Search

Background and Aim Radiofrequency ablation (RFA) and ethanol ablation are accepted methods of tissue destruction for treating cystic tumors. The aim of the present study was to evaluate the feasibility, efficacy, and safety of endoscopic ultrasound (EUS)-guided ablation using normal porcine gallbladders as a substitute model for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN). Methods Six adult mini pigs were included in this prospective study. EUS-guided RFA with or without ethanol ablation of the gallbladder was carried out using a prototype 18-gauge endoscopic RFA electrode, and RFA and ethanol ablation were done in a single session. Outcomes were assessed in terms of macroscopic and microscopic evaluations of the treated gallbladders. Results The prototype RFA electrode was used for ablation of the mucosa, aspiration of the internal contents of the gallbladder, and ethanol injection. RFA plus ethanol lavage resulted in a greater mean percentage of denuded gallbladder mucosa (97.5%) than RFA alone (55.8%). Effects of ablation extending to the cystic duct and partially denuded cystic duct mucosae were detected in five of the six pigs. There were no major procedure-related adverse events. Conclusions EUS-guided ablation of the gallbladder mucosa was feasible and effective in the porcine model. Additional studies will be required to fully assess the risk of procedure-related damage to the main pancreatic duct before using this technique in a clinical setting.

Department of Industrial Chemistry, Pukyong National University, Busan 48547, Korea(Received February 2, 2016 ; revised February 18, 2016 ; accepted February 25, 2016)AbstractA chromium-free Ce-based conversion coating formed by immersion in a solution containing cerium chlorideand nitric acid on AZ31 magnesium alloy has been studied. The effects of acid pickling on the morphologyand the corrosion resistance of the cerium conversion coating were investigated. The corrosion resistanceof the conversion coating prepared on AZ31 Mg alloy after organic acid pickling was better than that ofinorganic acid pickling. The morphology of the conversion-coated layer was observed using optical microscopeand SEM. Results show that the conversion coatings are relatively uniform and continuous, with thickness1.0 to 1.1µm. The main elements of the conversion coating of AZ31 Mg alloy are Mg, O, Al, Ce andZn by EDS analysis. The electrochemical polarization results showed that the Ce-based conversion coatingcould reduce the corrosion activity of the AZ31 Mg alloy substrates in the presence of chloride ions.

We used various nondestructive analyses to investigate various host material systems in the emitting layer (EML) of simple-structured, green phosphorescent organic light-emitting diodes (OLEDs) to clarify how the host systems affect its luminous efficiency (LE) and operational stability. An OLED that has a unipolar single-host EML with conventional poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PSS) showed high operating voltage, low LE (∼26.6 cd/A, 13.7 lm/W), and short lifetime (∼4.4 h @ 1000 cd/m(2)). However, the combined use of a gradient mixed-host EML and a molecularly controlled HIL that has increased surface work function (WF) remarkably decreased operating voltage and improved LE (∼68.7 cd/A, 77.0 lm/W) and lifetime (∼70.7 h @ 1000 cd/m(2)). Accumulated charges at the injecting interfaces and formation of a narrow recombination zone close to the interfaces are the major factors that accelerate degradation of charge injection/transport and electroluminescent properties of OLEDs, so achievement of simple-structured OLEDs with high efficiency and long lifetime requires facilitating charge injection and balanced transport into the EML and distributing charge carriers and excitons in EML.

Background and Aims Radiofrequency ablation (RFA) has been used as a valuable treatment modality for various unresectable malignancies. EUS-guided radiofrequency ablation (EUS-RFA) of the porcine pancreas was reported to be feasible and safe in our previous study, suggesting that EUS-RFA may be applicable as an adjunct and effective alternative treatment method for unresectable pancreatic cancer. This study aimed to assess the technical feasibility and safety of EUS-RFA for unresectable pancreatic cancer. Methods An 18-gauge endoscopic RFA electrode and a radiofrequency generator were used for the procedure. The length of the exposed tip of the RFA electrode was 10 mm. After insertion of the RFA electrode into the mass, the radiofrequency generator was activated to deliver 20 to 50 W ablation power for 10 seconds. Depending on tumor size, the procedure was repeated to sufficiently cover the tumor. Results EUS-RFA was performed successfully in all 6 patients (median age 62 years, range 43-73 years). Pancreatic cancer was located in the head (n = 4) or body (n = 2) of the pancreas. The median diameter of masses was 3.8 cm (range 3cm-9cm). Four patients had stage 3 disease, and 2 patients had stage 4 disease. After the procedure, 2 patients experienced mild abdominal pain, but there were no other adverse events such as pancreatitis or bleeding. Conclusions EUS-RFA could be a technically feasible and safe option for patients with unresectable pancreatic cancer.

In this study, we propose a hexagonal photonic crystal fiber (PCF) including an elliptical Si core for high nonlinearity and birefringence, simultaneously. The propagation properties are rigorously investigated by numerical full-vector analysis. The designed fiber provides high nonlinearity and birefringence for a wide range of wavelengths, from 1.25 to 2 μm, maintaining low propagation loss by virtue of a high nonlinear coefficient and large Si refractive index. The optimal values of nonlinearity and birefringence are 2 × 105 W−1 km−1 and 0.92, respectively. In addition, the proposed hexagonal PCF can be easily fabricated with a conventional draw technique compared with other PCFs composed of complex structures to achieve high nonlinearity. It also has a high fabrication tolerance for the rotational angle of the elliptical Si core. We believe that this type of the fiber could be applied to various efficient nonlinear applications.

An orbital angular momentum (OAM) mode is a good candidate as an orthogonal basis mode set for mode division multiplexing (MDM) owing to its unique phase properties. Photonic crystal fibers support large numbers of OAM modes with notable performances. However, the effective index difference between high order OAM modes is not large enough. In this work, we propose two types of epsilon-near-zero (ENZ) materials-embedded circular photonic crystal fibers for high mode separation. Compared with previously developed photonic crystal fibers, the designed fibers exhibit a high refractive index contrast owing to the inserted ENZ materials. The designed fibers support up to 42 OAM modes. Most of these OAM modes provide a large effective index difference (Δneff > 10−3) while maintaining a radial sing mode condition over a wide wavelength range from 1.3 μm to 1.8 μm. The proposed fibers could potentially be exploited in MDM for stable transmission of OAM modes and other OAM-based applications.

