The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 495
Slide Session
K-LI-08 Liver
Serum Vitamin D Defi ciency in Non-Alcoholic Fatty Liver Disease; Chicken or the Egg?
Young Taek Kim1, Dae Won Jun1, Kang Nyeong Lee1, Hang Lak Lee1, Oh Young Lee1, Ho Soon Choi1, Byung Chul Yoon1, Joon Soo Hahm1
Hanyang University Seoul Hospital, Korea1
Background: It’s well known that serum vitamin D level is reduced in non-alcoholic fatty liver disease (NAFLD). Serum vitamin D level affect by dietary intake, decreased sunlight exposure, or reduced 25(OH)D conversion from liver disease. However, there is no study for cause relations with vitamin defi ciency in NAFLD. We investigate to changes of serum vitamin D level through diet control and risk factors of serum vita- min D concentration.
Methods: Ninety newly diagnosed NAFLD patients were enrolled. NAFLD was diag- nosed by liver-spleen Hounsfi eld ratio and elevated liver enzyme. All patients received nutritional education for two months. Nutrition education was performed by the dietitians for every two weeks. Five days food diary, abdominal CT scan, and blood chemistry were done at baseline and 8 week.
Results: 82 patients complete diet education program among 90 patients. 64 patients (78.0%) reduced their body weight. 48 patients (58.5%) normalized their ALT levels.
49 patients (59.7%) increased liver-spleen Hounsfi eld unit. Baseline serum vitamin D level was 13.0ng/mL. Only 8 subjects (8.9%) had more than 20 ng /mL, and 29 pa- tients (35.4%) had less than 10mg/mL. Although 57.7% of the patients decreased their vitamin D consumption, serum vitamin D level was signifi cantly increased (13.0ng/mL vs. 15.9ng/mL, p<0.001). Physical activity and sunlight exposure did not change during study period. Serum vitamin D level increased after weight reduction independent of dietary vitamin D intake, sunlight exposure, and physical activity.
Conclusions: Weight loss through reducing total calorie intake increased serum vita- min D level in NAFLD patients independent of sunlight exposure, and physical activity.
K-BP-01 Pancreatobiliary
A Newly Modifi ed Access Balloon Catheter for Direct Peroral Cholangioscopy Using an Ultra-Slim Upper Endoscope in Patients with Biliary Obstruction
Yun Nah Lee1, Jong Ho Moon1, Hyun Jong Choi1, Hee Jae Jung1, Moon Han Choi1, Tae Hoon Lee1, Sang-Woo Cha1, Young Deok Cho1, Sang-Heum Park1, Sun-Joo Kim1 Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Korea1
Background and Aims: Direct peroral cholangioscopy (DPOC) using an ultra-slim endo- scope is one of possible POCs by single operator to provide direct visualization of the bile duct. However, currently available accessory for DPOC is limited for the effective procedure. The aim of this study was to evaluate the feasibility and success rate of intraductal guided DPOC with a novel access balloon catheter for cholangioscopy to maintain access.
Patients and Methods: From January 2014 to July 2014, 36 patients with biliary ob- struction underwent DPOC. Biliary obstruction on intra-pancreatic segment was ex- cluded. All patients underwent an endoscopic sphincterotomy and/or papillary balloon dilation. Intraductal balloon guided DPOC using modifi ed two lumens 5F access balloon catheter for cholangioscopy (MTW Endoskopie, Wesel, Germany) was performed. The success of cholangioscopy was defi ned as advance of the endoscope into the distal margin of obstruction.
Results: The success rate of intraductal balloon guided direct POC using access balloon catheter was 97.2% (35/36 patients). 26 patients were malignant, and 5 patients was benign biliary stricture, 4 patients showed impacted stone. DPOC was failed in one patient with benign stricture. Interventional procedures including forceps biopsy or lithotripsy were performed successfully, if needed. Procedure related complication was not occurred in all patients except one self-limited cholangitis.
Conclusions: Modifi ed access balloon catheter for cholangioscopy seems to facilitate performing intraductal balloon guided DPOC for the direct visual examination of bile duct in patients with biliary obstruction.
