horng-yuan wang - Academia.edu (original) (raw)

Papers by horng-yuan wang

Research paper thumbnail of Crohn's Disease: Specific Concerns in the Elderly

International Journal of Gerontology, 2016

Crohn's disease (CD) and ulcerative colitis are the principal types of inflammatory bowel disease... more Crohn's disease (CD) and ulcerative colitis are the principal types of inflammatory bowel disease, which has a bimodal age distribution, with~10e15% of the affected population older than 60 years. The management of CD in the elderly population is more complex due to comorbidities, polypharmacy, impaired mobility, and surgical candidacy criteria. Further difficulty exists in the data and experience from clinical trials, which often exclude the elderly. Therefore, few data are available that directly compare treatment efficacies in younger and older patients. Recognizing prescribed medications and natural disease history in this population is the first step in preventing complications and improving quality of care delivered to older individuals with CD. This review focuses on the CD-related treatment, associated complications, and limitations in the elderly population.

Research paper thumbnail of Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Intestinal research, 2017

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflamm... more Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with...

Research paper thumbnail of Using typical endoscopic features to diagnose esophageal squamous papilloma

World journal of gastroenterology, Jan 21, 2016

To better understand some of the superficial tiny lesions that are recognized as squamous papillo... more To better understand some of the superficial tiny lesions that are recognized as squamous papilloma of the esophagus (SPE) and receive a different pathological diagnosis. All consecutive patients with esophageal polypoid lesions detected by routine endoscopy at our Endoscopy Centre between October 2009 and June 2014 were retrospectively analysed. We enrolled patients with SPE or other superficial lesions to investigate four key endoscopic appearances (whitish color, exophytic growth, wart-like shape, and surface vessels) and used narrow band imaging (NBI) to distinguish their differences. These series endoscopic images of each patient were retrospectively reviewed by three experienced endoscopists with no prior access to the images. All lesion specimens obtained by forceps biopsy were fixed in formalin and processed for pathological examination. The following data were collected from patient medical records: gender, age, indications for esophagogastroduodenoscopy, and endoscopic cha...

Research paper thumbnail of A phase 3b study of sofosbuvir plus ribavirin in Taiwanese patients with chronic genotype 2 hepatitis C virus infection

Liver International, 2016

In Taiwan, patients with chronic hepatitis C virus (HCV) infection are currently treated with peg... more In Taiwan, patients with chronic hepatitis C virus (HCV) infection are currently treated with pegylated interferon-alpha plus ribavirin, but interferon-based regimens can be poorly tolerated, especially by those with advanced liver disease and the elderly. Sofosbuvir, an oral nucleotide analog inhibitor of HCV NS5B polymerase, is approved in Europe, the United States, and Japan for treating chronic HCV infection. This phase 3b study examined the efficacy and safety of sofosbuvir plus ribavirin in Taiwanese patients with chronic genotype 2 HCV infection ± compensated cirrhosis. In this multicenter, open-label, phase 3b (NCT02021643) study, 87 patients (n=43, treatment-naive; n=44, treatment-experienced) received 12 weeks of treatment with sofosbuvir plus weight-based ribavirin. The primary efficacy end point was the proportion of patients with sustained virologic response 12 weeks after treatment discontinuation (SVR12). Safety and pharmacokinetic data were also collected. All 87 patients (100%; 95% confidence interval, 92-100%) achieved SVR12, including the 13 patients with compensated cirrhosis. The most common treatment-emergent adverse events (AEs) were insomnia (16%, 14/87) and upper respiratory tract infection (16%, 14/87). No grade 3 or grade 4 AE was reported. There was one serious AE (biliary colic), which was deemed unrelated to study treatment. Laboratory abnormalities other than ribavirin-related reductions in hemoglobin were uncommon. The results from this phase 3b study demonstrate that 12 weeks of treatment with the interferon-free regimen sofosbuvir plus ribavirin is effective and well tolerated in both treatment-naive and treatment-experienced Taiwanese patients with chronic genotype 2 HCV infection. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Off-treatment efficacy of 3-year nucleos(t)ide analogues in chronic hepatitis B patients

