The 7th Joint Session between

JDDW - KDDW - TDDW

Abstract Booklet
https://www.jddw.jp/

Welcome Address form Presidents

The 7th Joint Session between

JDDW - KDDW - TDDW

Kazuhiko Koike
I am Kazuhiko Koike, President of the Organization of Japan Digestive Disease Week (JDDW). It is agreat pleasure for me to announce and host the 7th JDDW-KDDW-TDDW (JKT) joint symposium in Kobe.
Through the past six occasions, various improvements have been made by the efforts of the respective
DDWs, which have indeed fostered this academic activity to become more and more mature and meaningful. This 7th JKT joint symposium will be held as parallel sessions using two rooms in order to secure
enough time for deeper discussions on the respective important topics of the upper GI, lower GI, liver andpancreato-biliary categories. In addition, proceedings of the joint symposium will be prepared so that the
JKT joint symposium will become a precious opportunity to promote collaborations for clinical research
work among investigators of the 3 DDWs.
At the beginning of 2023, the 8th wave of COVID-19 caused by the SARS-CoV Omicron strain is finally coming to an end inJapan, and Japan government has executed the plan of the class change of SARS-CoV infectious diseases from category 2 to 5. Although there are still some uncertainties, I hope that many of you will visit Kobe, and that it will be a fruitful academic meeting.
Finally, I would like to express my heartfelt appreciation to the executive board members of the KDDW and TDDW, and all
the presenters, moderators and discussants of this symposium for your kind understanding and warm support.
President, Japan Digestive Disease Week

Jae Gyu Kim
I would like to congratulate JDDW 2023 and the 7th Joint Session between JDDW-KDDW-TDDW 2023 as
the representative of Korean Digestive Disease Week 2023 and the Korean Society of Gastroenterology.
I am really grateful to the JDDW 2023 Steering Committee for preparing well even under difficult
circumstances.
The Joint Session between JDDW-KDDW-TDDW 2023 has developed by the continuous efforts fromJDDW of Japan, KDDW of Korea and TDDW of Taiwan until now. I think our three countries have todevelop the Joint Session even more based on these good collaboration and foundation so far. I am very
pleased to see that these goals are gradually being realized after I look through the contents of the
program. I am confident that our researchers and scholars from three countries will be able to enjoy a
festival where they share new knowledge and interests in the field of gastroenterology. In addition, I would like to say that our
three countries need to work together for further development based on this Joint Session.
The 8th Joint Session will be held in Korea next year. We will do our best to make it a great success. Lastly, I would like toexpress my deepest gratitude to everyone who prepared for the Joint Session between JDDW-KDDW-TDDW 2023 and to those
who attended.
President, Korea Digestive Disease Week 2023
President, The Korean Society of Gastroenterology

Ming-Shiang Wu
Dear Esteemed Colleagues and Distinguished Guests,
On behalf of the Gastroenterological Society of Taiwan (GEST), it is my great pleasure to extend a warm
welcome to the first in-person meeting of the Japan-Korea-Taiwan (JKT) joint session at JDDW 2023.
This significant event marks a momentous occasion as we convene for the first time in person after enduring
the challenges posed by the COVID-19 pandemic. The resilience and commitment of our medical communities
have allowed us to come together again, fostering the spirit of collaboration and knowledge exchange.
Japan, Korea, and Taiwan share not only common digestive disease patterns but also similar trajectories in
economic development and healthcare systems. These similarities create a unique synergy that enhances
our collective ability to address the complexities of digestive health. This joint session stands as an ideal
platform for clinicians and researchers from these three countries to share cutting-edge knowledge and the latest advances indigestive medicine.
In this collaborative environment, I am confident that our shared expertise will pave the way for innovative breakthroughs,
ultimately benefiting patients across our nations. I encourage all participants to actively engage in discussions, foster partnerships, and explore new avenues of research.
I extend my heartfelt gratitude to everyone involved in organizing this event, and I eagerly anticipate fruitful discussions,inspiring insights, and lasting collaborations.
Thank you for your dedication to advancing the field of gastroenterology. Together, let us embark on this journey of knowledge
exchange and transformative progress.
Warm regards,
Prof. Ming-Shiang Wu
President, The Gastroenterological Society of Taiwan (GEST)CONTENTS
JKT1

Lower GI

Recent updates in multidisciplinary treatment for colorectal cancer in Asia
Speaker

