The purpose of this study was to compare the safety and efficacy of midazolam sedated Endoscopic retrograde cholangiopancreatography (ERCP) with unsedated ERCP in patients 70 years of ages and older.

Seventy elderly patients 70 years of age or older who underwent ERCP were divided into two groups: midazolam sedated group (n=43) and unsedated group (n=27). Procedure time, success rate, complications related with ERCP procedure, satisfaction score were analyzed between two groups.

Mean procedure time was 20.6 minutes for sedated group and 21.0 minutes for unsedated group (P=0.88). Success rate was 87.5% for sedated group and 100% for unsedated group (P=0.07). Incidence of complications from ERCP procedure showed no significant differences between the sedated and unsedated groups (P=0.10). There was no mortality in both groups related to the sedation or post-ERCP complication. Compared to the unsedated procedure, the sedated ERCP procedure was associated with higher patient satisfaction (P<0.001) and better repeat compliance (P=0.004).

There was no significant difference in success rate and complications at sedated and unsedated ERCP in patients 70 years of age and older. Unsedated ERCP showed 66.6% satisfaction score compared to sedated ERCP.

To investigate clinicopathologic findings and gallbladder (GB) function in patients with endoscopic bile reflux at outpatients clinic.

We classified endoscopic bile reflux into two groups by bile reflux index (BRI). Those who scored above 14 were the BRI (+) group, and those below 14 were the BRI (-) group. We analyzed clinical characteristics, endoscopic findings including Helicobacter pylori, GB function by DISIDA scan, and electron microscope (EM) findings of endoscopic bile reflux. And we compared clinicopathologic characteristics and GB function between two groups.

Endoscopic bile reflux identified in 9.7% of all cases with gastrointestinal symptoms. There are cholecystectomy in 6.7%, gastrectomy in 2.7%, and GB dysfunction in 20.0%. They had prominent gastrointestinal symptoms with variable endoscopic findings. Foveolar hyperplasia is the most common pathologic finding and H. pylori colonization of the stomach was inhibited in cases of bile reflux gastritis. Bile reflux also had distinguishable ultra-structural changes identifiable by EM. BRI (+) group had more old age, GB dysfunction than BRI (-) group. Clinical symptoms and endoscopic findings did not differ between the two groups of endoscopic bile reflux.

Endoscopic bile reflux was common findings with young adults (30's) at outpatients clinic. Foveolar hyperplasia is common pathologic finding. GB dysfunction were identified as significant risk factors for BRI (+) group.

This study aimed to provide an actualized classification system for acute pancreatitis (AP) by applying new principle and investigated the benefits of new classification.

Medical records and computed tomography (CT) images of 235 consecutive patients with AP admitted to the Ewha Womans University Mokdong Hospital between 2005 and 2010 were reviewed. The patients of severe pancreatitis who has necrosis were only 68 cases, these are too small for comparing to mild form. So we analyzed mild form of pancreatitis preferentially into two groups; group A, without morbidity and without organ failure (145 patients, mild acute pancreatitis, MAP); group B, with morbidity and without organ failure (22 patients, aggressive mild acute pancreatitis, AMAP). Clinical characteristics, laboratory findings, duration of hospitalization, need for the intensive care unit (ICU), organ failure, needs of intervention, another severity indexes and death were evaluated.

AMAP (group B) was higher proportion of need for the ICU care and of organ failure than MAP after age-adjusting (P<0.01). Also AMAP had higher incidence of associated malignancy, pseudocysts, and increasing fasting sugar level.

The AMAP is a different type of MAP. We need new category of different grade of mild form pancreatitis, because AMAP showed different clinical course. New classification of mild acute pancreatitis is relatively effective, and has clinically significant value.

Endoscopic Retrograde Cholangiopancreatogrphy (ERCP) and endoscopic sphincterotomy are useful for both diagnosis and treatment of patients with acute gallstone pancreatitis. In this study, we assessed the feasibility of emergency ERCP in patients with all gallstone pancreatitis.