The Kaohsiung Journal of Medical Sciences, 2016

Lamivudine, telbivudine, and entecavir are the first-line drugs covered by the Taiwan National He... more Lamivudine, telbivudine, and entecavir are the first-line drugs covered by the Taiwan National Health Insurance as 3-year treatments for patients with chronic hepatitis B virus (HBV), but the optimal treatment duration of each remains unclear. We aimed to detect HBV treatment-cessation durability, and compare the predictors in patients with and without clinical relapse. In this retrospective cohort study, 210 patients with chronic HBV who tested hepatitis B e-antigen positive or hepatitis B e-antigen negative were treated for 3 years with a nucleos(t)ide analogue. Of these, 102 patients continued therapy after 3 years, while 88 patients stopped treatment and were followed for 1 year due to financial difficulties. Efficacy was assessed in terms of alanine aminotransferase (ALT) level normalization, HBV DNA clearance, virus breakthrough, clinical relapse, and liver decompensation. The durability predictors were evaluated by host factors, HBV DNA, and drug differences. Eighty patients (14 on lamivudine, 19 on telbivudine, and 47 on entecavir) were recruited. There was no difference in clinical-relapse rate among lamivudine, telbivudine, and entecavir (35.7% vs. 36.8% vs. 31.9%, respectively; p = 0.916), and liver decompensated hepatitis was absent. In baseline clinical characteristics, there were no differences between the clinical-relapse and nonrelapse groups in age, sex, cirrhosis, prior treatment, HBV DNA, pretreatment ALT, or hepatitis B e-antigen (HBeAg). The mean 3(rd) year serum ALT level differed significantly between clinical-relapse and nonrelapse patients (37.5 U/L vs. 27.7 U/L, respectively; p = 0.044). The 3-year nucleos(t)ide analogue off-treatment in patients with chronic HBV delivered according to the Taiwan National Health Insurance guidelines had an overall 33.8% 1-year clinical-relapse rate without any decompensated hepatitis flare-ups.

Research paper thumbnail of Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?

World Journal of Gastroenterology

AIM: This study was to investigate whether surgery could increase cancer dissemination and postop... more AIM: This study was to investigate whether surgery could increase cancer dissemination and postoperative recurrence in patients with hepatocellular carcinoma (HCC) by detection of human α-fetoprotein messenger RNA (hAFP mRNA). hAFP mRNA in the peripheral blood of patients with HCC has been considered as a surrogate marker for circulating tumor cells.

Research paper thumbnail of Ultrasonography of splenic abnormalities

Research paper thumbnail of Bleeding gastrointestinal stromal tumor in a patient with a history of leiomyoma of the ileum

Formosan Journal of Surgery, 2013

ABSTRACT Small intestine tumors, such as gastrointestinal stromal tumors (GISTs), are rare and di... more ABSTRACT Small intestine tumors, such as gastrointestinal stromal tumors (GISTs), are rare and difficult to be diagnosed. The most common GIST symptoms are abdominal pain and bleeding. A novel enteroscopy method is helpful in the localization and preoperative evaluation of small bowel tumors. We report a 77-year-old woman who had a history of leiomyoma in the ileum 20 years previously. She presented with intermittent bloody stool passage. Pathological examination showed a GIST in the ileum measuring 3.5 cm × 2.5 cm × 2.0 cm. The aim of this case report is to remind clinicians that GISTs should be considered if a patient with a history of leiomyoma in the small bowel has obscure, inexplicable gastrointestinal bleeding.

