Kwangrok Jung

Autoimmune pancreatitis (AIP) is a distinct subtype of chronic pancreatitis characterized by immune-mediated inflammation and a favorable response to steroid therapy. Currently, the lack of standardized clinical practice guidelines in South Korea has led to significant variations in clinical practice, with diagnosis, steroid use, maintenance therapy, and relapse management often relying on individual clinician’s experience and judgment. To address this issue, the Pancreas Research Group of the Korean Pancreatobiliary Association (KPBA) has developed a clinical practice guideline for the diagnosis, treatment, and follow-up of AIP, reflecting the latest global evidence and the specific healthcare environment in Korea. These recommendations were established through an extensive literature review and expert consensus using the Delphi method, with the level of evidence and strength of recommendation presented according to a standardized classification system. This clinical practice guideline aims to support consistent and rational clinical decision-making for patients with AIP and to provide a standard for evidence-based treatment suitable for the Korean medical context.

Background/Aim: Pyogenic infections are common in pancreatic cancer patients with fever. This study evaluated procalcitonin as a biomarker for bacterial infection in this population.Methods: A retrospective study was conducted at Seoul National University Bundang Hospital on 149 pancreatic cancer patients who experienced 199 febrile episodes during hospitalization in 2021. The diagnostic performance of white blood cell (WBC) count, C-reactive protein (CRP), and procalcitonin was assessed using receiver operating characteristic curve analysis and area under the curve (AUC).Results: Among 199 febrile episodes, 57.3% occurred in patients with metastatic disease. The most common cause of fever was cholangitis (22.6%), followed by pneumonia (10.1%). Positive blood cultures were more frequent in patients with elevated procalcitonin (51.7% vs. 14.9%, p<0.001). Gram-negative infections were more common in the high procalcitonin group, while culture-negative cases predominated in the low group. Procalcitonin showed stronger correlation with CRP (r=0.31) than with WBC (r=0.16). AUCs were 0.550 (WBC), 0.580 (CRP), and 0.763 (procalcitonin). Patients with procalcitonin ≥1.84 ng/mL had longer hospital stays (9.36 vs. 7.37 days; p=0.0266).Conclusions: Procalcitonin showed the highest diagnostic accuracy for bacterial infection in febrile pancreatic cancer patients and may help guide antibiotic decisions.

Lazertinib is an oral, third-generation, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for the treatment of non-small cell lung cancer (NSCLC). This case report presents a rare instance of small cell carcinoma transformation in pancreatic metastasis in a patient with EGFR-mutated NSCLC undergoing treatment with lazertinib. Small cell carcinoma transformation indicates a mechanism of treatment resistance, and tissue biopsy is essential to confirm this. When isolated progression of a lesion is suspected during TKI therapy in EGFR-mutated NSCLC, histological evaluation is necessary to confirm the transformation for the treatment strategy.

Jinwoo Ahn, Yoo Sung Song, Bomi Kim, Soomin Yang, Kwangrok Jung, Jong-Chan Lee, Jaihwan Kim, Jin-Hyeok Hwang. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl240458

Jae Hyup Jung, Seung Hyun Won, Kwangrok Jung, Jun Suh Lee, Jong-Chan Lee, Jin Won Kim, Yoo‑Seok Yoon, Jin-Hyeok Hwang, Ho‑Seong Han, Jaihwan Kim. Gut and Liver 2024;18:737-46. https://doi.org/10.5009/gnl230303

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) requires radiation. This study aimed to assess the clinical factors influencing radiation exposure and devise a scoring model for predicting high‐dose radiation exposure.Methods: Endoscopic retrograde cholangiopancreatography cases recorded between 2016 and 2019 in a single tertiary teaching hospital were retrospectively reviewed. A scoring model was created by bootstrap method in a derivation cohort (2016–2018) and was assessed in a validation cohort (2019).Results: Out of 4223 ERCPs, 2983 and 1240 cases were included in the derivation and validation cohorts, respectively. In the derivation cohort, 746 cases (top 25%) comprised the high‐dose exposure group, and 2237 cases (bottom 75%) comprised the low‐dose exposure group. Nine clinical parameters associated with high‐dose exposure were male, pancreatic sphincterotomy, balloon dilatation, biliary or pancreatic drainage, procedures with contrast dye, endoscopist, in‐hospital ERCP, and spot image. Stone removal was included by bootstrap analysis. As presented in a nomogram, the weight score of each variable was as follows: male, 1; pancreatic sphincterotomy, 3; balloon dilatation, 7; stone removal, 3; biliary or pancreatic drainage, 5; procedures with contrast dye, 1; endoscopist B, 4; endoscopist C, 5; in‐hospital procedure, 3; and spot image, 3. A total score ≥ 15 suggested a high‐dose radiation exposure. The sensitivity and specificity of the model for high‐dose exposure were 0.562 and 0.813, respectively. In the validation cohort, the model showed reasonable predictability.Conclusions: Various factors were associated with radiation exposure. The simple scoring system in this study could guide endoscopists in predicting the risk of high‐dose radiation exposure.

Kwangrok Jung, Jaewoo Park, Jae Hyup Jung, Jong-Chan Lee, Jaihwan Kim, and Jin-Hyeok Hwang. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl210346