Evolution of lower rectal cancer treatment with multidisciplinary approach.
Yuji Toiyama ��������������������������������������������������������������������������������������������������������������������������������������������������������� pg 8
Long-term Outcomes of Endoscopic Resection in T1 Colorectal Cancer and Strategies for Determining Additional
Surgery

Yunho Jung ����������������������������������������������������������������������������������������������������������������������������������������������������������� pg 9
Adding bevacizumab to neoadjuvant chemoradiotherapy increases pathological complete remission and survival inpatients with locally advanced rectal cancer

Jason Chia-Hsien Cheng ������������������������������������������������������������������������������������������������������������������������������������ pg 10

Rising Star Program
Colonoscopy for colorectal cancer screening and management of early colorectal cancer
Masau Sekiguchi ������������������������������������������������������������������������������������������������������������������������������������������������ pg 11
Recent advances in multidisciplinary treatment for colorectal cancer
Hyun Seok Lee ��������������������������������������������������������������������������������������������������������������������������������������������������� pg 12
Role of endoscopic muscular dissection for rectal cancer with clinical complete response after concurrent
chemoradiotherapy

Chao-Wen Hsu ���������������������������������������������������������������������������������������������������������������������������������������������������� pg 14

JKT2

Upper GI

Multimodal treatments for esophagogastric junction cancer
Speaker

Neoadjuvant chemotherapy and conversion surgery for EGJ adenocarcinoma
Yu Imamura ��������������������������������������������������������������������������������������������������������������������������������������������������������� pg 16
Minimally invasive surgery for gastroesophageal junction adenocarcinoma
Jin-Jo Kim������������������������������������������������������������������������������������������������������������������������������������������������������������ pg 17
Exploring the feasibility of endoscopic management for T1b esophageal cancer
Chu-Kuang Chou ������������������������������������������������������������������������������������������������������������������������������������������������� pg 18

Rising Star Program
Approach and therapeutic value index for Siewert type 2 esophagogastric junction adenocarcinoma

Eisuke Booka ������������������������������������������������������������������������������������������������������������������������������������������������������ pg 19
Endoscopic treatment for esophagogastric junction carcinoma
Yang Won Min ����������������������������������������������������������������������������������������������������������������������������������������������������� pg 20
Recent advances in perioperative treatment for esophagogastric junction cancer

KuoHsing Chen ��������������������������������������������������������������������������������������������������������������������������������������������������� pg 21

JKT3

Biliary, Pancreas

Current status and future perspectives of Interventional EUS in Asia
SpeakerCurrent status and future perspectives of Interventional EUS in Japan
Akio Katanuma ��������������������������������������������������������������������������������������������������������������������������������������������������� pg 24
Development and Clinical Application of a Novel Stent for EUS-Guided Transmural Drainage
Lee Sang Hyub ��������������������������������������������������������������������������������������������������������������������������������������������������� pg 25
Endoscopic ultrasound-guided gastroenterostomy with a lumen-apposing metal stent : a multicenter prospective study
Yu-Ting Kuo �������������������������������������������������������������������������������������������������������������������������������������������������������� pg 27

Rising Star Program
Clinical outcomes of EUS-guided antegrade stone removal for common bile duct stones in patients with surgicallyaltered anatomy
Shuntaro Mukai ��������������������������������������������������������������������������������������������������������������������������������������������������� pg 28
Current status and future perspectives of Interventional EUS in Asia
focused on EUS-guided gallbladder drainage in South Korea

Se Woo Park ������������������������������������������������������������������������������������������������������������������������������������������������������� pg 29
Radiofrequency ablation: A novel endoscopic focal treatment of pancreatic cancer
Meng-Ying Lin ����������������������������������������������������������������������������������������������������������������������������������������������������� pg 30

JKT4

Liver

Tailoring multiple lines of systemic therapy for advanced HCC
Speaker

Tailoring systemic treatment based on tumor burden for advanced hepatocellular carcinoma.
Tatsuya Yamashita �������������������������������������������������������������������������������������������������������������������������������������������� pg 32
Surgical Conversion in Locally Advanced Hepatocellular Carcinoma Through Multimodal Systemic Therapy
Su Jong Yu ���������������������������������������������������������������������������������������������������������������������������������������������������������� pg 33
Proton Therapy for Hepatocellular Carcinoma
Huang Bing-Shen ������������������������������������������������������������������������������������������������������������������������������������������������ pg 34

