated. 'Delayed recurrence' was defined as a relapse 8 weeks after a successful initial treatment. Multivariate logistic regression analysis was performed to identify risk factors for the delayed recurrence. Kaplan-Meier curves were used to analyze mortality rates.ResultsA total of 120 patients were enrolled; among them, 87 were followed-up for at least 1 year, with a mean follow-up period of 34.1±25.1 months. Delayed recurrence was observed in 17 patients (19.5%), and significant risk factors were age (over 70 years, P=0.049), nasogastric tube insertion (P=0.008), and proton pump inhibitor or H2-blocker treatments (P=0.028). The 12- and 24-month mortality rates were 24.6% and 32.5%, respectively. No deaths were directly attributed to CDI.ConclusionsDelayed recurrence of CDI was not rare, occurring in 19.5% of the study population. Although CDI-related mortality was not reported, 2-year (32.5%) mortality rate of CDI patients implies that a CDI diagnosis may predict severe morbidity and poor prognosis of the underlying disease.

Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration. [ABSTRACT FROM AUTHOR]

Most cases of hypertriglyceridemia (HTG)-induced gestational pancreatitis occur when a person with hyperlipidemia is overweight due to pregnancy or has secondary triggers associated with triglycerides (TGs). In Korea, 6 cases of HTG-induced gestational pancreatitis have been reported, but none of the affected patients had TG levels below 1,000 mg/dL. A 36-year-old female at 30 weeks of gestation was admitted due to pain in her upper abdomen. Initial biochemical analysis revealed a TG level of 260 mg/dL, an amylase level of 2,951 U/L and a lipase level of 3,500 U/L. Abdominal ultrasonography showed pancreatic swelling with a hypoechogenic rim. After several days, the patient was discharged and had a normal delivery at 38 weeks of gestation. This case report is the first to describe acute pancreatitis occurring in the presence of type IV hyperlipoproteinemia even though the TG level was less than 500 mg/dL, contrary to findings in previously reported cases. [ABSTRACT FROM AUTHOR]

Background: Free perforation is the most severe and debilitating complication associated with Crohn's disease (CD), and it usually requires emergency surgery. The aim of this study was to evaluate the incidence of free perforation among Korean patients with CD. Methods: The CrOhn's disease cliNical NEtwork and CohorT (CONNECT) study was conducted nationwide in Korea, and patients who were diagnosed with CD between 1982 and 2008 were included in this retrospective study. We investigated the incidence of free perforation among these patients and their clinical characteristics. Results: A total of 1346 patients were analyzed and 88 patients (6.5%) were identified with free perforation in CD. The mean age of the free perforation group was 31.8 ± 13.0 years, which was significantly higher than that of the non-perforated group (27.5 ± 12.1 years) (p = 0.004). Free perforation was the presenting sign of CD in 46 patients (52%). Of the 94 perforations that were present in 88 patients, 81 involved the ileum. Multivariate logistic regression analysis determined that free perforation was significantly associated with being aged ⩾ 30 years at diagnosis (OR 2.082, p = 0.002) and bowel strictures (OR 1.982, p = 0.004). The mortality rate in the free perforation group was significantly higher (4.5%) than that in the non-perforated group (0.6%) (p < 0.001). Conclusion: The incidence of free perforation in Korean patients with CD was 6.5%. Being aged ⩾ 30 years at CD diagnosis and bowel strictures were significant risk factors associated with free perforation. [ABSTRACT FROM AUTHOR]

Background/Aims: Antibiotic usage and increasingly aging populations have led to increased incidence of Clostridium difficile infection (CDI) in worldwide. Recent studies in Korea have also reported increasing CDI incidence; however, there have been no reports on the long-term outcomes of CDI. We therefore investigated the long-term clinical outcomes of patients with CDI, including delayed recurrence, associated risk factors and mortality. Methods: Hospitalized patients diagnosed with CDI at Seoul Paik Hospital between January 2007 and December 2008 were included. Their medical records were retrospectively investigated. 'Delayed recurrence' was defined as a relapse 8 weeks after a successful initial treatment. Multivariate logistic regression analysis was performed to identify risk factors for the delayed recurrence. Kaplan-Meier curves were used to analyze mortality rates. Results: A total of 120 patients were enrolled; among them, 87 were followed-up for at least 1 year, with a mean follow-up period of 34.1±25.1 months. Delayed recurrence was observed in 17 patients (19.5%), and significant risk factors were age (over 70 years, P=0.049), nasogastric tube insertion (P=0.008), and proton pump inhibitor or H2-blocker treatments (P=0.028). The 12- and 24-month mortality rates were 24.6% and 32.5%, respectively. No deaths were directly attributed to CDI. Conclusions: Delayed recurrence of CDI was not rare, occurring in 19.5% of the study population. Although CDI-related mortality was not reported, 2-year (32.5%) mortality rate of CDI patients implies that a CDI diagnosis may predict severe morbidity and poor prognosis of the underlying disease. [ABSTRACT FROM AUTHOR]

Background/Aims Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most common and severe complications of ERCP. When selective cannulation is difficult in the bile duct, biliary cannulation is performed after a guidewire or plastic stent is inserted into the pancreatic-duct (P-duct). In this case, the incidence of PEP is known to be higher than selective cannulation in the bile duct at once. When the guidewire is well inserted in the main P-duct, the use of a pancreatic stent without the use of contrast medium may reduce the P-duct irritation and pancreatitis. Therefore, we compared the incidence of PEP by dividing the patients who was received P-duct contrast or was not. Methods Between March 1, 2019 and August 31, 2019, 122 naive papilla patients visited at the Daejeon Eulji Hospital for ERCP. A retrospective study was performed on 36 people who had a P-duct stent among the patients who inserted a guidewire in the P-duct. Patients aimed at pancreatic procedures such as chronic pancreatitis were excluded from the study. Of 36 patients, 17 patients underwent a guidewire to the P-duct, followed by pancreatogram and inserted a pancreatic duct stent (endoscopic retrograde pancreatic drainage [ERPD] with pancreatogram). On the other hand, 19 patients inserted a guidewire on the P-duct and then put a P-duct stent without pancreatogram (ERPD without pancreatogram). Results Baseline characteristics of 17 ERPD with pancreatogram and 19 ERPD without pancreatogram were not statistically different except cannulation time (Table 1). Two of 16 patients with pancreatogram developed PEP, and only one of 11 patients without pancreatogram developed PEP (11.8% vs 5.3%, p=0.593). In univariate logistic regression, cannulation time was the only discriminating factors of PEP. Conclusions Pancreatic duct stent without pancreatogram may reduce post-ERCP pancreatitis than pancreatic duct stent with pancreatogram, but there was no statistical difference. [ABSTRACT FROM AUTHOR]