We retrospectively reviewed the medical records of 66 patients, who underwent ERCP with a diagnosis of acute gallstone pancreatitis between July 1994 and December 2002. Obstructive jaundice from gallstones is excluded, because it is a distinct indication of emergency ERCP. Patients were divided into the group A (emergency ERCP group : ERCP was performed within 72 hours after hospitalization, mean 37.0±16.4 hours, range 6-70 hours) and group B (elective ERCP group ; ERCP, over 72 hours after hospitalization, mean 124.0±49.3 hours, range 76-288 hours). Comparisons of the clinical characteristics and incidence of complications were made between these two groups.

There was no significant difference for biochemical measurements, severity of pancreatitis, complications of pancreatitis, characteristics of ampulla, and length of hospital stay between the two groups, Group A had more cases (40.9%) with macroscopic stones on ERCP than group B (24.2%).

Although ERCP was a very useful modality for the diagnosis and treatment of patients having acute gallstone pancreatitis, an emergency ERCP would not be necessary unless there is definite obstructive jaundice.

As the general population ages increase leading to an increase in the demand for therapeutic ERCP interventions. The aims of this study are to assess the outcomes, safety and complications associated with ERCP performed in elderly patients.

ERCP was performed in 287 patients aged 70years or over from Jan. 2000 to Dec. 2005. All the patients were evaluated and retrospectively reviewed. The main indications, complications, success rate, mortality and risk factors of procedure were analysed.

287 patients(162 females and 122 males, mean age 78 years, range 70-94years) underwent diagnostic and therapeutic ERCP. Mortality rate was 0.03% and success rate was 91.7%. Minor complications including procedure-related complications such as pancreatitis(2.8%), minor bleeding(1.4%), and aggravated cholangitis(2.1%), mild hypoxia(SaO₂ < 90%, 15.1%), premature ventral contraction(1.0%), and tachycardia(50.7%) were transient. Major events were presented as severe hypoxia(SaO₂ < 85%) in three pts(1.0%), and atrial fibrillation in one patients (0.03%).

This study showed that diagnostic and therapeutic ERCP is safe in elderly patients. Minor complications are usually transient and mortality is similar to previous reported rate.

Pancreatitis is the most common and serious complication of ERCP. On the basis of several reports, corticosteroid, octreotide, or calcium channel blocker might be effective in this regard. The aim of this study was to determine whether the phamacologic agents(steroid, variable amount of octreotide, and verapamil) prevent post-ERCP pancreatitis.

A total of 80 patients were randomized. All patients received intravenously gabexate mesilate(Foy®) before endoscopy. Group 1 has been dose of octreotide (0.2mg blous and 6mg intravenous infusion) in group 3, and verapamil in group 4. Clinical outcomes and risk factors were analysed in each groups. We checked cytokines (IL-1, TNF-α) in group 3 and 4 compared with control and alcohol induced pacreatitis.

The overall frequency of hyperamylasemia and pancreatitis were 35% (28/80) and 13.7% (11/80), respectively. There was no difference among 4 groups with the incidence and severity of pancreatitis. The groups were similar with regard to demographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. There was no risk factors of ERCP-pancreatitis in all groups. In the cytokine data, TNF-α was markedly decreased on right after ERCP in patients with hyperamyasemia and pancreatitis.

Prophylactic administered corticosteroid, octredtid, or verpamil would not be helpful for prevention in post-ERCP pancreatitis. Also IL-1 and TNF-α may not be useful markers in prediction of ERCP-pancretitis. But TNF-α would be useful marker as mild form ERCP-pancreatitis and alcoholic pancreatitis.

