Efficacy of Endobiliary Radiofrequency Ablation using a Novel Endoluminal Radiofrequency Ablation Catheter in a Swine Model.

Purpose: Endobiliary radiofrequency ablation (RFA) is a new endoscopic ablative technique. However, the ideal power setting for RFA has not yet been clarified. Therefore, we intended to evaluate the effects of endobiliary RFA according to time variations using novel RFA. Materials and methods: Nine female pigs were divided into three groups according to ablation time (60, 90, and 120 seconds) with the same setting (10 watts, 80 °C). All pigs underwent endoscopic retrograde cholangiography (ERC) and endobiliary RFA in the common bile duct. Gross and histologic examinations were performed after 24 hours. Results: The ERC and application of the endobiliary RFA were 100% successful, and the post-RFA cholangiogram did not show contrast leakage. The median depth of microscopic ablation was significantly different among the three groups (60 vs. 90 vs. 120 seconds = 1.90 (1.17-2.23) vs. 2.44 (2.31-2.60) vs. 2.52 (2.47-2.64) mm, p = 0.018). There was also a linear relationship between ablation time and microscopic ablation depth (r2 = 0.552, p = 0.002). However, no significant differences in macroscopic or microscopic ablation length were observed. In addition, there were focal ablation injuries in adjacent liver tissue in five of the nine pigs (2/3 in 60, 1/3 in 90, and 2/3 in 120 seconds). Conclusion: Endobiliary RFA using a novel RFA catheter resulted in controlled ablation with a linear relationship between microscopic ablation depth and ablation time in a swine model. Clinical studies are needed to validate the safe energy condition of endobiliary RFA in malignant biliary obstruction.

Diagnostic value of magnetic resonance cholangiopancreatography to detect bile duct stones in acute biliary pancreatitis.

OBJECTIVES: This study aims to evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct (CBD) stones in acute biliary pancreatitis (ABP). METHODS: The medical records of patients presenting with ABP from January 2008 to July 2013 were reviewed to assess the value of MRCP in detecting CBD stones in ABP. Endoscopic retrograde cholangiopancreatography (ERCP) was used as the reference standard to assess the diagnostic yield of MRCP in detecting choledocholithiasis. When ERCP was unavailable, intraoperative cholangiography or clinical follow-up was used as the reference standard. RESULTS: Seventy-eight patients who underwent MRCP were diagnosed with ABP, and thirty of the 78 patients (38%) were confirmed to have CBD stones per the study protocol. The sensitivity of MRCP in detecting CBD stones in ABP was 93.3% compared to 66.7% for abdominal CT (P < 0.008). The overall accuracy of MRCP in detecting choledocholithiasis was 85.9% compared to 74.0% for abdominal CT (P < 0.041). The area under the receiver operating characteristic curve (AUC) of MRCP in detecting CBD stones was 0.882, which was more accurate than the AUC of 0.727 for abdominal CT (P = 0.039). In 38 patients who underwent ERCP, the sensitivity and negative predictive value of MRCP in detecting CBD stones were both 100% regardless of the dilatation of the bile duct (≥7 mm versus < 7 mm). CONCLUSION: MRCP is an effective, noninvasive modality to detect CBD stones in ABP and can help identify patients who require ERCP.

The association between peptic ulcer diseases and mental health problems: A population-based study: a STROBE compliant article.

This study aimed to investigate the association between the prevalence of peptic ulcer disease (PUD) and mental health problems, such as severe stress, depressive mood, and suicidal ideation.The population-based cross-sectional study was comprised of 14,266 subjects participating in the fourth annual Korea National Health and Nutrition Examination survey from 2007 to 2009. The participants were divided into 2 groups according to the self-reported questionnaires: the PUD group and the non-PUD group. The association between PUD and mental health problems, such as severe stress, depressed mood, suicidal ideation, and psychological counseling history, were evaluated by using multivariate analysis and logistic regression.Among the 14,266 participants over 19-years old, 813 participants (5.6%) had PUD. Compared to the non-PUD group (n = 13,453), the PUD group had a significantly higher percentage of males, current smokers, and heavy drinkers, lower education status, lower income, and greater presence of diabetes mellitus, hypertension, metabolic syndrome and mental health problems, including severe stress, depressed mood, suicidal ideation, and psychological counseling history. After adjustment for lifestyle and medical and environmental factors, mental health problems were found to be associated with a significantly higher risk for PUD.Psychological problems, such as severe stress, depressed mood, suicidal ideation, and psychological counseling, were associated with PUD prevalence.