K-BP-02 Pancreatobiliary
The Usefulness of White Light Imaging with Narrow- Band Imaging for Diagnosing Ampullary Lesion
Jin-Seok Park1, Dong Wan Seo1, Tae Jun Song1, Do Hyun Park1, Sang Soo Lee1, Sung Koo Lee1, Myung-Hwan Kim1
Asan Medical Center, Korea1
Background: The differentiation between ampullary neoplasms and benign ampullary lesions is challenging owing to the similar endoscopic fi ndings. Narrow-band imaging system (NBI) could provide clear images of microvessel and mucosal microstructure and it has been widely used for the diagnosis of early gastric and colonic cancer. The aim of this study is to evaluate the usefulness of NBI in differentiating ampullary neo- plasm from other benign diseases.
Methods: Forty-five patients with total 60 ampullary lesions were retrospectively reviewed between March 2010 and January 2011. Inclusion criteria were those suspi- cious ampullary lesions with enlarged or protruded morphology detected during du- odenoscopy. Meaningful NBI images were classifi ed as irregular arrangements of villi, irregular size of villi, disappearance of ridged villi structure, demarcation with normal villi and abnormal microvasculature. The correlation between NBI images and histolog- ical fi ndings was analyzed
Results: Based on the histological examination, there were 11 adenocarcinoma, 26 adenoma and 23 benign inflammatory diseases in our cohort. The meaningful NBI features detected according to our classifi cation were: 45% had irregular arrangement of villi; 63% had Irregular size of villi; 50% had disappearance of ridge between villi;
48% had demarcation with normal villi; and 58% had abnormal microvasculature. In multivariate analysis, irregular arrangement of villi (OR, 15.76; 95% CI, 3.38-64.12;
P<0.001) and abnormal microvasculature (OR, 86.63; 95% CI, 14.56-515.41; P<0.001) were the signifi cant independent factors in identifying ampullary tumor. All adenomas and adenocarcinomas had at least one of the abrnomal NBI features.
Conclusions: Conclusion: In patients with enlarged or protruded ampullary lesions, the NBI fi ndings of irregular arrangement of villi and/or abnormal microvasculature were useful for the identifi cation of ampullary tumor.
K-BP-03 Pancreatobiliary
A Prospective Randomized Study for Effi cacy of Uncovered Double Bare Metallic Stent Compared to Uncovered Single Bare Metallic Stent in Malignant Biliary Obstruction: Interim Analysis
Moon Jae CHUNG1, Jeong Yup PARK1, Seungmin BANG1, Seung Woo PARK1, Si Young SONG1
Severance Hospital, Korea1
Background: It has been found that the patency duration of covered metallic stent is longer than that of uncovered metallic stent in malignant biliary obstruction. But distal migration occurs more frequently in covered metallic compared to uncovered metallic stent. The aim of this study was to compare conventional uncovered metallic stent and uncovered double bare metallic stent that was newly developed for the purpose of preventing tumor ingrowth and stent distal migration.
Methods: Patients with inoperable malignant distal biliary strictures were included in the study and randomized to receive an uncovered metallic stent (S&G Biotech Inc.) (n
= 18), an uncovered metallic stent (Taewoong Medical) (n = 17), or uncovered double bare metallic stent (S&G Biotech Inc.) (n = 17) in Severance Hospital from June 2013 to June 2014. Stent occlusion was diagnosed if patients had recurrent jaundice with evidence of elevated bilirubin levels along with biliary dilation on CT, magnetic reso- nance imaging, or US.
Results: The median patient age was 68.5 years (35-83) and 61.5% were male. The median follow-up period was 134.5 days (10-394). There was no statistically signifi - cant difference in patency duration between uncovered metallic stent (S&G Biotech Inc.), uncovered metallic stent (Taewoong Medical) or uncovered double bare metallic stent (S&G Biotech Inc.) (159±22 days vs. 151±24 days vs. 290±23 days). Three cases of post ERCP pancreatitis occurred in each group.
Conclusions: Interim analysis showed that even though there was no clinical differ- ence statistically, newly developed uncovered double bare metallic stent have trend toward longer patency duration compared to conventional uncovered metallic stent.
More sample size and follow-up period are required in order to verify these results.
