Seoul, South Korea
Seoul, South Korea

Time filter

Source Type

Lee W.Y.,Sungkyunkwan University | Park K.J.,Seoul National University | Cho Y.B.,Sungkyunkwan University | Yoon S.N.,University of Ulsan | And 9 more authors.
Stem Cells | Year: 2013

Fistula is a representative devastating complication in Crohn's patients due to refractory to conventional therapy and high recurrence. In our phase I clinical trial, adipose tissue-derived stem cells (ASCs) demonstrated their safety and therapeutic potential for healing fistulae associated with Crohn's disease. This study was carried out to evaluate the efficacy and safety of ASCs in patients with Crohn's fistulae. In this phase II study, forty-three patients were treated with ASCs. The amount of ASCs was proportioned to fistula size and fistula tract was filled with ASCs in combination with fibrin glue after intrale-sional injection of ASCs. Patients without complete closure of fistula at 8 weeks received a second injection of ASCs containing 1.5 times more cells than the first injection. Fistula healing at week 8 after final dose injection and its sustainability for 1-year were evaluated. Healing was defined as a complete closure of external opening without any sign of drainage and inflammation. A modified per-protocol analysis showed that complete fistula healing was observed in 27/33 patients (82%) by 8 weeks after ASC injection. Of 27 patients with fistula healing, 26 patients completed additional observation study for 1-year and 23 patients (88%) sustained complete closure. There were no adverse events related to ASC administration. ASC treatment for patients with Crohn's fistulae was well tolerated, with a favorable therapeutic outcome. Furthermore, complete closure was well sustained. These results strongly suggest that autologous ASC could be a novel treatment option for the Crohn's fistula with high-risk of recurrence. ©C AlphaMed Press.


Kim M.-J.,Daehang Hospital | Lee E.-J.,Daehang Hospital | Suh J.-P.,Daehang Hospital | Chun S.-M.,University of Ulsan | And 5 more authors.
American Journal of Clinical Pathology | Year: 2013

Objectives: To investigate the clinicopathologic and endoscopic features of precursor lesions associated with traditional serrated adenomas (TSAs). Methods: Mutation studies for BRAF, KRAS, PIK3CA, and EGFR and immunohistochemical staining for Ki-67 were performed on 107 TSAs from 104 patients. Results: Nondysplastic hyperplastic polyp (HP) or sessile serrated adenoma/polyp (SSA/P) precursor lesions were found in 56 (52.3%) TSAs, among which 32 (57.1%) cases showed a flat-elevated lesion with a type 2 pit pattern during endoscopy. TSAs with an SSA/P precursor lesion were usually found in the proximal colon, while TSAs with an HP or with no precursor lesion were mainly located in the distal colon and rectum (P < .001). TSAs with a precursor lesion showed a lower frequency of conventional epithelialdysplasia and KRAS mutation as well as a higher frequency of BRAF mutation compared with those with no precursor lesion (P = .002, P < .001, and P < .001, respectively). Conclusions: A significant proportion of HP or SSA/P precursor lesions accompanied by TSAs can be detected by endoscopy based on both their flat-elevated growth and type 2 pit patterns. The heterogeneity of TSAs in terms of clinicopathologic and molecular features correlated with the status or type of precursor lesions. © American Society for Clinical Pathology.


Chun J.,Tuckson Colorectal Surgery | Lee D.,Daehang Hospital | Stewart D.,Penn State Milton rshey Medical Center | Talcott M.,University of Washington | Fleshman J.,University of Washington
Surgical Innovation | Year: 2011

Purpose. The aim of this study was to compare characteristics of rectal compression and stapled anastomoses at multiple time points. Methods. A total of 50 domestic pigs underwent a rectal anastomosis with a compression device or a circular stapler. They were sacrificed at zero-time, 2 days, 1 week, 1 month, and 3 months. Burst and maximal tolerated pressure and sites of failure, internal diameters, and radiographic leak rates were assessed. Desmosine (elastin) levels were determined. Results. There were no clinical or radiographic leaks. Overall, 10 out of 27 (37%) compression anastomoses burst at higher pressures than the 14 out of 24 (58%) stapled anastomoses. Mean circumference and anastomotic index were greater for the EndoCAR at 1 week and 3 months. Desmosine levels were similar. Conclusions. In the porcine model, compression rectal anastomoses with the EndoCAR had improved bursting pressures and internal circumference compared with circular stapled anastomoses. © 2011 SAGE Publications.