Research paper thumbnail of Ectopic sebaceous gland in the esophagus—Case reports and review of the literature

Advances in Digestive Medicine, 2015

Research paper thumbnail of Partial splenic embolization: 12-month hematological effects and complications

Hepato-gastroenterology

To investigate the hematological effects and immediate postoperative complications of partial spl... more To investigate the hematological effects and immediate postoperative complications of partial splenic embolization (PSE) in patients with liver cirrhosis. Record of liver cirrhosis patients with thrombocytopenia and leukopenia in whom PSE was performed between June 1995 and June 2005 were reviewed. Peripheral blood counts were evaluated at baseline, at 1 week, and at months 1, 3, 6, and 12 months post-PSE and clinically significant complications were recorded. In the twenty patients who underwent PSE, significant improvements in thrombocyte and leukocyte levels were noted at all time points compared to baseline levels up to one year following PSE (P<0.01). The complication rate was 100% because all patients experienced fever and abdominal pain. Only 7 patients (35%) experienced additional, mild post-embolization complications, and only 2 (10%) experienced serious complications. The mortality rate in this study was 0%. PSE significantly improved thrombocytopenia and leukopenia. Th...

Research paper thumbnail of A young female with alternating diarrhea and constipation

Advances in Digestive Medicine, 2015

Research paper thumbnail of Transarterial Chemoembolization-induced Tumor Lysis Syndrome: Different Results in the Same Hepatocellular Carcinoma Patient

International Journal of Gerontology

Tumor lysis syndrome (TLS) is rarely induces after Transarterial chemoembolization for hepatocell... more Tumor lysis syndrome (TLS) is rarely induces after Transarterial chemoembolization for hepatocellular carcinoma. We present a patient with a large hepatocellular carcinoma who received twice transarterial embolization (TAE). Tumor lysis syndrome was induced after the first TACE in this patient. Due to the previous experience, precautionary measures were taken before the second TAE. Therefore no complications were noted afterwards. We should be aware of tumor lysis syndrome, especially in high risk patients.

Research paper thumbnail of Benign esophageal lesions: Endoscopic and pathologic features

Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding... more Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding the endoscopic and pathologic features of esophageal lesions is essential for their detection, differential diagnosis, and management. The purpose of this review is to provide updated features that may help physicians to appropriately manage these esophageal lesions. The endoscopic features of 2997 patients are reviewed. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor. Most benign esophageal lesions can be diagnosed according to their endoscopic appearance and findings on routine biopsy, and submucosal lesions, by endoscopic resection. Management is generally based upon the confidence of diagnosis and whether the l...

Research paper thumbnail of Modified single-balloon endoscopy for ERCP in a patient with Billroth II gastrectomy

Research paper thumbnail of Meta-analysis: The effect of patient education on bowel preparation for colonoscopy

Endoscopy International Open, 2015

The proportion of outpatients with inadequate bowel preparation before colonoscopy is high owing ... more The proportion of outpatients with inadequate bowel preparation before colonoscopy is high owing to patient unawareness of its importance and poor adherence to instructions. This meta-analysis aimed to determine the effect of educational intervention on the quality of bowel preparation before colonoscopy. A comprehensive literature review identified randomized controlled trials measuring the effect of educational intervention on the quality of bowel preparation. Two reviewers independently screened relevant articles, extracted data, and assessed the risk of bias. The primary outcome was the quality of each bowel preparation before colonoscopy, using a particular assessment scale. The secondary outcomes were polyp detection rates during the procedure and the need for a repeat colonoscopy due to incomplete examination. Nine randomized controlled trials were included in this meta-analysis. In all, 2885 patients were enrolled, with 1458 receiving education and 1427 assigned to the control group. An educational intervention before colonoscopy significantly improved bowel preparation (relative risk [RR] = 1.22; 95 % confidence interval [CI], 1.10 - 1.36), however, no significant differences were identified in polyp detection rates (RR = 1.14; 95 %CI 0.87 - 1.51) or the need for repeat colonoscopy (RR = 0.52; 95 %CI 0.25 - 1.04) between the groups. Asymmetry in the appearance of the funnel plot and the result of Egger test (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) suggested that publication bias existed. Evidence from these randomized controlled trials shows that a brief counseling session with patients before colonoscopy ensures better bowel preparation. However, evidence is insufficient to assess improvements in polyp detection rate and avoidance of a repeat colonoscopy. Despite these encouraging observations, this meta-analysis had some limitations, including potential publication bias and significant heterogeneity of the types of bowel purgatives. These results should be interpreted with caution.

