Publications by authors named "Arunchai Chang"

13 Publications

  • Page 1 of 1

Diagnostic power of DNA methylation markers suggestive of cholangiocarcinoma in ERCP-based brush cytology.

Gastrointest Endosc 2021 Jul 12. Epub 2021 Jul 12.

Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand. Electronic address:

Background & Aims: Accurate differentiation between cholangiocarcinoma (CCA) and benign biliary stricture is of paramount importance. Biliary brush cytology is a simple and safe diagnostic approach that provides relatively high specificity; however, sensitivity is limited. Previous reports indicated the aberrations of DNA methylation in CCA. This study was aimed to investigate the diagnostic performance of the methylation index (MI) of HOXA1, NEUROG1 gene promoters in CCA.

Methods: Patients with biliary stricture who underwent endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology in Siriraj Hospital from September 2016 to December 2019 were prospectively enrolled. The MI of HOXA1 (MI_H) and MI of NEUROG1 (MI_N) were determined by quantitative methylation-specific polymerase chain reaction. The diagnostic power for CCA was tested for MI from both genes and serum CA19-9.

Results: A total of 67 patients were included in the study; 41 patients had a final diagnosis of CCA, and 26 patients were determined to have a benign biliary stricture. The results showed that both MI_H and MI_N had higher sensitivity/accuracy (95.1%/82.3% and 90.2%/89.5%, respectively) than brush cytology (61.5%/78.1%) and CA19-9 (69.4%/77.8%). The combination of brush cytology, both methylation markers and CA19-9 increased sensitivity/accuracy to 97.4%/91.0%. Methylation markers were positive in 5 out of 6 patients with confirmed CCA whose cytology and CA19-9 were negative.

Conclusions: DNA methylation increased sensitivity for the diagnosis of CCA; therefore, the usage of DNA methylation is promising for diagnosis of CCA in patients with biliary strictures. A future validation study is warranted to assess its role in clinical practice.
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http://dx.doi.org/10.1016/j.gie.2021.07.005DOI Listing
July 2021

Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial.

Indian J Gastroenterol 2021 Jun 15. Epub 2021 Jun 15.

NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Background: We aimed to assess the efficacy of lactulose as prophylaxis against hepatic encephalopathy (HE) in cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB).

Methods: We conducted a randomized, double-blinded, placebo-controlled, multicenter study from October 2012 to February 2014. Cirrhotic patients presenting with AUGIB (aged 18-80 years, without HE at the time of admission) were enrolled and randomized to receive blinded medications (both physically indistinguishable), labeled "Lactulose A" and "Lactulose B" for 5 days along with standard treatment depending on the type of bleeding (variceal and nonvariceal). The primary endpoint was the development of overt HE according to the West-Haven criteria. Modified intention-to-treat analysis was performed.

Results: Forty-six patients completed the protocol: Lactulose A (placebo, n = 22) and Lactulose B (lactulose, n = 24). There was no significant difference in baseline characteristics and clinical outcomes between the two groups. Nine (19.6%) patients developed HE: five (22.7%) in the placebo group and four (16.7%) in the lactulose group (p = 0.718). One patient (2.2%) died in lactulose group. All patients tolerated the medication and no significant difference in adverse effects was detected (59.1% in placebo vs. 50.0% in lactulose group, p = 0.536). On multivariate analysis, increased baseline Child-Turcotte-Pugh (CTP) score (odds ratio [OR] 2.176; 95% confidence interval [CI] 1.012-4.681, p = 0.047) and presence of diarrhea (OR 16.261; 95% CI 1.395-189.608, p = 0.026) were independent risk factors for the development of HE.

Conclusion: Five-day lactulose is ineffective as prophylaxis against HE in cirrhotic patients with AUGIB. Unnecessary treatment with laxatives should be avoided in these patients.

Trial Registration: Clinical trial registry number TCTR20200526003 (retrospectively registered).
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http://dx.doi.org/10.1007/s12664-021-01150-2DOI Listing
June 2021

Primary follicular lymphoma of the duodenum: a case report and review of literatures.

Gastroenterol Hepatol Bed Bench 2021 ;14(2):185-189

Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.