Several studies evaluated the current guideline of the American Society for Gastrointestinal Endoscopy (ASGE) and reported only suboptimal accuracy. This study evaluated the diagnostic performance of the ASGE guideline based on computed tomography (CT) and role of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in patients with suspected choledocholithiasis but negative CT finding.Patients with suspected choledocholithiasis undergoing ERCP between January 2016 and January 2017 were retrospectively analyzed. All patients underwent CT to detect choledocholithiasis. EUS or MRCP was performed when the CT scan showed negative findings. Patients were classified into the high and intermediate-risk groups, based on predictors from the ASGE criteria.Of 583 patients with suspected choledocholithiasis, 340 (58.3%) had stones on ERCP (65.9% in the high-risk group and 40.6% in the intermediate-risk group). The accuracy of ASGE guideline for CT was 63.98% (79.12% sensitivity, 42.80% specificity) and 36.02% (20.88% sensitivity, 57.20% specificity) in the high-risk and intermediate-risk groups, respectively. In 103 patients in the high-risk group underwent both CT and US, the accuracy of CT was higher than that of US for detecting choledocholithiasis (78.64% vs. 53.40%), with a significant difference in area under the curve (AUC) (0.78 vs. 0.59, P 0.001). Of 339 with negative CT finding, the accuracy of EUS was higher than that of MRCP (90.91% vs. 82.76%), but with no significant difference in AUC (0.91 vs. 0.83, P = 0.347).CT-based ASGE guideline showed superior diagnostic performance than US for predicting choledocholithiasis. The diagnostic options, EUS or MRCP, with negative CT finding showed comparable performance. Therefore, the diagnostic modality should be selected based on availability, experience, cost, and contraindications.

Background: A recent study reported that tumor-infiltrating neutrophil (TIN) has potential on malignant tumor progression leading to metastasis. In our study, to control the effect of TIN, 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol (PLAG) was used. PLAG has shown its efficacy in modulating the neutrophil counts in chemotherapy-induced neutropenia by attenuating neutrophil extravasation via down-regulation of adhesion molecules, inflammatory cytokines, and chemokines. In this study, we investigated whether PLAG has an anti-metastatic effect on A549 lung cancer orthotopic implantation model via modulating TIN. Methods: To investigate the anti-metastatic effect of PLAG on lung cancer metastasis, RFP-labeled A549 cells were implanted into the lungs of BALB/c nude mice via intratracheal injection and bred for 12 weeks. After 6 weeks from tumor implantation, PLAG with three concentrations (25/50/100 mpk) were daily administrated for another 6 weeks. Each image of the growth of the primary tumor and colonization of metastatic tumor to other sites were acquired using CT and IVIS. TIN was analyzed in the primary tumor using immunohistochemistry (IHC). To identify the mechanism of PLAG on preventing the neutrophil-associated metastasis of cancer cells, direct or non-direct co-culture methods were used. Results: In the orthotopic implantation model, metastatic tumors to GI-track and brain were detected by IVIS. It was confirmed that metastasis to GI-track was decreased by 73% in 100 mpk PLAG-treated group, while metastasis to the brain was decreased by about 92% in PLAG-diet compared with positive control. Primary lung tumor growth was retarded by PLAG in a dose-dependent manner. The size of the primary tumor was much smaller than the positive control and alveolar tissue was similar to that of normal mice in 100 mpk PLAG-diet. In contrast, massive neutrophil infiltrations in positive and delivery groups, but significantly reduced upon PLAG administration. Moreover, p-EGFR was concomitantly detected with a similar pattern of neutrophil infiltration. During the direct contact in vitro assay, the A549 lung cancer spheroid cells were scattered by neutrophils, but it was effectively hindered by PLAG treatment. Neutrophil-stimulated cancer in the non-direct contact method showed enhanced metastatic activity. However, such a phenomenon was significantly reduced with the PLAG-treated group. Moreover, neutrophil stimulated the expression of EMT markers, whereas it was effectively down-regulated by PLAG administration. Transactivation between tumor cells and neutrophil was mediated by neutrophil elastase (NE). NE binds to and activates protease-activated receptor 2 (PAR2) on cancer cells and subsequently activated EGFR for metastasis to occur by cleaving HB-EGF through the ARR2/clathrin complex. On the other hand, the suppression of metastasis by PLAG was mediated through the regulation of the NE-PAR2 pathway and acceleration of intracellular trafficking and degradation of PAR2. Conclusion: In this study, TIN was observed in the primary lung tumor and metastasis into GI-track and brain, but PLAG dramatically reduced infiltration of neutrophil. The collective results suggest that TIN educates tumor cells for enhancing metastasis by EGFR transactivation. However, PLAG effectively interfered the transactivation. Having not met the medical needs for treating metastasis, PLAG may be a promising candidate as an anti-metastatic drug by modulating the TIN. Citation Format: GUEN TAE KIM, SUN YOUNG YOON, KI-YOUNG SOHN, MYUNG-HWAN KIM, JAE WHA KIM. Anti-metastatic effect of PLAG via interference of neutrophil elastase/PAR2/EGFR signaling on A549 lung cancer orthotopic implantation model [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr C037. doi:10.1158/1535-7163.TARG-19-C037

Background: Tumor microenvironments (TME) promote tumor growth and induction of metastasis along with the strong presence of tumor-infiltrating neutrophil (TIN), which further contributes to abnormal tumor growth and metastasis. From this tumor-prone environment, we hypothesize that the effective destruction of TIN may enhance the therapeutic efficacy of chemotherapy for reducing the tumor. In this study, we investigated the synergistic effect of PLAG in the MDA-MB-231 breast cancer xenograft model concomitantly treated with the AC-regimen in modulating the effect of TIN. Methods: MDA-MB-231 breast cancer xenograft model was used for evaluation of the tumor growth in the AC-regimen alone and PLAG co-treated animals. AC-regimen was delivered via intraperitoneal injection twice a week with a dose of 2/20 and 5/50 mpk (Doxorubicin/Cyclophosphamide) and PLAG was daily administered with 100 and 250 mpk. Tumor growth was measured in 3-day intervals. Neutrophil chemotaxis-related chemokines, CXCL1/2/8 and circulating neutrophils were also evaluated in a 2-week interval. Expression of apoptosis-related molecular markers (Bax/Bak) and TIN in the tumor lesion was analyzed by immunohistochemistry (IHC) staining. Results: PLAG has synergistic effects on decreasing the tumor burden in the PLAG and AC-treated xenograft model. In AC-treated groups with 2/20 or 5/50 mpk, retardation of tumor growth was observed from the calculated tumor size and regulation of apoptosis-associated markers was proved by TUNEL assay and IHC. Modulated chemokine expression from tumor burden and subsequent neutrophil recruitment were also detected in proportion to the tumor mass. The measured tumor sizes in the PLAG co-treated group were consistently smaller than those from the AC-regimen alone group till the mice were sacrificed. It was confirmed that the tumor burden of the PLAG co-treated group with 5/50 AC-regimen was significantly decreased in a concentration-dependent manner compared to the AC-regimen alone group (p Citation Format: GUEN TAE KIM, SUN YOUNG YOON, KI-YOUNG SOHN, MYUNG-HWAN KIM, JAE WHA KIM. The synergistic effect of PLAG on the antitumor efficacy of AC-regimen via alleviating neutrophil tumor infiltration on breast tumor xenograft model [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B054. doi:10.1158/1535-7163.TARG-19-B054