Chun J.,University of Washington | Parikh P.,University of Washington | Lee D.,Daehang Hospital | Fleshman J.,University of Washington
Surgical Innovation | Year: 2011

Purpose. To assess the safety of anastomosis ring (EndoCAR) following chemoradiation. Methods. A total of 10 pigs received radiation to a bioequivalent dose of 4500 cGy with 4 doses of 5-fluorouracil 400 mg/m2 and leucovorin 20 mg/m2 intravenous bolus. On day 21, each animal underwent 2 rectal anastomoses, 10 cm apart, using a 27-mm EndoCAR device and a 29-mm circular stapler. Burst pressures, desmosine and hydroxyproline levels and radiographic leaks were assessed at 2 weeks. Results. In all, 8 pigs were included in the analysis (1 pig died, 1 specimen damaged at harvest). Leaks occurred in 6 (170-300 mm Hg) stapled and 2 ring anastomoses (150-200 mm Hg; P =.13). Internal circumferences were similar (5.5 vs 5.2 cm; P =.5). Desmosine and hydroxyproline levels were similar between groups. Conclusion. Rectal anastomosis, after chemoradiation to the pig rectum using a ring (EndoCAR), is similar to stapled anastomosis. Further trials are needed in humans to determine any clinical advantage associated with these findings. © SAGE Publications 2011.


Lee E.-J.,Daehang Hospital | Lee J.B.,Daehang Hospital | Lee S.H.,Daehang Hospital | Kim D.S.,Daehang Hospital | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Purpose: Endoscopic submucosal dissection (ESD) is a very useful endoscopic technique, making it possible to perform en bloc resection regardless of lesion size. Since the introduction of ESD at our hospital, we have performed 1,000 colorectal ESDs during 56 months. The purpose of this study was to evaluate the clinical outcomes of our colorectal ESD experience and to access the efficacy and safety of colorectal ESD. Methods: Between October 2006 and August 2011, we performed ESD on 1,000 consecutive colorectal tumors in 966 patients. We evaluated the clinical outcomes of all said cases. Results: The mean resected tumor size was 24.1 ± 13.3 (3-145) mm. Our overall endoscopic en bloc resection rate was 97.5 % (975/1,000), and our R0 resection rate was 91.2 % (912/1,000) respectively. Our perforation rate was 5.3 % (53/1,000). Of these 53 perforations, 50 cases were treated through conservative management with/without endoscopic clipping, whereas the remaining 3 patients received laparoscopic operation. Pathological examination showed adenocarcinoma in 37.2 % of cases (372/1,000) and neuroendocrine tumors in 11.2 % (112/1,000). We recommended additional radical surgery to 82 patients who had a risk of lymph node metastasis. Follow-up colonoscopies were performed on 722 patients. During the median follow-up period of 13 (1-62) months, there were three recurrences (0.4 %). Conclusions: ESD is technically difficult, with a substantial risk of perforation. However, ESD enabled en bloc resection and pathologically complete resection of large colorectal epithelial tumors and submucosal tumors. As experience with the technique increases, ESD may gradually replace piecemeal endoscopic mucosal resection and radical colon resection in the treatment of colorectal tumors. © 2012 Springer Science+Business Media, LLC.


Song K.H.,Daehang Hospital
Journal of the Korean Society of Coloproctology | Year: 2012

Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae. © 2012 The Korean Society of Coloproctology.