Follicular lymphoma (FL) is one of the most common types of non-Hodgkin lymphoma (NHL). The gastrointestinal tract is the most involved extra-nodal site of NHL. Primary duodenal FL (DFL) is a rare entity with only a few reported cases. It mainly involves the second part of the duodenum and has an excellent prognosis. We report the case of a 74-year-old man who underwent esophagogastroduodenoscopy. Endoscopic findings revealed multiple small whitish mucosal nodules which were detected around the major duodenal papilla. Biopsy of these lesions was compatible with grade I FL. Further investigation failed to demonstrate any evidence of nodal or systemic involvement; thus, the clinical staging was stage I, according to the Lugano staging system. A "watch and wait" policy was chosen. Neither lesion aggregation nor lymphadenopathy was noted during the 5-year follow-up period. In conclusion, this was an uncommon case of DFL with an indolent nature and excellent prognosis. However, further studies are needed to clarify the characteristics, prognosis, and therapeutic approach.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101518PMC
January 2021

Efficacy and safety of EUS-guided hepaticoesophagostomy (EUS-HES) for malignant biliary obstruction: the first case series.

Surg Endosc 2021 Feb 24. Epub 2021 Feb 24.

Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.

Background: EUS-guided hepaticoesophagostomy (EUS-HES) was reported as an alternative procedure when puncture through the esophagus was inevitable. However, the existing data is very limited. We aimed to evaluate the efficacy and safety of EUS-HES in patients with difficult malignant biliary obstruction.

Methods: All cases who underwent EUS-HES at our institute were retrospectively reviewed.

Results: A total of 11 patients underwent EUS-HES from January 2011 to December 2017. Five were male, and the mean age was 57.9 ± 6.3 years. The majority of the patients (8 out of 11 patients) had a biliary obstruction caused by cholangiocarcinoma. The technical success was 100%. The mean procedure time was 73.2 ± 37.6 min. The main reason for EUS-HES was the improper alignment of the bile duct due to left lobe hypertrophy. The clinical success was 90.9%. The mean overall survival was 97.8 ± 68.5 days. No major procedure-related complication, particularly pneumomediastinum, occurred.

Conclusions: EUS-HES is a technically feasible and safe procedure to provide biliary drainage, especially in patients with left hepatic lobe hypertrophy. Using a bougie dilator instead of balloon dilation can avoid previously reported complications.
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http://dx.doi.org/10.1007/s00464-021-08378-1DOI Listing
February 2021

Immunoglobulin G4-associated autoimmune hepatitis with peripheral blood eosinophilia: a case report.

BMC Gastroenterol 2020 Dec 11;20(1):420. Epub 2020 Dec 11.

Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, 10700, Thailand.

Background: Immunoglobulin G4 (IgG4) associated autoimmune hepatitis (AIH) has been recognized as a type of autoimmune disease that responds to corticosteroid. The diagnosis is based on elevation of the serum IgG4 level, abundance of IgG4 enhanced plasma cell infiltration in the portal region of the liver, and satisfaction of the criteria for "definite AIH" under the revised International Autoimmune Hepatitis Group (IAIHG) scoring system. However, the clinical course of the disease is unclear.

Case Presentation: A 65-year-old man with jaundice and peripheral blood eosinophilia. His IAIHG and simplified score was compatible with definite AIH and his IgG4 level was elevated. Magnetic resonance imaging did not reveal abnormalities in the hepatobiliary system or pancreas. A liver biopsy revealed interface hepatitis with IgG4 positive plasma cell infiltration in the portal region, without evidence of bile duct injury. He responded to 4-week period of induction prednisolone therapy and had no recurring symptoms under maintenance therapy of 5 mg prednisolone during the 3-year follow up.

Conclusions: This was a rare case that demonstrated an association between IgG4 associated AIH and the presence of peripheral blood eosinophilia.
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http://dx.doi.org/10.1186/s12876-020-01559-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731570PMC
December 2020

A rare case of massive pericardial effusion due to spontaneous rupture of Streptococcus anginosus group liver abscess.

Clin J Gastroenterol 2020 Dec 25;13(6):1258-1264. Epub 2020 Jul 25.

Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand.