Background/Aim: Chemotherapy-induced neutropenia (CIN) is the major dose-limiting toxicity of systemic cancer chemotherapy leading to dose reductions, treatment delays or treatment early termination, which may compromise treatment outcome. EC-18 is a synthetic, orally available and lipid-based small molecular compound (1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol). EC-18 prevents CIN by attenuating neutrophil extravasation via down-regulation of adhesion molecules, pro-inflammatory cytokines & chemokines (Cell & Bioscience 2019;9:4). The aim of this study is to evaluate the safety, tolerability, pharmacokinetics (PK) and preliminary activity of EC-18 for CIN (NCT03104595). Methods: A standard 3+3 design was used. EC-18 (softgel capsule) was administered on Day 1 through Day 21 to patients with metastatic breast cancer receiving combined doxorubicin and cyclophosphamide (AC regimen) in four dose-escalation cohorts (500mg/day, 1,000mg/day, 1,500mg/day, 2,000mg/day, respectively) with 3 subjects per each cohort. The first cohort was treated at a starting dose (500mg/day) and the subsequent cohorts were sequentially treated at increasing doses levels. PK was assessed on Day 1 and Day 15 in the first cycle of chemotherapy. Results: EC-18 was shown to be well tolerated in all participants and none of the subjects experienced drug-related severe adverse events or adverse events leading to discontinuation of treatment. Dose-limiting toxicity (DLT) did not occur and maximum-tolerated dose (MTD) was not determined accordingly. The baseline-adjusted absolute neutrophil count (ANC) of the patients showed a tendency to improve the neutrophil decline with increasing doses of EC-18 during the course of the study. With increasing dosage amount of EC-18, the time period (day) for the recovery of neutropenia from nadir to ANC > 500/mm3 showed a tendency to become shorter proportionally; 4.0 days in 500mg/day, 3.7 days in 1,000mg/day, 3.0 days in 1,500mg/day and 2.3 days in 2,000mg/day, respectively. In the PK outcomes, the plasma exposure on 500-2000 mg was observed in a dose-dependent manner. No plasma accumulation by the repeated dosing was observed based on the PK results of Day 1 and 15. The PK analysis and simulation suggested that the higher dose than 2000 mg would reach a systemic steady-state. Conclusion: EC-18 is safe and well tolerated. Studies in patients clearly demonstrated pharmacokinetics. Preliminary results suggest EC-18 has the potential to prevent and treat chemotherapy-induced neutropenia. Further dose-expansion cohorts trial is planned to explore a maximum tolerated dose and determine an efficacious dose for phase 2 clinical trial. Citation Format: Sung-Bae Kim, Myung-Hwan Kim. A phase 1/2a, open-label, dose-escalation study of EC-18 in patients with metastatic breast cancer for the prevention of chemotherapy-induced neutropenia [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A070. doi:10.1158/1535-7163.TARG-19-A070

Primary sclerosing cholangitis (PSC), a chronic progressive disease of unknown etiology, is characterized by fibrosis and strictures involving the intra- and extrahepatic bile ducts [1, 2]. PSC is a distinct entity from IgG4-related sclerosing cholangitis (IgG4-SC), but some IgG4-SC masquerades as PSC by way of similar manifestations, such as frequent stenosis of both intra- and extrahepatic bile ducts, bile ductal wall thickening, male predominance, cholestatic liver dysfunction, and initial mild symptoms [3–7]. The differential diagnosis between PSC and IgG4-SC is clinically important because their treatment modalities and prognosis are very different [2, 7, 8]. Timely diagnosis of IgG4-SC can lead clinicians to prescribe adequate corticosteroid therapy that can reverse bile duct strictures/wall thickening and cholestatic liver dysfunction and could potentially prevent future advanced liver disease [2]. A proper diagnosis of PSC, in turn, is crucial for optimizing the surveillance of the disease progression to hepatic decompensation and the need for liver transplantation.

BackgroundDetermining the growth rate of pancreatic cystic lesions on follow-up imaging is important in managing patients with these lesions. However, the growth rates of serous pancreatic neoplasms (SPNs) have been reported to vary among studies.PurposeTo determine the in vivo growth rate of SPNs.Material and MethodsThis retrospective, single-institutional study included patients diagnosed with SPNs during 2006–2015. The diagnosis of SPNs was based on the results of surgery, endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) or core needle biopsy (CNB), or typical radiologic features of SPN. A linear mixed-effects model was utilized to determine whether the diagnostic intervention was associated with tumor growth rate in all patients. The in vivo growth rate of SPNs was estimated from patients without or before diagnostic intervention. SPN growth rates were compared before and after diagnostic intervention.ResultsSPN growth rates in the overall patient cohort (n = 304) differed significantly between patients who did and did not undergo diagnostic interventions. The in vivo SPN growth rate in 204 patients without or before diagnostic intervention was 1.9 mm/year (95% confidence interval [CI] = 1.6–2.2). In the 130 patients who underwent diagnostic intervention, the SPN growth rate was significantly greater before than after diagnostic intervention (1.8 vs. 0.2 mm/year).ConclusionsIn the absence of diagnostic intervention, the in vivo growth rate of SPNs was 1.9 mm/year (95% CI = 1.6–2.2). EUS-guided FNA or CNB may affect the growth rate of SPNs.