The role of Helicobacter pylori(HP) in benign and malignant pancreatico-biliary tract disease is concerned in recent papers. The urease gene of Hp were found in human bile, and bacteria morphologically resembling Hp were found in resected gallbladder mucosa from patients with gallbladder disease. It was hypothesized that there is an association between the presence of Hp in bile and pancreatico-biliary disease. The aims of this study are to examine if Hp exist in the bile juice and to investigate whether Hp plays a role in the pancreatico-biliary disease.

Thirty-eight patients (18 males and 20 females, mean age 71 ?27yr ; range 45-92yr) with gallstone and malignant pancreatico-biliary disease were enrolled in this study ; 23 cases were gallstone diseases, 10 cases were cholangiocarcinomas, and 5 cases were pancreatic cancers. Thirty-eight controls were age- and sex-matched and enrolled from subject attending routine medical check-up. The presence of Hp in stomach was confirmed by ?⁴C-breath test. The polymerase chain reaction (PCR) assay was used to detect the Hp in bile.

The Hp-positive rate in stomach was much higher in control (26/38,68.4%) than the patients with pancreatico-biliary disease(l1/38, 28.9%) (p<0.01). The Hp-positive rate in bile of pancreatico-biliary disease was 18.4% but, there is no relation between of the presence of Hp in the stomach and in the bile (p=0.33). Also there was no significant difference of the presence of Hp in bile (p>0.05) and stomach (p=0.28) between benign and malignant disease.

The Hp-positive rate in bile was similar in benign and malignant pancreatico-biliary disease. But Hp may not be important risk factor in pancreatico-biliary disease in Hp-prevatent country like south Korea.

Unexpected carcinoma of gallbaldder(GB) can be found in 1-2% of specimens after surgery of benign biliary disease. This study was designed to investigate the clinicopathological and radiological characteristics of unexpected GB cancer presumed benign biliary disease and compare with originally diagnosed GB cancer.

The modical records of nineteen patients(5 males and 14 females, mean age : 64±9 years) with unexpected GB cancer diagnosed postoperatively(Group 1 : cholecystitis, 12 cases ; GB empyema, 4 cases ; cholecystitis with bile duct stone, 3 cases) and thirty seven patients (12males and 25 females, mean age : 68±11 years) with originally diagnosed GB cancer(Group 2) were retrospectively reviewed at Ewha Womans university Mokdong hospital from October, 1993 to March, 1999.

Clinical findings including right upper quadrant pain, fever, and chilling were pre-dominant in group 1 and general weakness, anorexia, and weight loss were predominant in group 2. Ultrasonographic findings of the group 1 were not typical to detect GB cacer Diffuse thickened GB wall showed 47.3% and the gallstone showed 89.5% in group 1. The mass of thickened GB wall irregularly revealed in all and gallstone showed in 50% of group 2. The TMN stage of goup 1 revealed earlier stage than group 2. The curative resection was performed in 84.2% and 10% in group 1 and 2, respectively.

The stage of unexpected GB cancer revealed relatively early stage and the curative resection rate was higher than originally diagnosed GB cancer. Therefore, the careful and detail intraoperative histologic examination of considered in patient with clinical features of benign biliary disease to detect early and improve prognosis in the patients of GB cancer.

Pancreatitis is the most common and serious complication of diagnostic and therapeutic ERCP. On the basis of several reports, corticostroid or octreotide might be effective in this regard. The aim of this study was to determine whether the pharmacologic agents(stroid and octreotide) prevent post-ERCP pancreatitis.

Patients received an intravenous infusion of hydrcortisone(100mg) and octreotide (0.2mg bolus) in treated group Tmmediately before endoscopy. A total of 140 patients(73men and 67 women, with an average age of 61.5 yr) who were scheduled to undergo diagnostic or therapeutic ERCP. Nine patients were excluded from the final evaluation for incomplete records. The remaining 131 patients, 61 in the treated group and 70 in the control group, were analyzed.