Research paper thumbnail of A man with abdominal fullness

Advances in Digestive Medicine, 2015

Research paper thumbnail of Oral sodium phosphate for bowel preparation in endoscopic submucosal dissection training in a pig model: A pilot study

Advances in Digestive Medicine, 2015

Research paper thumbnail of Gallbladder sarcomatoid carcinoma: A case report and review of current literature

Advances in Digestive Medicine, 2015

ABSTRACT Gallbladder sarcomatoid carcinoma is a rare neoplasm characterized by the simultaneous p... more ABSTRACT Gallbladder sarcomatoid carcinoma is a rare neoplasm characterized by the simultaneous presence of malignant epithelial and mesenchymal components. There is little information about the clinical behavior and optimal treatment for these tumors. The current study examines the case of a 52-year-old female patient who presented with postprandial epigastric pain that had persisted for 1 year. A diagnosis of gallbladder sarcomatoid carcinoma was confirmed by pathology after radical resection. Peritoneal metastasis occurred 3 months later, and the patient died 6 months after diagnosis. This study found that the prognosis of gallbladder sarcomatoid carcinoma is poor even after curative resection and there is as yet no known effective adjuvant therapy.

Research paper thumbnail of Modified endoscopic mucosal resection of gastric heterotopic pancreas: Report of two cases

Advances in Digestive Medicine, 2014

Heterotopic pancreas is a congenital anomaly characterized by the presence of ectopic pancreatic ... more Heterotopic pancreas is a congenital anomaly characterized by the presence of ectopic pancreatic tissue far from the pancreas. The treatment of heterotopic pancreas may include expectant observation, endoscopic resection, or surgery. The aim of this study was to describe the technique of cap-assisted endoscopic mucosal resection for the management of heterotopic pancreas of the stomach. Two patients, a 41-year-old woman and a 31year-old man, were referred to us for the management of gastric subepithelial lesions. Endoscopic ultrasound was used in the female patient to disclose two small hypoechoic lesions arising from the submucosal layer. Cap-assisted endoscopic mucosal resection was performed in both patients without complications. Histopathological examination of the resected specimens showed heterotopic pancreatic tissue in the submucosal layer. Our technique is a suction, snaring, and cut method. This method does not need a special cap with a shallow circumferential lip on the inside and the snare does not need to be pre-looped. This technique allowed a histopathological confirmation of the suspected diagnosis in both patients.

Research paper thumbnail of Adhesive small bowel obstruction: how long can patients tolerate conservative treatment?

World journal of gastroenterology : WJG, 2003

To evaluate how long patients with small bowel obstruction caused by postoperative adhesions can ... more To evaluate how long patients with small bowel obstruction caused by postoperative adhesions can tolerate conservative treatment. The records of patients with small bowel obstruction due to postoperative adhesions were retrospectively reviewed. Data collected included the number of admissions, type of management for each admission, duration of conservative treatment, number of repeat laparotomies, and operative findings. One hundred fifty-five patients with this condition from January 1999 to December 2001, for a total of 293 admissions were enrolled in this study. Medical treatment alone was given in 220 admissions, and repeat laparotomy was performed in 73 admissions. The period of observation in patients managed medically ranged from 2 to 12 days (average: 6.9 days), while for those who underwent surgery, the range was 1 to 14 days (average 5.4 days). At surgery, adhesions were the only finding in 46 cases, while there were intestinal complications in 27, or 9.2 % of all 293 admi...