To intraindividually compare the diagnostic performance of CT and MRI in differentiating non-diffuse-type autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDA). Sixty-one patients with non-diffuse-type AIP and 122 patients with PDA, who underwent dynamic contrast-enhanced CT and MRI with MR pancreatography, were included. Two blinded radiologists independently rated their confidence in differentiating the two diseases on a 5-point scale, and the diagnostic performances of CT and MRI were compared. The presence of key imaging features to differentiate AIP and PDA were compared between CT and MRI. The area under the receiver operating characteristic curve was significantly greater on MRI (0.993–0.995) than on CT (0.953–0.976) for both raters (p≤0.035). The sensitivities of MRI were higher than those of CT for the diagnosis of AIP (88.5–90.2% vs. 77–80.3%, p≤0.07) and PDA (97.5–99.2% vs. 91.8–94.3%, p≤0.031) for both raters, although the difference for AIP was statistically marginal (p=0.07) for rater 1. In AIP, multiple pancreatic masses, delayed homogeneous enhancement of the pancreatic mass, and multiple main pancreatic duct (MPD) strictures were observed significantly more frequently using MRI than CT (p≤0.008). In PDA, discrete pancreatic mass and MPD stricture were observed significantly more frequently using MRI than CT (p≤0.012). The diagnostic performance of MRI is better for differentiating non-diffuse-type AIP from PDA, which is due to the superiority of MRI over CT in demonstrating the key distinguishing features of both diseases. • Imaging differential diagnosis of non-diffuse-type AIP and PDA is challenging. • MRI has better diagnostic performance than CT in differentiating non-diffuse-type AIP from PDA. • MRI is superior to CT in demonstrating key distinguishing features of non-diffuse-type AIP and PDA.

Purpose nab-paclitaxel plus gemcitabine (AG) and FOLFIRINOX have been established as standard first-line treatment in metastatic pancreatic cancer (mPC). We performed retrospective analysis comparing the efficacies of AG and FOLFIRINOX in daily practice setting. Materials and Methods We analyzed 308 patients who presented initially as mPC and received AG (n = 149) or FOLFIRINOX (n = 159) as first-line treatment between 2013 and 2016. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Result There were no significant differences between the two groups in terms of baseline characteristics, except older age and higher Charlson Comorbidity Index (CCI) score in AG group. The response rates (34% vs 34%) and median PFS (6.8 vs 5.1 months) were comparable between two groups (p = 0.88 and p = 0.19, respectively), while median OS was significantly better with AG than FOLFIRINOX (11.4 vs 9.6 months; p = 0.002). Elevated baseline CA19–9 level and liver metastasis were independent adverse prognostic factors for PFS and OS. In subgroup analyses, PFS with AG was better in patients with age ≥ 65 years, peritoneal metastasis, and higher CCI than that with FOLFIRINOX. Conclusion Both AG and FOLFIRINOX showed comparable efficacy outcomes in daily practice setting. AG might be preferentially considered in patients with peritoneal metastasis, comorbid medical conditions or old age.

Background/objectives The pancreatoduodenal groove (anatomical groove) is a potential space bordered by the head of the pancreas, duodenum, and common bile duct. Discerning between groove carcinoma (GC) and groove pancreatitis (GP) is often difficult, but clinically important. We retrospectively analyzed and compared the findings of computed tomography (CT), laboratory tests, and endoscopic ultrasound-fine needle aspiration (EUS-FNA) for GC and GP. Methods GC (n = 36) and GP (n = 44) patients at Asan Medical Center from January 1, 2000, to May 31, 2017 were retrospectively reviewed. MDCT findings, baseline characteristics, laboratory test results, and EUS and EUS-FNA findings of GC and GP patients were compared. Results CT showed no significant difference in groove enhancement between the groups. Mass-like lesions, cystic groove lesions, and calcification were observed in 86.1% and 15.9%, 38.9% and 75%, and 2.8% and 29.5% of GC and GP patients, respectively. Patients were tested for total bilirubin (GC: 2.0 vs. GP: 0.6 mg/dL), cancer antigen 19-9 (CA19-9) (GC: 76 vs. GP: 12.5 U/mL), and carcinoembryonic antigen (GC: 2.4 vs. GP: 2 ng/mL). Three GP patients died, and one GP patient was diagnosed with GC. However, among 30 GC patients with at least 1-year follow-up, 20 died. In multivariate logistic regression, CA19-9, and mass-like lesion on multidetector CT (MDCT) were discriminating factors between GC and GP. Among 23 (10 GC, 13 GP) patients who underwent EUS-FNA, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, accuracy of EUS-FNA were 90%, 100%, 100%, 92.86%, and 95.65%, respectively. Conclusions Several MDCT and laboratory findings favor GC over GP. EUS-FNA should be considered in patients with elevated CA19-9 levels and mass-like lesions on MDCT.

Supplemental material for Growth rate of serous pancreatic neoplasms in vivo: a retrospective, observational study by Chan Park, Hyoung Jung Kim, So Yeon Kim, Seung Soo Lee, Jae Ho Byun, Song Cheol Kim and Myung-Hwan Kim in Acta Radiologica

Background and Objectives: EUS-guided biliary drainage (EUS-BD) is a feasible procedure when ERCP fails, as is percutaneous transhepatic BD (PTBD). However, little is known about patient perception and preference of EUS-BD and PTBD. Patients and Methods: An international multicenter survey was conducted in seven tertiary referral centers. In total, 327 patients, scheduled to undergo ERCP for suspected malignant biliary obstruction, were enrolled in the study. Patients received decision aids with visual representation regarding the techniques, benefits, and adverse events (AEs) of EUS-BD and PTBD. Patients were then asked the choice between the two simulated scenarios (EUS-BD or PTBD) after failed ERCP, the reasons for their preference, and whether altering AE rates would influence their prior choice. Results: In total, 313 patients (95.7%) responded to the questionnaire and 251 patients (80.2%) preferred EUS-BD. The preference of EUS-BD was 85.7% (186/217) with EUS-BD expertise, compared to 67.7% (65/96) without EUS-BD expertise (P < 0.001). The main reason for choosing EUS-BD was the possibility of internal drainage (78.1%). In multivariate analysis, the availability of EUS-BD expertise was the single independent factor that influenced patient preference (odds ratio: 3.168; 95% of confidence interval, 1.714–5.856; P < 0.001). The preference of EUS-BD increased as AE rates decreased (P < 0.001). Conclusions: In this simulated scenario, approximately 80% of patients preferred EUS-BD over PTBD after failed ERCP. However, preference of EUS-BD declined as its AE rates increased. Further technical innovations and improved proficiency in EUS-BD for reducing AEs may encourage the use of this procedure as a routine clinical practice when ERCP fails.