The overall frequency of hyperamylasmia and pancreatitis were 33.6%(44/131) and 7.6%(10/131), respectively. The all pancreatitis were mild. There was no difference between the groups with the incidence and severity of pancreatitis. The procedure-induced pancreatitis occured in 5 of 61(8.2%) patients treated with hydrocortisone and octreotide and 5 of 70(7.2%) patients in the control group(p=ns). the groups were similar with regard to desmographic characteristics, type of procedure performed(diagnostic or therapeutic), the presence of diverticulum, visualization of pancreatic duct. The only risk factor of ERCP-pancreatitis is the visualization of pancreatic duct in both groups.

Prophylactic administered corticosteroid and octreotide did not prevent of post-ERCP pancreatitis. Pancreatic injury may be only related to maneuver of pancreatic duct.

This study is to compare the clinical and cost effectiveness of various pharmacologic therapies with of without endoscopic procedure in the Forrest II ulcer.

Between May 2001 and June 2002, total of 58 Forrest II bleeding activity patients (37 cases of NBVV, 6 adherent blood clots, 9 flat red spot, and 6 flat black spot) with gastric ulcer(32 cases) and duodenal ulcer(26 cases) were analyzed. UGI endoscopy was performed within 12 hours of the first bleeding episodes, and underwent repetitive endoscopy after 48h. All the patients were randomly assigned to receive somatostatin(group I), PPI(omeparzole : group II), only H2 blocker (famotidine, group III), or endoscopic injection therapy followed by famotidine (group IV). We compared with rebleeding rates, changes of ulcer size, and modified estimated costs for 3 day-hospital in four groups respectively.

1) Twelve patients experienced rebleeding(20.7%). 2) The rates of rebleeding were 16.6% (2/12) in group I, 28.6%(4/14) in group II, 5.9%(1/17) in group III, 26.7% in group IV. There was no significant difference in rebleeding rate among the groups, but there was low rebleeding tendency in group III, compared with group II(p=0.087). 3) Type of stigmata including non-bleeding visible vessels and adherent clots were associated with an increased rate of recurrent bleeding(p=0.01). 4) When modified estimated costs were calculated, group III could be treated at the lowest cost(p<0.05).

In Forrest II bleeding ulcer, medical therapy, especially famotidine could be suggested prudently as a proper treatment modality for this lesion, considering the cost-effectiveness.

The aims of this study were to assess the clinical observation of outpatient who showed hematochezia, and to determine whether specific clinical symptoms associated with hematochezia were predictive of important gastrointestinal pathology.

Prospective study was carried out from July 1998 to July 1999 with sixty-five outpatients(35 males and 30 females with mean age, 43±11 years) who had no evidence of recent bleeding. Patients were interviewed by questionnaires about the amount and frequency of bleeding, change in bowel habits, weight loss, usage of aspirin/NSAIDs, and family history, prior gastrointestinal pathologic illness before colonoscopy. Based on this information, endoscopist were asked to predict whether the bleeding was from a benign perianal or other lesion. Important gastrointestinal pathology was defined as carcinoma, adenomas more than 1cm, active ulcerative colitis, and active tuberculosis by colonoscopy.

Colonoscopic findings were as follows : 27 cases of benign anorectal lesion ; 16 cases of polyps, 10 cases of normal ; 8 cases of acute colitis and nonspecific colitis ; 7 cases of coloerctal cancer, 7 cases of ulcerative colitis and intestinal tuberculosis ; and other cases. Important gastrointestinal pathology was 17 cases. Variables including duration, type and frequency of bleeding, weight loss and change in bowel habit did not predict the colonoscopic diagnosis. Of the 35 patients diagnosed clinically by endoscopist to begin anorectal lesion alone, 18 patients were found to have benign anorectal lesion, 2 patients had cancer, 2 patient had polyp(bigger than 1cm), and 1 patient had ulcerative colitis.

In outpatients with hematochezia, the incidence of colon cancer was 10.8%. Clinicians were unable to distinguish significant colonic lesions by history. Therefore accurate diagnostic workup is needed for this group of patients.