Research paper thumbnail of Crohn's Disease: Specific Concerns in the Elderly

International Journal of Gerontology, 2016

Crohn's disease (CD) and ulcerative colitis are the principal types of inflammatory bowel disease... more Crohn's disease (CD) and ulcerative colitis are the principal types of inflammatory bowel disease, which has a bimodal age distribution, with~10e15% of the affected population older than 60 years. The management of CD in the elderly population is more complex due to comorbidities, polypharmacy, impaired mobility, and surgical candidacy criteria. Further difficulty exists in the data and experience from clinical trials, which often exclude the elderly. Therefore, few data are available that directly compare treatment efficacies in younger and older patients. Recognizing prescribed medications and natural disease history in this population is the first step in preventing complications and improving quality of care delivered to older individuals with CD. This review focuses on the CD-related treatment, associated complications, and limitations in the elderly population.

Research paper thumbnail of Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Intestinal research, 2017

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflamm... more Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with...

Research paper thumbnail of Using typical endoscopic features to diagnose esophageal squamous papilloma

World journal of gastroenterology, Jan 21, 2016

To better understand some of the superficial tiny lesions that are recognized as squamous papillo... more To better understand some of the superficial tiny lesions that are recognized as squamous papilloma of the esophagus (SPE) and receive a different pathological diagnosis. All consecutive patients with esophageal polypoid lesions detected by routine endoscopy at our Endoscopy Centre between October 2009 and June 2014 were retrospectively analysed. We enrolled patients with SPE or other superficial lesions to investigate four key endoscopic appearances (whitish color, exophytic growth, wart-like shape, and surface vessels) and used narrow band imaging (NBI) to distinguish their differences. These series endoscopic images of each patient were retrospectively reviewed by three experienced endoscopists with no prior access to the images. All lesion specimens obtained by forceps biopsy were fixed in formalin and processed for pathological examination. The following data were collected from patient medical records: gender, age, indications for esophagogastroduodenoscopy, and endoscopic cha...

Research paper thumbnail of A phase 3b study of sofosbuvir plus ribavirin in Taiwanese patients with chronic genotype 2 hepatitis C virus infection

Liver International, 2016

In Taiwan, patients with chronic hepatitis C virus (HCV) infection are currently treated with peg... more In Taiwan, patients with chronic hepatitis C virus (HCV) infection are currently treated with pegylated interferon-alpha plus ribavirin, but interferon-based regimens can be poorly tolerated, especially by those with advanced liver disease and the elderly. Sofosbuvir, an oral nucleotide analog inhibitor of HCV NS5B polymerase, is approved in Europe, the United States, and Japan for treating chronic HCV infection. This phase 3b study examined the efficacy and safety of sofosbuvir plus ribavirin in Taiwanese patients with chronic genotype 2 HCV infection ± compensated cirrhosis. In this multicenter, open-label, phase 3b (NCT02021643) study, 87 patients (n=43, treatment-naive; n=44, treatment-experienced) received 12 weeks of treatment with sofosbuvir plus weight-based ribavirin. The primary efficacy end point was the proportion of patients with sustained virologic response 12 weeks after treatment discontinuation (SVR12). Safety and pharmacokinetic data were also collected. All 87 patients (100%; 95% confidence interval, 92-100%) achieved SVR12, including the 13 patients with compensated cirrhosis. The most common treatment-emergent adverse events (AEs) were insomnia (16%, 14/87) and upper respiratory tract infection (16%, 14/87). No grade 3 or grade 4 AE was reported. There was one serious AE (biliary colic), which was deemed unrelated to study treatment. Laboratory abnormalities other than ribavirin-related reductions in hemoglobin were uncommon. The results from this phase 3b study demonstrate that 12 weeks of treatment with the interferon-free regimen sofosbuvir plus ribavirin is effective and well tolerated in both treatment-naive and treatment-experienced Taiwanese patients with chronic genotype 2 HCV infection. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Off-treatment efficacy of 3-year nucleos(t)ide analogues in chronic hepatitis B patients