OBJECTIVE:IgG4-related disease (IgG4-RD) can cause fibroinflammatory lesions in nearly any organ, leading to organ dysfunction and failure. The IgG4-RD Responder Index (RI) was developed to help investigators assess the efficacy of treatment in a structured manner. The aim of this study was to validate the RI in a multinational investigation. METHODS:The RI guides investigators through assessments of disease activity and damage in 25 domains, incorporating higher weights for disease manifestations that require urgent treatment or that worsen despite treatment. After a training exercise, investigators reviewed 12 written IgG4-RD vignettes based on real patients. Investigators calculated both an RI score as well as a physician's global assessment (PhGA) score for each vignette. In a longitudinal assessment, 3 investigators used the RI in 15 patients with newly active disease who were followed up over serial visits after treatment. We assessed interrater and intrarater reliability, precision, validity, and responsiveness. RESULTS:The 26 physician investigators included representatives from 6 specialties and 9 countries. The interrater and intrarater reliability of the RI was strong (0.89 and 0.69, respectively). Correlations (construct validity) between the RI and PhGA were high (Spearman's r = 0.9, P < 0.0001). The RI was sensitive to change (discriminant validity). Following treatment, there was significant improvement in the RI score (mean change 10.5 [95% confidence interval (95% CI) 5.4-12], P < 0.001), which correlated with the change in the PhGA. Urgent disease and damage were captured effectively. DISCUSSION:In this international, multispecialty study, we observed that the RI is a valid and reliable disease activity assessment tool that can be used to measure response to therapy.

BACKGROUND AND AIM Little is known about the standard care of small (

The aim of this work is to be compared the effect of supports textural properties with pre-treatment method on dispersion of Pd particle. The CNTs were functionalized by different concentration of acid in order to obtain materials with different chemical and physical properties. The characteristics of functionalized CNTs were investigated by FT-IR and Rama spectropy. The Pd/CNTs catalysts prepared on support having the different surface properties were characterized by XRD, FE-TEM and CO-chemisorption. When pretreated 8M concentration, the CNTs has the highest amount of oxygen functional group and ID/IG ratio, in this study. Pd/CNT8M has high dispersion and small particle size. From these results, we confirmed that characteristics of Pd/CNTs catalyst such as particle size and dispersion of Pd are influenced by density of oxygen functional group and disorder of CNTs. And we have observed that acid treatment concentration of 8M is sufficient to functionalize the CNTs by introducing -COOH group of CNTs surfaces.

Accurate diagnosis of autoimmune pancreatitis (AIP) is important to clinicians since it is difficult to differentiate AIP from pancreatic malignancies. Furthermore, unlike pancreatic malignancies, AIP has dramatic response to steroids. A 61-years-old man presented with acute pancreatitis. Imaging studies showed two separate pancreatic masses, irregular narrowing of main pancreatic duct, and a renal mass that highly suggested AIP. Endoscopic ultrasound-guided core needle biopsy of the pancreatic masses and ultrasound-guided biopsy of the renal mass revealed peripheral T-cell lymphoma. The patient is currently undergoing chemotherapy. We present a case of pancreatic lymphoma masquerading as AIP with literature review. Korean J Pancreatobiliary 2015;20(4):204-208

Background and Aims EUS-guided biliary drainage (EUS-BD) has been proposed as an alternative for patients after failed ERCP. To date, the evaluation of dedicated device for one-step EUS-BD has been limited. To determine feasibility and safety of a newly designed 7F stent introducer with tapered metal tip as a push-type dilator for one-step metal stent placement without additional fistula dilation in EUS-BD. Methods Thirty-two patients with malignant biliary obstruction and failed ERCP were randomly assigned to a dedicated stent introducer with a modified hybrid metal stent (DH group, n = 16) or a conventional 8.5F biliary metal stent introducer with a fully covered metal stent (FC group, n = 16). The technical success, procedural times, clinical success rate, and adverse event rates were evaluated. Results One-step technical success without additional fistula dilation in the DH was 88% (14/16). Multi-step process in a stent placement was performed in all patients of the FC group. The procedural time in the DH was significantly shorter than the FC (10 vs. 15 min, P = 0.007). No difference in overall technical or clinical success was seen between the groups. The rate of an early adverse event was common in the FC compared with the DH (31.3% [5/16] in the FC vs. 6.3% [1/16] in the DH, P = 0.172), although not statistically significant. Conclusions A dedicated device for one-step EUS-BD may be technically feasible, safe, and shorten the procedural times with less chance of an additional fistula dilation process, resulting in a potential reduction of the early adverse events.

Small ampullary tumors and inflammatory lesions have similar endoscopic findings and are difficult to differentiate. Narrow-band imaging (NBI) can visualize microvessels and mucosal microstructure clearly and is widely used to diagnose early gastric and colon cancer.To evaluate the usefulness of NBI for differentiating ampullary tumors from benign diseases.Retrospective cohort study.Tertiary-care hospital.All 45 patients who had suspicious ampullary lesions (enlarged or protruded morphology) during duodenoscopy and underwent NBI between March 2010 and January 2011.NBI.NBI images were assessed for irregular villous arrangement, irregular villous size, ridge disappearance, demarcation with normal villi, and abnormal microvasculature. Histology of NBI-guided lesion biopsy specimens provided the final diagnoses. Agreement between NBI images and histologic findings was analyzed.Of the 60 ampullary lesions, 11, 26, and 23 were adenocarcinomas, adenomas, and benign inflammatory diseases, respectively. Irregular villous arrangement, irregular villous size, ridge disappearance, demarcation with normal villi, and abnormal microvasculature were observed in 45%, 63%, 50%, 48%, and 58% of the lesions, respectively. Multivariate analysis revealed that irregular villous arrangement (odds ratio [OR] 15.76; 95% confidence interval [CI], 3.38-64.12; P .001) and abnormal microvasculature (OR 86.63; 95% CI, 14.56-515.41; P .001) were significant independent factors for identifying ampullary adenomas and adenocarcinoma. All tumors had at least one abnormal NBI feature.Retrospective design.The NBI findings of irregular villous arrangement and/or abnormal microvasculature were useful for differentially diagnosing ampullary tumors. NBI may complement the accurate diagnosis of ampullary lesions by white-light imaging.