Lee E.-J.,Daehang Hospital | Lee J.B.,Daehang Hospital | Choi Y.S.,Daehang Hospital | Lee S.H.,Daehang Hospital | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

Background The possible risk of colonic perforation during endoscopic submucosal dissection (ESD) for colorectal tumors is a barrier to wide application. This retrospective study was performed to evaluate the risk and the predictive factors for perforation during ESD procedure. Methods Between October 2006 and November 2010, a total of 499 consecutive patients (mean age 60.0 ± 11.3 years) who underwent ESD for large-sized (C20 mm), nonpedunculated colorectal tumor were analyzed. First, incidence rate and clinical course of perforation were evaluated. Second, patient-related variables (age, sex, history of aspirin or antiplatelet agents, and comorbidity), endoscopic variables (tumor size, location, and type), procedure-related variables (experience of procedures, procedure time, and materials of submucosal injection), and pathologic diagnosis were analyzed. Results The mean size of the lesions was 28.9 mm. The overall en bloc resection rate was 95.0%. Perforation occurred in 37 out of 499 patients (7.4%). Thirty-four patients could be successfully treated conservatively. Thetype (laterally spreading tumor) and the location (right-sided colon) of the tumors, less experience of the procedure (<100 cases) in each endoscopist, and submucosal injection without hyaluronic acid were associated with higher frequency of perforation (all P<0.05). On multivariate analysis, laterally spreading type of tumor [odds ratio (OR) 4.10, 95% confidence interval (CI) 1.17-14.34] and submucosal injection with hyaluronic acid (OR 0.31, 95% CI 0.13-0.72) were independent predictive factors. Conclusions Perforation rate was 7.4%, and most cases could be successfully managed nonsurgically. In case of laterally spreading type of tumor, more caution is needed during submucosal dissection and long-lasting submucosal cushion is important for preventing perforation. © The Author(s) 2011.


Snare polypectomy of a giant pedunculated colorectal polyp is sometimes technically demanding, and, therefore, piecemeal resection is inevitable, despite the relative risk of invasive cancer and postpolypectomy bleeding. The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection in comparison with conventional snare polypectomy for giant pedunculated polyps We retrospectively reviewed the clinical outcomes and complications of endoscopic polypectomy for giant pedunculated polyps from October 2006 to November 2011. All the patients who underwent endoscopic submucosal dissection (n = 23) or snare polypectomy (n = 20) for pedunculated polyps ≥ 3 cm were enrolled consecutively. In the case of a giant pedunculated polyp with 1) poor visualization of the stalk, 2) technical difficulties in snare positioning for en bloc resection, or 3) need for trimming of the head, we did not attempt piecemeal snare polypectomy, and we performed endoscopic submucosal dissection instead. (These were arbitrarily defined as "difficult" giant pedunculated polyps.) Data on the patient's demography, endoscopic and histopathologic findings, clinical outcomes, and complications were analyzed. Among the 43 giant pedunculated polyps, 23 polyps were defined as "difficult" polyps and were removed with endoscopic submucosal dissection. Subpedunculated (stalk <1 cm) type was more common in the "difficult" polyp group (p = 0.01). The overall incidence of cancer was 18.6% (8/43). En bloc resection rates were 100% (23/23) in the endoscopic submucosal dissection group and 90% (18/20) in the snare polypectomy group. The procedure times of snare polypectomy and endoscopic submucosal dissection group did not differ significantly (41.7 ± 13.7 minutes vs 44.9 ± 35.6 minutes, p = 0.70). Postpolypectomy bleeding was noted in 1 case (4.3%) in the endoscopic submucosal dissection group and in 3 cases (15%) in the snare polypectomy group. Endoscopic submucosal dissection, as well as the snare polypectomy for giant pedunculated polyps, appeared to be effective without major complications and can be an alternative option to achieve en bloc resection, particularly for difficult cases, such as giant subpedunculated polyps.