Purulent pericardial effusion is a rare and life-threatening complication of pyogenic liver abscess if not diagnosed and intervened early. Due to its nonspecific presentation, diagnosis of pyogenic liver abscess is challenging. Herein, we discuss the case of a 31-year-old healthy male that presented with acute chest tightness for one day in the setting of spontaneous rupture of pyogenic liver abscess and developed transdiaphragmatic extension of purulent pericardial effusion. The abscess resolved with antibiotic therapy (beta-lactam), ultrasound-guided aspiration, and pericardial window. Culture of pericardial fluid yielded the Streptococcus anginosus group. He was subsequently discharged following clinical resolution and normalization of liver function tests after 15 days of treatment. Follow-up ultrasonography revealed that the liver abscess and pericardial effusion were resolved in 8 weeks post treatment and intervention.
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http://dx.doi.org/10.1007/s12328-020-01196-3DOI Listing
December 2020

Prospective Comparison of the AIMS65 Score, Glasgow-Blatchford Score, and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding.

Clin Endosc 2021 Mar 16;54(2):211-221. Epub 2020 Jul 16.

Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.

Background/aims: This study aimed to determine the performance of the AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), and Rockall score (RS) in predicting outcomes in patients with upper gastrointestinal bleeding (UGIB), and to compare the results between patients with nonvariceal UGIB (NVUGIB) and those with variceal UGIB (VUGIB).

Methods: We conducted a prospective observational study between March 2016 and December 2017. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. The associations of all three scores with mortality were evaluated using multivariate logistic regression analysis.

Results: Of the total of 337 patients with UGIB, 267 patients (79.2%) had NVUGIB. AIMS65 was significantly associated (odds ratio [OR], 1.735; 95% confidence interval [CI], 1.148-2.620), RS was marginally associated (OR, 1.225; 95% CI, 0.973-1.543), but GBS was not associated (OR, 1.017; 95% CI, 0.890-1.163) with mortality risk in patients with UGIB. However, all three scores accurately predicted all other outcomes (all p<0.05) except rebleeding (p>0.05). Only AIMS65 precisely predicted mortality, the need for blood transfusion and the composite endpoint (all p<0.05) in patients with VUGIB.

Conclusion: AIMS65 is superior to GBS and RS in predicting mortality in patients with UGIB, and also precisely predicts the need for blood transfusion and the composite endpoint in patients with VUGIB. No scoring system could satisfactorily predict rebleeding in all patients with UGIB.
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http://dx.doi.org/10.5946/ce.2020.068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039743PMC
March 2021

Correction to: Comparison of Clinical Outcomes Between Surgical Gastrostomy and Percutaneous Endoscopic Gastrostomy with Introducer Technique in Patients with Upper Aerodigestive Malignancies: A Single-Center Analysis.

World J Surg 2020 Sep;44(9):3077-3078

Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.

In the original version of this article, there were data missing from Table 3. Following is the corrected table. The original article has been updated.
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http://dx.doi.org/10.1007/s00268-020-05579-yDOI Listing
September 2020

Comparison of Clinical Outcomes Between Surgical Gastrostomy and Percutaneous Endoscopic Gastrostomy with Introducer Technique in Patients with Upper Aerodigestive Malignancies: A Single-Center Analysis.

World J Surg 2020 09;44(9):3070-3076

Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.

Background: Conventional percutaneous endoscopic gastrostomy (PEG) in patients with upper aerodigestive malignancies inevitably carries a risk of stomal metastasis that could be avoided by the direct insertion of the gastrostomy tube through the abdomen. This study compared the efficacy and safety between surgical gastrostomy (SG) and Introducer PEG in patients with upper aerodigestive malignancies.

Methods: We retrospectively reviewed patients with upper aerodigestive malignancies undergoing SG or Introducer PEG. Procedure data, postprocedural clinical outcomes and 30-day mortality were assessed.

Results: In total, 99 patients were feasible to analysis: 53 were in the SG group, and 46 were in the Introducer PEG group. The SG group had a higher incidence of (in-hospital) major complications [28.3% VS 4.3%, p = 0.002], a longer procedure duration [52.02 ± 21.30 VS 21.46 ± 8.22 min, p < 0.001], higher pain scores at 24 h [median (interquartile range, IQR); 5(3-8) VS 1(0-5), p < 0.001] and longer length of hospitalization (LOH) [median (IQR); 5(4-6) days VS 3(2-4) days, p < 0.001)]. In-hospital (3.8% VS 0%, p = 0.493) and 30-day mortality (17.0% VS 13.0%, p = 0.586) were not different between the two groups. In univariate analysis, high BMI, anemia (hemoglobin <11 g/dL), normal nutritional status (serum albumin >3 g/dL) and procedural type were found to be predicting factors for complications. Procedural type (Introducer PEG) was an independent factor for major complications in multivariate analysis [OR = 0.12, 95% CI 0.02-0.61, p= 0.011].