Background/Objectives Prediction of malignancy in patients with BD-IPMNs is critical for the management. The aim of this study was to elucidate predictors of malignancy in patients with ‘pure' BD-IPMNs who had a main pancreatic duct (MPD) diameter of ≤5 mm according to the most recent international consensus criteria and in whom MPD involvement was excluded on postoperative histology. Methods We identified 177 patients with ‘pure' BD-IPMNs based on preoperative imaging and postoperative histology from 15 tertiary referral centers in Korea. BD-IPMNs with low-grade ( n = 72) and moderate-grade ( n = 66) dysplasia were grouped as benign and BD-IPMNs with high-grade dysplasia ( n = 10) and invasive carcinoma ( n = 29) were grouped as malignancy. Results On univariate analysis, particular symptoms (jaundice and clinical pancreatitis), CT findings (cyst size > 3 cm, the presence of enhancing mural nodules) and EUS features (the presence of mural nodules, the mural nodule size > 5 mm) were significant risk factors predicting malignant BD-IPMNs. Multivariate analysis revealed that the cyst size > 3 cm (odds ratio = 9.9), the presence of enhancing mural nodules on CT (odds ratio = 19.3) and the mural nodule size > 5 mm on EUS (odds ratio = 14.9) were the independent risk factors for the presence of malignancy in BD-IPMNs ( p Conclusions The cyst size > 3 cm, the presence of enhancing mural nodules on CT, the mural nodule size > 5 mm on EUS are three independent predictors of malignancy in patients with ‘pure' BD-IPMNs.

A. Khosroshahi, Z. S. Wallace, J. L. Crowe, T. Akamizu, A. Azumi, M. N. Carruthers, S. T. Chari, E. Della-Torre, L. Frulloni, H. Goto, P. A. Hart, T. Kamisawa, S. Kawa, M. Kawano, M. H. Kim, Y. Kodama, K. Kubota, M. M. Lerch, M. L€ ohr, Y. Masaki, S. Matsui, T. Mimori, S. Nakamura, T. Nakazawa, H. Ohara, K. Okazaki, J. H. Ryu, T. Saeki, N. Schleinitz, A. Shimatsu, T. Shimosegawa, H. Takahashi, M. Takahira, A. Tanaka, M. Topazian, H. Umehara, G. J. Webster, T. E. Witzig, M. Yamamoto, W. Zhang, T. Chiba, and J. H. Stone

Background/Aims: We aimed to evaluate the feasibility and efficacy of a forward-viewing linear endoscopic ultrasound (FV-EUS) in diagnostic EUS procedures compared to stan- dard oblique-viewing EUS (OV-EUS). Methods: This study was a prospective, randomized study that permitted cross- over. Fifty-one patients with subepithelial pancreatobiliary and upper gastrointestinal lesions underwent FV-EUS and OV-EUS sequentially, in random order. The EUS visualization was performed by a novice endosonographer, and the image quality of specific lesions was scored by an expert endo- sonographer. If fine-needle aspiration (FNA) was indicated, it was performed using both echoendoscopes by an expert endosonographer. Results: Both of the EUS procedures had similar visualization times and image quality. In general, the visualization time was inversely related to the diameter of the specific lesions. In subepithelial lesions of the stomach and duodenum, the visualization time (98.8±62.2 seconds vs 139.0±66.6 seconds, p=0.008) and image quality (4.1±1.3 vs 3.3±1.7, p=0.02) of FV-EUS were significantly superior to OV-EUS. FV-EUS-guided FNA of pancreatic masses was suc- cessful in seven patients (87.5%). Conclusions: FV-EUS may increase the ease of access to gastrointestinal subepithelial lesions compared to conventional OV-EUS. The performance of FV-EUS for evaluating pancreatobiliary diseases and per- forming interventions was comparable to conventional OV- EUS. (Gut Liver 2015;9:679-684)

In 1911, Dubouis determined all positive integers that are represented by a sum of k positive squares for any k ≥ 4 . In this article, we generalize Dubouis' result to the binary case. We determine all binary forms that are represented by a sum of k nonzero squares for any k ≥ 5 .

Background/Aims Endoscopic ultrasonography (EUS)-guided ethanol ablation is gaining popularity for the treatment of focal pancreatic lesions. The aim of this study was to evaluate the safety, feasibility, and treatment response after EUS-guided ethanol injection for small pancreatic neuroendocrine tumors (p-NETs). Methods This was a retrospective analysis of a prospectively collected database including 11 consecutive patients with p-NETs who underwent EUS-guided ethanol injection. Results EUS-guided ethanol injection was successfully performed in 11 patients with 14 tumors. The final diagnosis was based on histology and clinical signs as follows: 10 non-functioning neuroendocrine tumors and four insulinomas. During follow-up (median, 370 days; range, 152 to 730 days), 10 patients underwent clinical follow-up after treatment, and one patient was excluded because of loss to follow-up. A single treatment session with an injection of 0.5 to 3.8 mL of ethanol resulted in complete responses (CRs) at the 3-month radiologic imaging for seven of 13 tumors (response rate, 53.8%). Multiple treatment sessions performed in three tumors with residual viable enhancing tissue increased the number of tumors with CRs to eight of 13 (response rate, 61.5%). Mild pancreatitis occurred in three of 11 patients. Conclusions EUS-guided ethanol injection appears to be a safe, feasible, and potentially effective method for treating small p-NETs in patients who are poor surgical candidates.

Reduction of the retrogradation of Injeolmi (IM) during storage for 3 days at 4 °C due to the addition of 0.8 % (w/w) wheat flour was analyzed. The optimum reaction temperature for the hydrolytic enzyme activity of α-amylase in the wheat flour was 30 °C for gelatinized waxy rice. Activity sharply increased until 7 h and then leveled off. The amylose content of IM remained almost constant, while that of wheat flour-added Injeolmi (WFIM) increased by 24 % during storage. Average amylopectin chain lengths of the starches in IM and WFIM increased from 27.91 to 30.36 and from 29.57 to 57.98, respectively, during storage. In the X-ray diffraction pattern, IM starch showed the characteristic peak located at 17°, while no distinct diffraction peak was observed for WFIM starch after storage. Enthalpy changes (ΔH) indicated by differential scanning calorimetry of IM and WFIM were 1.1060 and 0.6159 J/g, respectively. The hardness of IM significantly increased from 149.27 to 2202.52 g f during storage while that of WFIM increased only from 112.14 to 128.08 g f which was 5.82 % compared to that of IM.