The Kaohsiung Journal of Medical Sciences, 2016

Lamivudine, telbivudine, and entecavir are the first-line drugs covered by the Taiwan National He... more Lamivudine, telbivudine, and entecavir are the first-line drugs covered by the Taiwan National Health Insurance as 3-year treatments for patients with chronic hepatitis B virus (HBV), but the optimal treatment duration of each remains unclear. We aimed to detect HBV treatment-cessation durability, and compare the predictors in patients with and without clinical relapse. In this retrospective cohort study, 210 patients with chronic HBV who tested hepatitis B e-antigen positive or hepatitis B e-antigen negative were treated for 3 years with a nucleos(t)ide analogue. Of these, 102 patients continued therapy after 3 years, while 88 patients stopped treatment and were followed for 1 year due to financial difficulties. Efficacy was assessed in terms of alanine aminotransferase (ALT) level normalization, HBV DNA clearance, virus breakthrough, clinical relapse, and liver decompensation. The durability predictors were evaluated by host factors, HBV DNA, and drug differences. Eighty patients (14 on lamivudine, 19 on telbivudine, and 47 on entecavir) were recruited. There was no difference in clinical-relapse rate among lamivudine, telbivudine, and entecavir (35.7% vs. 36.8% vs. 31.9%, respectively; p = 0.916), and liver decompensated hepatitis was absent. In baseline clinical characteristics, there were no differences between the clinical-relapse and nonrelapse groups in age, sex, cirrhosis, prior treatment, HBV DNA, pretreatment ALT, or hepatitis B e-antigen (HBeAg). The mean 3(rd) year serum ALT level differed significantly between clinical-relapse and nonrelapse patients (37.5 U/L vs. 27.7 U/L, respectively; p = 0.044). The 3-year nucleos(t)ide analogue off-treatment in patients with chronic HBV delivered according to the Taiwan National Health Insurance guidelines had an overall 33.8% 1-year clinical-relapse rate without any decompensated hepatitis flare-ups.

Research paper thumbnail of Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?

World Journal of Gastroenterology

AIM: This study was to investigate whether surgery could increase cancer dissemination and postop... more AIM: This study was to investigate whether surgery could increase cancer dissemination and postoperative recurrence in patients with hepatocellular carcinoma (HCC) by detection of human α-fetoprotein messenger RNA (hAFP mRNA). hAFP mRNA in the peripheral blood of patients with HCC has been considered as a surrogate marker for circulating tumor cells.

Research paper thumbnail of Ultrasonography of splenic abnormalities

Research paper thumbnail of Bleeding gastrointestinal stromal tumor in a patient with a history of leiomyoma of the ileum

Formosan Journal of Surgery, 2013

ABSTRACT Small intestine tumors, such as gastrointestinal stromal tumors (GISTs), are rare and di... more ABSTRACT Small intestine tumors, such as gastrointestinal stromal tumors (GISTs), are rare and difficult to be diagnosed. The most common GIST symptoms are abdominal pain and bleeding. A novel enteroscopy method is helpful in the localization and preoperative evaluation of small bowel tumors. We report a 77-year-old woman who had a history of leiomyoma in the ileum 20 years previously. She presented with intermittent bloody stool passage. Pathological examination showed a GIST in the ileum measuring 3.5 cm × 2.5 cm × 2.0 cm. The aim of this case report is to remind clinicians that GISTs should be considered if a patient with a history of leiomyoma in the small bowel has obscure, inexplicable gastrointestinal bleeding.