Conclusions: In patients with upper aerodigestive malignancies, Introducer PEG was associated with lower rate of (in-hospital) major complications, faster operative time, lower pain scores and shorter LOH.

Clinical Trials Registry Number: TCTR20181220004.
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http://dx.doi.org/10.1007/s00268-020-05532-zDOI Listing
September 2020

Endoscopic Management of a Proximally Migrated Fully Covered SEMS Using the Stent-in-Stent Technique.

Case Rep Med 2020 26;2020:3438469. Epub 2020 Mar 26.

Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.

Endoscopic biliary decompression stent placement is an important approach for the palliative management of distal malignant biliary obstruction. However, migration of the inserted stent can occur, either distally or proximally; proximal migration is less common, but it also presents a greater challenge for endoscopic resolution. We present a case of a 67-year-old woman who had locally advanced pancreatic cancer and developed a common bile duct obstruction. Upon clinical presentation of chronic, painless, progressive jaundice, the obstruction was managed by placing of a 10 mm × 60 mm covered self-expandable metal stent (CSEMS), which successfully facilitated palliative biliary drainage. Six months later, however, the patient developed recurrent jaundice, which was determined to be due to proximal migration of the CSEMS. Repeat endoscopic retrograde cholangiography was performed, and initial attempts to retrieve the migrated stent failed. Finally, another 10 mm × 60 mm CSEMS was placed across the stricture site, inside the previous stent, which remained in place. The treatment resolved the obstruction and jaundice, and the patient experienced no adverse events.
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http://dx.doi.org/10.1155/2020/3438469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136765PMC
March 2020

Successful Closure of a Benign Refractory Tracheoesophageal Fistula Using an Over-the-Scope Clip after Failed Esophageal Stent Placement and Surgical Management.

Clin Endosc 2020 May 28;53(3):361-365. Epub 2019 Oct 28.

Vikit Viranuvatti Siriraj Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.
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http://dx.doi.org/10.5946/ce.2019.106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280855PMC
May 2020

Duodenal tuberculosis; uncommon cause of gastric outlet obstruction.

Clin J Gastroenterol 2020 Apr 21;13(2):198-202. Epub 2019 Jun 21.

Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.

Gastrointestinal tuberculosis manifesting as isolated duodenal involvement is uncommon. We present a case of 52 years old man with post-prandial abdominal pain, early satiety and weight loss. Upper endoscopy showed circumferential duodenal stricture adjacent to the ampulla with nodularity, erythema, and ulcerations of the overlying mucosa causing gastric outlet obstruction. Biopsy of duodenal stricture revealed chronic duodenitis and the patient was treated with acid suppression therapy. Endoscopic balloon dilation was also performed with no response. Abdominal computer tomography scan showed multiple enlarged abdominal lymph nodes and subsequent duodenal tissue culture was positive for Mycobacterium tuberculosis. His symptoms and duodenal stricture resolved completely after treatment with anti-tuberculous regimen.
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http://dx.doi.org/10.1007/s12328-019-01007-4DOI Listing
April 2020

Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent.

World J Clin Cases 2016 Apr;4(4):112-7

Arunchai Chang, Varayu Prachayakul, Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok 10700, Thailand.

One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type pain. Obstruction of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches, ranging from pharmacologic, endoscopic and radiologic treatments to surgical interventions. When the conservative treatment approaches fail to resolve symptomatic cases, however, endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach, despite its well-recognized drawbacks. When the conventional transpapillary approach fails to achieve the necessary drainage, the patients may benefit from application of the less invasive endoscopic ultrasound (EUS)-guided pancreatic duct interventions. Here, we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 mo. Computed tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at genu. After conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms, EUS-guided pancreaticogastrostomy (PGS) was applied using a fully covered, self-expandable, 10-mm diameter metallic stent. The treatment resolved the case and the patient experienced no adverse events. EUS-guided PGS with a regular biliary fully covered, self-expandable metallic stent effectively and safely treated pancreatic-type pain in chronic pancreatitis.
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http://dx.doi.org/10.12998/wjcc.v4.i4.112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832117PMC
April 2016
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