Magnetic resonance cholangiography(MRC) has emerged as an accurate and noninvasive modality for the evaluation of the biliary diseases. We performed this study to access the accuracy and efficacy of MRC for the diagnosis of obstructive biliary diseases.

From March 1999 to September 2000, 87 patients with obstructive biliary diseases(24 malignant cancers, 55 cholelithiasis, 8 other obstructive biliary diseases) underwent MRC.

MRC correctly revealed the obstructing biliary lesions and the cause of obstructions in 100% and 92% of the cases of malignancy respectively. The sensitivity and specificity of MRC were 94%, and 82% for extrahepatic bile duct stones, 94%, 100% for intrahepatic bile duct stones, and 84%, 100% for gallbladder stones retrospectively. In the other cause of biliary obstructions(3 benign biliary stricture, 2 acalculous cholecystitis, 2 xanthogranulomatous cho-lecystitis, and 1 extrinsic compression due to lymphadenopathy), MRC correctly showed the level of obstructions in all patients. But, MRC could not diagnose accurate causes of the obstruction except 3 patients(1 acalculous cholecystitis, 1 xanthogranulomatous cholecystitis, and 1 extrinsic compression due to lymphadenopathy).

This study demonstrated that MRC was able to accurately identify the level and the cause of biliary obstructions in both malignancy and cholelithiasis. MRC was easily performed for a short duration and was a noninvasive diagnostic modality for assessing the biliary tree. Therefore, MRC was very efficacious clinically for the diagnosis of obstructive biliary diseases.

Although Helicobacter pylori exists worldwide, no large population studies has been conducted on the epidemiology of the infection in South Korea. The purpose of this study is to examine the seroprevalence and determinants of H. pylori infection in an urban community in Korea.

From 22,803 residents, 1000 were randomly recruited from the 1st, 2nd, 5th and 6th clusters of Mokdong apartment complex by multi-stage sampling. In 742 subjects(74.2% of the initial sample) H. pylori specific IgG antibodies were measured by enzyme-linked immunosorbent assay. A questionnaire asking about monthly income, number of family members, education, and other social background was distributed to all subjects. In addition, each subject was measured for height and weight.

The overall seroprevalence of H. pylori infection was 48.0%. H. pylori prevalence significantly increased with age from 41.9% to 54.9%. The prevalence of infection seemed to increase with males, more family members and smoking. However, the occupation, body mass index, education, generation, alcohol consumption and monthly income of the patient were not significantly related to H. pylori seroprevalence.

This study is a large cross-sectional, randomly sampled epidemiologic study of H. pylori infection in an urban community in Korea. The seroprevalence of H. pylori infection was 48.0%. Age was discovered to be the primary risk factor with no other determinants such as the sex and sociodemography being associated to the infection of H. pylori.

Helicobacter pylori(H. pylori) infection causes an active chronic gastritis and is an important etiological factor in developement of peptic ulcers. Successful treatment of this infection heals ulcers and reduces the risk of peptic ulcer relapse. We performed this study to assess the safety, tolerance and efficacy of a one week course of triple therapy with twice daily dosing using ranitidine bismuth citrate(RBC) with clarithromycin and amoxicillin for eradication of H. pylori.

H. pylori positive thirty-five patient(mean age 51.7±15.8 years, range : 16-74 years, Male : Female=27 : 9) with active peptic ulcer were enrolled in study. H. pylori infection was detected by CLO-test or histology, both antral and corpus biopsies. Patients were treated for 7 days with combination of RBC 400mg bid, clarithromycin 500mg bid, amoxicillin 1g bid. Eradication was defined as no evidence of H. pylori infection by Urea breath test performed at 4-6 weeks after the completion of therapy. Adverse events and compliance were assessed.