Research paper thumbnail of Ectopic sebaceous gland in the esophagus—Case reports and review of the literature

Advances in Digestive Medicine, 2015

Research paper thumbnail of Partial splenic embolization: 12-month hematological effects and complications

Hepato-gastroenterology

To investigate the hematological effects and immediate postoperative complications of partial spl... more To investigate the hematological effects and immediate postoperative complications of partial splenic embolization (PSE) in patients with liver cirrhosis. Record of liver cirrhosis patients with thrombocytopenia and leukopenia in whom PSE was performed between June 1995 and June 2005 were reviewed. Peripheral blood counts were evaluated at baseline, at 1 week, and at months 1, 3, 6, and 12 months post-PSE and clinically significant complications were recorded. In the twenty patients who underwent PSE, significant improvements in thrombocyte and leukocyte levels were noted at all time points compared to baseline levels up to one year following PSE (P<0.01). The complication rate was 100% because all patients experienced fever and abdominal pain. Only 7 patients (35%) experienced additional, mild post-embolization complications, and only 2 (10%) experienced serious complications. The mortality rate in this study was 0%. PSE significantly improved thrombocytopenia and leukopenia. Th...

Research paper thumbnail of A young female with alternating diarrhea and constipation

Advances in Digestive Medicine, 2015

Research paper thumbnail of Transarterial Chemoembolization-induced Tumor Lysis Syndrome: Different Results in the Same Hepatocellular Carcinoma Patient

International Journal of Gerontology

Tumor lysis syndrome (TLS) is rarely induces after Transarterial chemoembolization for hepatocell... more Tumor lysis syndrome (TLS) is rarely induces after Transarterial chemoembolization for hepatocellular carcinoma. We present a patient with a large hepatocellular carcinoma who received twice transarterial embolization (TAE). Tumor lysis syndrome was induced after the first TACE in this patient. Due to the previous experience, precautionary measures were taken before the second TAE. Therefore no complications were noted afterwards. We should be aware of tumor lysis syndrome, especially in high risk patients.

Research paper thumbnail of Benign esophageal lesions: Endoscopic and pathologic features

Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding... more Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding the endoscopic and pathologic features of esophageal lesions is essential for their detection, differential diagnosis, and management. The purpose of this review is to provide updated features that may help physicians to appropriately manage these esophageal lesions. The endoscopic features of 2997 patients are reviewed. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor. Most benign esophageal lesions can be diagnosed according to their endoscopic appearance and findings on routine biopsy, and submucosal lesions, by endoscopic resection. Management is generally based upon the confidence of diagnosis and whether the l...

Research paper thumbnail of Modified single-balloon endoscopy for ERCP in a patient with Billroth II gastrectomy

Research paper thumbnail of Meta-analysis: The effect of patient education on bowel preparation for colonoscopy

Endoscopy International Open, 2015

The proportion of outpatients with inadequate bowel preparation before colonoscopy is high owing ... more The proportion of outpatients with inadequate bowel preparation before colonoscopy is high owing to patient unawareness of its importance and poor adherence to instructions. This meta-analysis aimed to determine the effect of educational intervention on the quality of bowel preparation before colonoscopy. A comprehensive literature review identified randomized controlled trials measuring the effect of educational intervention on the quality of bowel preparation. Two reviewers independently screened relevant articles, extracted data, and assessed the risk of bias. The primary outcome was the quality of each bowel preparation before colonoscopy, using a particular assessment scale. The secondary outcomes were polyp detection rates during the procedure and the need for a repeat colonoscopy due to incomplete examination. Nine randomized controlled trials were included in this meta-analysis. In all, 2885 patients were enrolled, with 1458 receiving education and 1427 assigned to the control group. An educational intervention before colonoscopy significantly improved bowel preparation (relative risk [RR] = 1.22; 95 % confidence interval [CI], 1.10 - 1.36), however, no significant differences were identified in polyp detection rates (RR = 1.14; 95 %CI 0.87 - 1.51) or the need for repeat colonoscopy (RR = 0.52; 95 %CI 0.25 - 1.04) between the groups. Asymmetry in the appearance of the funnel plot and the result of Egger test (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) suggested that publication bias existed. Evidence from these randomized controlled trials shows that a brief counseling session with patients before colonoscopy ensures better bowel preparation. However, evidence is insufficient to assess improvements in polyp detection rate and avoidance of a repeat colonoscopy. Despite these encouraging observations, this meta-analysis had some limitations, including potential publication bias and significant heterogeneity of the types of bowel purgatives. These results should be interpreted with caution.