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. Methods: Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. Results: In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. Conclusions: ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients. (Gut Liver 2015;9:417-423)

Background. von Hippel–Lindau (VHL) disease is an autosomal dominant disorder characterized by the development of multiple tumors in the central nervous system and visceral organs. In this study, we describe clinical features of pancreatic involvement in VHL disease, of which there have been few reported studies to date. Methods. We reviewed medical records of 63 VHL patients, diagnosed at Asan Medical Center between January 1995 and December 2013. Demographic, genetic, and radiologic features, and the clinical course of VHL patients with pancreatic involvement were retrospectively analyzed. Results. Among the 63 VHL patients, 55 (87.4%) had VHL-associated pancreatic lesions (male: female, 31:24; median age at onset, 33 years; range, 12–67 years). These presented as single simple cysts (n = 5, 9.1%), multiple simple cysts (n = 14, 25.5%), serous cystadenoma (n = 29, 52.7%), or neuroendocrine tumors (NETs) (n = 17, 30.9%). Genetic tests were performed on 35 of the 55 patients (63.6%) and VHL gene m...

Background EUS-guided and percutaneous lavage therapy for large hepatic cysts can replace surgical drainage. EUS-guided therapy can especially enable the alcohol lavage to be done with a 1-step approach. Objective To evaluate the utility of EUS-guidance and percutaneous ethanol lavage therapy. Design Retrospective cohort study. Setting Tertiary-care referral teaching hospital. Patients Adult patients with large liver cysts who underwent cyst drainage and alcohol ablation between 2009 and 2012. Interventions Ethanol lavage via percutaneous and/or EUS-guided approaches. Main Outcome Measurements Feasibility, efficacy, and safety of ethanol lavage. Results Seventeen patients with 19 hepatic cysts were enrolled. The median cyst volume before therapy was 368.9 mL (interquartile range, 195.3-795.9 mL). Ten cysts were drained by the percutaneous approach with a pigtail catheter, and 8 cysts underwent EUS-guided aspiration and lavage treatment. In 1 case, both the percutaneous approach and EUS-guided puncture were used. During the median 11.5-month follow-up of the percutaneous approach group, the cysts showed 97.5% reduction. During the median 15-month follow-up of the EUS-guided group, the cysts showed nearly 100% reduction. Percutaneous catheter drainage ethanol lavage was more feasible for right-sided larger cysts, whereas the EUS-guided approach was useful for left-sided lobe cysts. Limitations Single-center retrospective study. Conclusion Excellent symptomatic and radiologic responses and long-term results were achieved with percutaneous catheter–guided and EUS-guided ethanol lavage. Ethanol lavage could be considered a primary method of treatment for hepatic cysts given its high degree of technical feasibility and safety.

Background and aim Fully covered self-expandable metal stent (FCSEMS) placement has been tried for pancreatic ductal strictures in chronic pancreatitis. However, the long-term outcome of this procedure remains unknown. The present study aimed to investigate the procedural and long-term outcomes of FCSEMS placement in patients with benign refractory pancreatic ductal strictures. Methods Between August 2011 and September 2015, 18 patients underwent endoscopic treatment with FCSEMS for benign refractory pancreatic ductal stricture. Technical success, clinical success, radiological success, and adverse events were assessed. Results Stent placement was successful in all patients (technical success rate, 100%). Reduction in pain score of >50% was achieved in 15 of the 18 patients (clinical success rate, 83.3%). In all patients, stents could easily be removed at a median of 7.5 months (interquartile range [IQR], 6-13.6) after their insertion. FCSEMS migration did not develop in any patient. Ductal stricture was improved in 15 patients (radiological success rate, 83.3%). After definite stent removal, 13 of the 15 (86.7%) patients who had responded to pancreatic stenting maintained the response during follow up (median of 47.3 months; IQR, 7.4-57.1). Conclusions FCSEMS placement appears to be safe and effective for the treatment of benign refractory pancreatic ductal strictures as it can provide persistent improvement in the stricture in long-term follow up.

BACKGROUND AND AIM Endoscopic snare papillectomy (ESP) is an effective treatment for ampullary adenoma. Argon plasma coagulation (APC) is widely used as an additional method to control bleeding or ablate the residual tumor. However, the efficacy of this procedure has not yet been fully evaluated. This study aimed to evaluate the usefulness of APC as an additional method to ESP. METHODS Patients who underwent ESP for ampullary adenoma between September 2005 and September 2015 were retrospectively reviewed. Using propensity score matching, we compared short- and long-term outcomes between the ESP-with-additional-APC group (ESP + APC group) and the ESP-only group. Primary outcome was early post-ESP adverse events (AE), and secondary outcomes were late AE and recurrence. RESULTS Among 109 patients, additional APC was carried out in 59 (54.1%) patients. After matching, 41 patients were included in both groups, respectively. Bleeding rate was significantly lower in the ESP + APC group than in the ESP-only group (7.3% vs 31.7%, odds ratio = 0.180, P

Background/Aims Differentially diagnosing focal-type autoimmune pancreatitis (f-AIP) and pancreatic cancer (PC) is challenging. Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) may provide information for differentiating pancreatic masses. In this study, we evaluated the usefulness of CEH-EUS in differentiating f-AIP from PC. Methods Data were collected prospectively and analyzed on patients who underwent CEH-EUS between May 2014 and May 2015. Eighty consecutive patients were diagnosed with f-AIP or PC. PC and f-AIP were compared for enhancement intensity, contrast agent distribution, and internal vasculature. Results The study group comprised 53 PC patients and 27 f-AIP patients (17 with type-1 AIP [15 definite and two probable], two with probable type-2 AIP, and eight with AIP, not otherwise specified). Hyper- to iso-enhancement in the arterial phase (f-AIP, 89% vs PC, 13%; p

The aim of this study was to intraindividually compare magnetic resonance pancreatography (MRP) image quality at 1.5 T and 3.0 T when demonstrating main pancreatic duct (MPD) abnormalities in patients with autoimmune pancreatitis (AIP).Thirty prospectively enrolled patients with AIP underwent MRP at both 1.5 T and 3.0 T followed by endoscopic retrograde pancreatography before treatment. Two readers independently analyzed the MRP images and graded the visualization of MPD strictures and full-length MPD, using endoscopic retrograde pancreatography as the reference standard, as well as overall image artifacts on a 4-point scale. The contrast between the MPD and periductal area was calculated using a region-of-interest measurement.Visualization scores of MPD strictures and full-length MPD, and summed scores of each qualitative analysis, were significantly greater at 3.0-T MRP than at 1.5-T MRP for both readers (P ≤ 0.02). There were less image artifacts at 3.0 T compared with 1.5 T (P ≤ 0.052). The contrast between the MPD and periductal area was significantly greater at 3.0-T MRP than at 1.5-T MRP (P0.001).The MRP at 3.0 T was superior to 1.5-T MRP for demonstrating MPD abnormalities in AIP, with better image contrast and fewer image artifacts. Consequently, 3.0-T MRP may be useful for the diagnosis and management of patients with AIP.

