WCIM 2014 SEOUL KOREA 553
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0915 Lower GI Tract
The Postoperative Effect of Thiopurines in Patients with Intestinal Behçet’s Disease
Hye Won Lee1, Jae Hee Cheon1, Soo Jung Park1, Sung Pil Hong1, Tae Il Kim1, Won Ho Kim1
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Korea1
Background: There have been no studies focusing on the effi cacy of postoperative thiopurine therapy in intestinal Behçet’s disease (BD). We conducted this study to as- sess the clinical effects of postoperative thiopurines in intestinal BD patients.
Methods: We reviewed the medical records of all patients with intestinal BD who had undergone surgery in a single tertiary academic medical center between 1991 and 2014. The cumulative probabilities of clinical recurrence were calculated using the Kaplan-Meier method and multivariate analysis.
Results: A total of 77 patients with intestinal BD received 5-ASA or thiopurine therapy after surgery at our center. Fifty (64.9%) patients received 5-ASA and twenty-seven (35.1%) patients received thiopurines after surgery. The recurrence rate of intestinal symptoms was signifi cantly lower in patients with postoperative thiopurines (P = 0.05).
The hazard ratio of postoperative thiopurines was 0.636 (95% CI 0.130-1.016, P = 0.053) compared to the hazard ratio of postoperative 5-ASA. However, the rate of re- operation, readmission, and death were not signifi cantly different between 5-ASA and thiopurine groups.
Conclusions: Thiopurine therapy after surgery showed a relatively good effect for preventing symptom recurrence in intestinal BD patients. More patients and long-term clinical data are necessary to validate the effect of postoperative thiopurines.
PS 0916 Lower GI Tract
Clinical Features and Risk Factors of Complication in Patients with Acute Diverticulitis
Yo Han Jeong1, Kyeng Ok Kim1, Kook Hyun Kim1, Si Hyung Lee1, Byung Ik Jang1, Tae Nyeun Kim1
Yeungnam University Mecical Center, Korea1
Background: The adoption of a western lifestyle in Asian countries may result in a higher prevalence of diverticulosis. Approximately 20% of all patients with diverticula develop acute diverticulitis. The aims of the present study were to evaluate the clinical feature of acute diverticulitis and analyze the risk factors of complications.
Methods: The medical records of 228 patients who were hospitalized due to acute diver- ticulitis between January 2008 and June 2014 were reviewed, retrospectively. The patients baseline characteristics, clinical symptoms, treatment and complications were assessed.
Results: Mean age of the patients was 54.76 ± 17.53 years and male to female ratio was 138 to 90 . Recurrent attack was noted in 47 patient (20.6%). The most common symptom was abdominal pain(92.1%), fever (50%) and bloating(46.5%).
Right colon involvement was more common(74.1%). Complication was noted in 54 patients(23.7%). The most common complication was abscess formation(9.6%) and perforation occurred in 7%. Abscess formation was treated by percutaneous drainage catheter insertion and colon perforation was treated by surgery. During the follow up period, 29 patient(12.7%) experienced recurrent attack of diverticulitis. Previous histo- ry of diverticulitis is not related with complication occurrence. Patients older than 60 years more frequently developed complications during hospitalization ( P=0.047, odds ratio : 1.857). Especillay, the frequency of perforation was high (P=0.02, odds ratio : 6.22). The risk factors for complication include older age than sixty, shock and fever.
Conclusion: The most common symptom of acute diverticulitis is abdominal pain, fever and bloating. The right sided diverticulitis is dominant. Complications rate was 23.7%. The risk factor of complication include older age than sixty ,shock and fever.
Therefore, we should pay particular attention to the patients who have these risk fac- tors about occurrence of complications.
PS 0917 Lower GI Tract
Clinical Signifi cance of CT-Defi ned Ascites in Patients with Colorectal Cancer
Jae Hyun Park1, Ji Won Kim1 SMG-SNU Boramae Medical Center, Korea1
Background: Peritoneal carcinomatosis from colorectal cancer has been associated with poor survival. The purpose of this study was to evaluate the clinical signifi cance of ascites which was only defi ned by the computed tomography (CT) and whose na- ture was not determined preoperatively, in the relationship with the peritoneal carci- nomatosis.
Methods: This is a retrospective single-institution study which examined 470 patients with colorectal cancer based on the pathologic examination in our institute between January 2009 and April 2014. Factors associated peritoneal carcinomatosis were ana- lyzed in 45 patients who had CT-defi ned ascites.
Results: CT detected ascites in 45 of 470 cases (9.57%). Among 45 patients, only 4 of 45 (8.89%) patients were associated with peritoneal carcinomatosis. There are not much differences in respect of cancer stage, CEA level, and ascites amount between two groups. But the tumor size and regional lymph node enlargement may have rela- tion with peritoneal carcinomatosis.
Conclusions: CT offers effi cient detection of ascites but there are not much under- standing between ascitic fl uid and peritoneal seeding. Ascites accompanied with en- larged regional lymph node and bulky sized tumor may be associated with peritoneal carcinomatosis. But in the patients with colorectal cancer, defined ascites alone is rarely associated with peritoneal carcinomatosis, if it does not accompany other signs suggestive of malignant seeding.
PS 0918 Lower GI Tract
Two Cases of Postoperative Colonic Stenosis Treated by Endoscopic Insulated-Tip Diathermic Knife.
Jang Hoon Kwon1, Koon Hee Han1, Moon Ho Kim1, Woo Sung Jang1, Jung Ho Yun1, Yun A Song1, Jong Kyu Park1, Gab Jin Cheon1
Internal Medicine, Korea1
Background: Recently published series have indicated that postoperative colonic stenosis can occur in 5% to 46% of patients. Endoscopic therapy with balloon dila- tion and temporary stents offers a minimally invasive method for surgical revision of benign anastomotic colonic stenoses. The balloon dilation of a stenotic segments of the gastrointestinal tract has been proven to be a convenient and less invasive treat- ment method for most patients, but repeated dilation may be required. Complications associated with endoscopic therapy, including perforation, bleeding, technical failure, and stent migration, have been reported. Further, a few cases of anastomotic colonic stenosis treated by electrocautery therapy have been reported.
Methods: In the present case report, we describe two cases of post-operative symp- tomatic anastomotic stenosis that were successfully treated by electrocautery incision therapy using an IT-knife.
Results: Radial incisions were made with the IT-knife If colon muscular layer is dam- aged during radial incision, the risk of perforation could be increased, so the depth of the incision, estimated by comparison with the known width of the open biopsy forceps, was not deeper than muscular layer. There was no immediate or delayed pro- cedure-related complication such as bleeding or perforation.
Conclusions: We consider that electrocautery incision therapy using an IT-knife could be a suitable alternative method. Benign short-segment stricture on a portion of the digestive tract also seems a suitable indication for electrocautery therapy.