Research paper thumbnail of A man with abdominal fullness

Advances in Digestive Medicine, 2015

Research paper thumbnail of Oral sodium phosphate for bowel preparation in endoscopic submucosal dissection training in a pig model: A pilot study

Advances in Digestive Medicine, 2015

Research paper thumbnail of Gallbladder sarcomatoid carcinoma: A case report and review of current literature

Advances in Digestive Medicine, 2015

ABSTRACT Gallbladder sarcomatoid carcinoma is a rare neoplasm characterized by the simultaneous p... more ABSTRACT Gallbladder sarcomatoid carcinoma is a rare neoplasm characterized by the simultaneous presence of malignant epithelial and mesenchymal components. There is little information about the clinical behavior and optimal treatment for these tumors. The current study examines the case of a 52-year-old female patient who presented with postprandial epigastric pain that had persisted for 1 year. A diagnosis of gallbladder sarcomatoid carcinoma was confirmed by pathology after radical resection. Peritoneal metastasis occurred 3 months later, and the patient died 6 months after diagnosis. This study found that the prognosis of gallbladder sarcomatoid carcinoma is poor even after curative resection and there is as yet no known effective adjuvant therapy.

Research paper thumbnail of Modified endoscopic mucosal resection of gastric heterotopic pancreas: Report of two cases

Advances in Digestive Medicine, 2014

Heterotopic pancreas is a congenital anomaly characterized by the presence of ectopic pancreatic ... more Heterotopic pancreas is a congenital anomaly characterized by the presence of ectopic pancreatic tissue far from the pancreas. The treatment of heterotopic pancreas may include expectant observation, endoscopic resection, or surgery. The aim of this study was to describe the technique of cap-assisted endoscopic mucosal resection for the management of heterotopic pancreas of the stomach. Two patients, a 41-year-old woman and a 31year-old man, were referred to us for the management of gastric subepithelial lesions. Endoscopic ultrasound was used in the female patient to disclose two small hypoechoic lesions arising from the submucosal layer. Cap-assisted endoscopic mucosal resection was performed in both patients without complications. Histopathological examination of the resected specimens showed heterotopic pancreatic tissue in the submucosal layer. Our technique is a suction, snaring, and cut method. This method does not need a special cap with a shallow circumferential lip on the inside and the snare does not need to be pre-looped. This technique allowed a histopathological confirmation of the suspected diagnosis in both patients.

Research paper thumbnail of Adhesive small bowel obstruction: how long can patients tolerate conservative treatment?

World journal of gastroenterology : WJG, 2003

To evaluate how long patients with small bowel obstruction caused by postoperative adhesions can ... more To evaluate how long patients with small bowel obstruction caused by postoperative adhesions can tolerate conservative treatment. The records of patients with small bowel obstruction due to postoperative adhesions were retrospectively reviewed. Data collected included the number of admissions, type of management for each admission, duration of conservative treatment, number of repeat laparotomies, and operative findings. One hundred fifty-five patients with this condition from January 1999 to December 2001, for a total of 293 admissions were enrolled in this study. Medical treatment alone was given in 220 admissions, and repeat laparotomy was performed in 73 admissions. The period of observation in patients managed medically ranged from 2 to 12 days (average: 6.9 days), while for those who underwent surgery, the range was 1 to 14 days (average 5.4 days). At surgery, adhesions were the only finding in 46 cases, while there were intestinal complications in 27, or 9.2 % of all 293 admi...