Lee E.-J.,Daehang Hospital | Lee J.B.,Daehang Hospital | Lee S.H.,Daehang Hospital | Youk E.G.,Daehang Hospital
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

Background: Endoscopic mucosal resection (EMR) is a useful therapeutic technique for colorectal tumors. However, for tumors larger than 20 mm, the chance of piecemeal resection is high. Recently introduced endoscopic submucosal dissection (ESD) enables en bloc resection regardless of the tumor size. This study aimed to compare the effectiveness and outcomes of EMR, EMR-precutting (EMR-P), and ESD in the treatment of colorectal tumors 20 mm in size or larger. Methods: This study reviewed 523 nonpedunculated colorectal tumors (499 patients) 20 mm or larger that received endoscopic treatment (EMR in 140 cases, EMR-P in 69 cases, and ESD in 314 cases) from January 2004 to November 2009. Results: The mean sizes of the tumors were 21.7 ± 3.5 mm (EMR), 23.5 ± 5.6 mm (EMR-P), and 28.9 ± 12.7 mm (ESD). The ratios of adenocarcinomas were 15.7% (EMR), 29% (EMR-P), and 37.9% (ESD). The en bloc resection rates were 42.9% (EMR), 65.2% (EMR-P), and 92.7% (ESD), and the complete resection rates were 32.9% (EMR), 59.4% (EMR-P), and 87.6% (ESD). Perforation occurred in 2.9% of the EMR-P cases and 8% of the ESD cases. The recurrence rates were 25.9% (EMR; median follow-up period, 26 months), 3.2% (EMR-P; median follow-up period, 16 months), and 0.8% (ESD; median follow-up period, 17 months). Conclusion For the treatment of large, nonpedunculated colorectal: tumors, ESD is more effective than either EMR or EMR-P. Although ESD is technically demanding, it has clinical significance by overcoming the limitations of both EMR and EMR-P. © Springer Science+Business Media, LLC 2012.


Choi Y.S.,Daehang Hospital | Lee J.B.,Daehang Hospital | Lee E.-J.,Daehang Hospital | Lee S.H.,Daehang Hospital | And 4 more authors.
Diseases of the Colon and Rectum | Year: 2013

BACKGROUND: Snare polypectomy of a giant pedunculated colorectal polyp is sometimes technically demanding, and, therefore, piecemeal resection is inevitable, despite the relative risk of invasive cancer and postpolypectomy bleeding. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection in comparison with conventional snare polypectomy for giant pedunculated polyps DESIGN AND SETTINGS: We retrospectively reviewed the clinical outcomes and complications of endoscopic polypectomy for giant pedunculated polyps from October 2006 to November 2011. Patients: All the patients who underwent endoscopic submucosal dissection (n = 23) or snare polypectomy (n = 20) for pedunculated polyps .3 cm were enrolled consecutively. In the case of a giant pedunculated polyp with 1) poor visualization of the stalk, 2) technical difficulties in snare positioning for en bloc resection, or 3) need for trimming of the head, we did not attempt piecemeal snare polypectomy, and we performed endoscopic submucosal dissection instead. (These were arbitrarily defined as ?gdifficult?h giant pedunculated polyps.) MAIN OUTCOME MEASURES: Data on the patient?fs demography, endoscopic and histopathologic findings, clinical outcomes, and complications were analyzed. Results: Among the 43 giant pedunculated polyps, 23 polyps were defined as ?gdifficult?h polyps and were removed with endoscopic submucosal dissection. Subpedunculated (stalk <1 cm) type was more common in the ?gdifficult?h polyp group (p = 0.01). The overall incidence of cancer was 18.6% (8/43). En bloc resection rates were 100% (23/23) in the endoscopic submucosal dissection group and 90% (18/20) in the snare polypectomy group. The procedure times of snare polypectomy and endoscopic submucosal dissection group did not differ significantly (41.7 ±} 13.7 minutes vs 44.9 ± 35.6 minutes, p = 0.70). Postpolypectomy bleeding was noted in 1 case (4.3%) in the endoscopic submucosal dissection group and in 3 cases (15%) in the snare polypectomy group. CONCLUSIONS: Endoscopic submucosal dissection, as well as the snare polypectomy for giant pedunculated polyps, appeared to be effective without major complications and can be an alternative option to achieve en bloc resection, particularly for difficult cases, such as giant subpedunculated polyps. © 2013 The ASCRS.

Loading Daehang Hospital collaborators
Loading Daehang Hospital collaborators