Background: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with transmural stenting has increased for biliary decompression in patients with an inaccessible papilla, the optimal biliary access point and the learning curve of EUS-HGS have not been studied. We evaluated the optimal biliary access point and learning curve for technically successful EUS-HGS. Methods: 129 consecutive patients (male n = 81, 62.3%; malignant n = 113, 87.6%) who underwent EUS-HGS due to an inaccessible papilla were enrolled. EUS finding and procedure times according to each needle puncture attempt in EUS-HGS were prospectively measured. Learning curves of EUS-HGS were calculated for two main outcome measurements (procedure time and adverse events) by using the moving average method and cumulative sum (CUSUM) analysis, respectively. Results: A total of 174 EUS-HGS attempts were performed in 129 patients. The mean number of needle punctures was 1.35 ± 0.57. Using the logistic regression model, bile duct diameter of the puncture site ⩽ 5 mm [odds ratio (OR) 3.7, 95% confidence interval (CI): 1.71–8.1, p < 0.01] and hepatic portion length [linear distance from the mural wall to the punctured bile duct wall on EUS; mean hepatic portion length was 27 mm (range 10–47 mm)] > 3 cm (OR 5.7, 95% CI: 2.7–12, p < 0.01) were associated with low technical success. Procedure time and adverse events were shorter after 24 cases, and stabilized at 33 cases of EUS-HGS, respectively. Conclusions: Our data suggest that a bile duct diameter > 5 mm and hepatic portion length 1 cm to ⩽ 3 cm on EUS may be suitable for successful EUS-HGS. In our learning curve analysis, over 33 cases might be required to achieve the plateau phase for successful EUS-HGS.

Aim To investigate the clinical course of ulcerative colitis (UC) patients who develop acute pancreatitis. Methods We analyzed 3307 UC patients from the inflammatory bowel disease registry at Asan Medical Center from June 1989 to May 2015. The clinical course of UC patients who developed acute pancreatitis was compared with that of non-pancreatitis UC patients. Results Among 51 patients who developed acute pancreatitis, 13 (0.40%) had autoimmune, 10 (0.30%) had aminosalicylate-induced, and 13 (1.73%) had thiopurine-induced pancreatitis. All 13 patients with autoimmune pancreatitis (AIP) had type 2 AIP. Two (15.4%) patients had pre-existing AIP, and three (23.1%) patients developed AIP and UC simultaneously. Compared to non-pancreatitis patients, AIP patients had UC diagnosed at a significantly younger age (median, 22.9 years vs 36.4 years; P = 0.001). AIP and aminosalicylate-induced pancreatitis patients had more extensive UC compared to non-pancreatitis patients. All patients with pancreatitis recovered uneventfully, and there were no recurrences. Biologics were used more frequently in aminosalicylate- and thiopurine-induced pancreatitis patients compared to non-pancreatitis patients [adjusted OR (95%CI), 5.16 (1.42-18.67) and 6.90 (1.83-25.98), respectively]. Biologic utilization rate was similar among AIP and non-pancreatitis patients [OR (95%CI), 0.84 (0.11-6.66)]. Colectomy rates for autoimmune, aminosalicylate-induced, and thiopurine-induced pancreatitis, and for non-pancreatitis patients were 15.4% (2/13), 20% (2/10), 15.4% (2/13), and 7.3% (239/3256), respectively; the rates were not significantly different after adjusting for baseline disease extent. Conclusion Pancreatitis patients show a non-significant increase in colectomy, after adjusting for baseline disease extent.

Biliary tract cancer (BTC) is a heterogeneous group of diseases comprising intrahepatic and extrahepatic cholangiocarcinoma and gallbladder cancer. Although gemcitabine plus cisplatin (GEMCIS) was established as the standard first-line chemotherapy based on the ABC-02 trial, more data are needed to define the clinical course of BTC and its prognostic factors with the standard GEMCIS treatment. Between April 2010 and June 2016, 740 patients with histologically documented cholangiocarcinoma and gallbladder cancer were treated with first-line GEMCIS in Asan Medical Center, Seoul, Korea. In 389 patients with measurable disease (53%), the objective response rate was 13% (n = 50) and there was no significant difference between primary tumor sites (p = 0.45). With a median follow-up duration of 27.3 months (95% CI 24.2–30.5), the median PFS and OS were 5.2 months (95% CI 4.7–5.6) and 10.4 months (95% CI 9.6–11.2), respectively. In multivariate analysis, male gender (female versus male, hazard ratio [HR] 0.83), baseline CA 19-9 level (elevated versus normal, HR 1.31), initially metastatic disease (versus locally advanced disease, HR 1.92), poor performance status (2 versus 0–1, HR 1.45), and measurable disease by RECIST criteria (versus non-measurable, HR 1.40) were significantly associated with a poorer OS (all p

Peripancreatic fluid collections (PFCs) have been adequately drained using multiple plastic stents placed in a single-step endoscopic ultrasound (EUS) procedure. Recent reports have presented the usefulness of metal stents for this procedure; however, there has been no prospective comparative study on their effectiveness and safety. We conducted a prospective randomized study to compare multiple plastic stents with fully covered, self-expanding metal stents (FCSEMSs) for the drainage of PFCs.Between January 2012 and May 2013, patients with PFCs demonstrated by various modalities were enrolled in our study. Patients were randomly assigned to receive either a FCSEMS or plastic stents for EUS-guided PFC drainage. The procedure time, technical success rate, and adverse event rates of the PFCs were evaluated.50 patients (41 men) were included and randomly assigned to either the FCSEMS group (n = 25) or the plastic stent group (n = 25). The median procedure time with FCSEMS was significantly shorter than with plastic stents (15.0 min vs. 29.5 min, P 0.01). The technical success rate was 100 % for both groups. The clinical success rate was 20 out of 23 for FCSEMS and 20 out of 22 for plastic stents (P = 0.97). No adverse events occurred in the FCSEMS group, while adverse events occurred in two patients in the plastic stent group (P = 0.16). One recurrence was observed during follow-up in the FCSEMS group and none in the plastic stent group (P = 0.15).EUS-guided PFC drainage with FCSEMSs is comparable to such drainage with plastic stents in terms of technical feasibility, efficacy, and safety; however, the use of FCSEMSs may also simplify and shorten the procedure.KCT0000766 (https://cris.nih.go.kr).