Twenty six out of 35 subjects completed the study. Patient's sex, age, smoking status, alcohol consumption, or history of ulcer had no significant effect on eradication of H. pylori. The per protocol and intention-to-treat eradication rate was 88.5%(23/26) and 65.7% (23/35), respectively. The per protocol eradication rate was 100%(10/10) for duodenal ulcer, 92.3%(12/13) for gastric ulcer, and 33.4%(1/3) for gastric and duodenal ulcer, respectively. Three patients experienced side effects during therapy, none that were considered severe.

Ranitidine bismuth citrate in combination with clarithromycin and amoxicillin in a one week b.i.d dosing regimen is well tolerated and effective in eradicating H. pylori infection.

Helicobacter pylori causes chronic gastritis, which progress to peptic ulcer, gastric atrophy, or gastric cancer. However, little is known about the role of Helicobacter pylori in reflux esophagitis. Corpus gastritis reduces the parietal cell mass and decreased peak acid output as a known risk factor for reflux esophagitis. So the relationship among reflux esophagitis and corpus gastritis and Helicobacter pylori needs to be clarified.

In prospective, controlled study of patients with reflux esophagitis without other gastrointestinal disease, the prevalence of Helicobacter pylori was assessed. Antral and corpus biopsy were performed and rapid urease test and Giemsa staining were taken for Helicobacter pylori status.

The prevalence of Helicobacter pylori was 43.8%(21/48) in reflux esophagitis and 67.5%(27/40) in reference group. The prevalence of Helicobacter pylori was significantly lower in patients compared with the reference group(p<O.O5). The corpus gastritis was no significant relationship with reflux esophagitis and Helicobacter pylory.

The prevalence of Helicobacter pylori infection in patients with reflux esophagitis is significantly lower than in the reference group, irrespective of corpus gastritis. It is suggested that Helicobacter pylori infection have a preventive role to reflux esophagitis, so we may be aware of balance between 'deleterious' and 'beneficial' effects of Helicobacter pylori eradication.

The apparent acute hepatitis A was occuring among adolescene and young adults during last several years. So here we present the clinical manifestations and laboratory finding and risk factors of 72 patients with acute hepatitis A who were referred to our community hospital.

Seventy-two Patients, 6 to 40 years of age(mean ; 22±8 years) with hepatitis A identified by testing their sera for IgM anti-HAV antibody. Medical records for patients with HAV infection were retrospectively reviewed for symptoms, signs, and laboratory values.

The prevalence of hepatitis A have been increased recently, especially during last 2 years. The probable exposures to HAV included food- or waterborne source, household, foreign travel, day care centers. The clinical symptoms are not distinguishable from hepatitis due to other agents. The mean laboratory tests included total bilirubin 6.0mg/dl, AST/ALT 1064.0±1123.4mIU/mL, 1561.7±1203.0mIU/ml, respectively. All 72 patients experienced complete clinical and biochemical recovery within 6 months after onset of illness.

Abrupt increase of hepatitis A was occuring among the adolescents and young adults recently. Improved sanitation has brought our countries shifting a nearly universal asymptomatic infection in children to a less common but more significant disease expression in adults.

Since he liver is the central organ of uric acid metabolism, I investigated the utility of serum uric acid level as an indicator of the residual liver function and prediction of survival in patients with liver cirrhosis.

I measured the liver function test including uric acid level in the patients with chronic liver disease(41 patients with chronic hepatitis and 66 patients with liver cirrhosis). The serum uric acid level was analyzed for prognostic value.

The serum uric acid level was significant decreased in patients with Child-Pugh class B and C group(group III) compared with Child-Pugh class A(group II) or chronic hepatitis(group I)(p<0.001). There was no difference of the level of uric acid between alcoholic and nonalcoholic cirrhotic patients(p=0.09). The serum uric acid level was correlated inversely with serum bilirubin level in patients with cirrhosis. The sensitivity and specificity of hypouricemia in detecting liver function status in patients with liver cirrhosis were 62.5% and 100%, respectively.

The hypouricemia is one of sensitive factors to assess liver function and predictive value of survival in liver cirrhosis.