Rising Star Program
Importance of preclinical rationales to establish appropriate treatment sequences in the era of chemo-diversity for HCC

Hideki Iwamoto ��������������������������������������������������������������������������������������������������������������������������������������������������� pg 35
Tailoring multiple lines of systemic therapy for advanced HCC
Cho Yuri �������������������������������������������������������������������������������������������������������������������������������������������������������������� pg 36
Role of liver-directed therapy for advanced hepatocellular carcinoma in the era of combination immunotherapy

Yung-Yeh Su ������������������������������������������������������������������������������������������������������������������������������������������������������� pg 37

The 7th Joint Session between

JDDW - KDDW - TDDW

Abstract

白

JKT1

9:00-11:15
Kairaku 3[Room 9]Lower GI

Recent updates in multidisciplinary treatment for colorectal
cancer in Asia

Chair (J):

Chair (K):

Chair (T):Discusser (J):

Discusser (K):Discusser (T):Speaker (J):Soichiro Ishihara

Department of Surgical Oncology The University of Tokyo Graduate School of Medicine, Japan

Tae Il Kim

Department of Internal Medicine, Yonsei University College of Medicine, Korea

Han-Mo Chiu

National Taiwan University Hospital, Taiwan

Yosuke Fukunaga

Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital,
Japan

Bo-In Lee

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Korea

Chien-Chih Chen

Koo Foundation Sun Yat-Sen Cancer Center, Taiwan

JKT1-1

Evolution of lower rectal cancer treatment with multidisciplinary approach.

Yuji Toiyama

Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute ofLife Sciences, Mie University Graduate School of Medicine, Tsu, Japan
Speaker (K):JKT1-2Long-term Outcomes of Endoscopic Resection in T1 Colorectal Cancer
and Strategies for Determining Additional Surgery

Yunho Jung

Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South
Korea
Speaker (T):JKT1-3

Adding bevacizumab to neoadjuvant chemoradiotherapy increases
pathological complete remission and survival in patients with locallyadvanced rectal cancer

Jason Chia-Hsien Cheng

Department of Oncology, National Taiwan University Hospital, Taiwan
Rising Star Program (J):JKT1-RS1Colonoscopy for colorectal cancer screening and management of earlycolorectal cancer

Masau Sekiguchi

Cancer Screening Center/Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
Rising Star Program (K):JKT1-RS2

Recent advances in multidisciplinary treatment for colorectal cancer

Hyun Seok Lee

Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook
National University, Kyungpook National University Chilgok Hospital, Korea
Rising Star Program (T):JKT1-RS3

Role of endoscopic muscular dissection for rectal cancer with clinicalcomplete response after concurrent chemoradiotherapy

Chao-Wen Hsu

Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Taiwan

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT1-1

Evolution of lower rectal cancer treatment with multidisciplinary
approach.

Yuji Toiyama1), Mikio Kawamura1), Yoshinaga Okugawa2)
Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute ofLife Sciences, Mie University Graduate School of Medicine, Tsu, Japan,
2)
Department of Genomic Medicine, Mie University Hospital, Tsu, Japan
1)

In Japan, historically, surgery is the primary treatment for lower rectal cancer. Total mesorectal excision (TME) has
established the standard surgical approach for rectal cancer since 1980 and has significantly improved local control
and survival rates. In addition, from evidence achieved by JCOG0212, the JSCCR Guidelines recommend performing TMEwith lateral lymph node dissection (LLND) for cT3 or deeper lower rectal cancer.
In the West, the therapeutic effects of extended lymph node dissection including with LLND were reported in the 1950s.
However, due to a high incidence of distant recurrence and postoperative sexual and urinary dysfunction, several
clinical trials demonstrated the usefulness of radiation therapy with concurrent chemotherapy before surgery for the
suppression of local recurrence. Since then, preoperative chemoradiotherapy (CRT) + TME has become the standard
treatment.
Thus, while both preoperative CRT and LLND aim to control pelvic local recurrence, they face challenges in controlling
distant metastasis and improving survival. In this context, a powerful preoperative treatment known as Total Neoadjuvant
Therapy (TNT), which sequentially introduce radiation therapy and systemic chemotherapy before surgery, has been
introduced in Western countries, and demonstrated further shrinking the primary tumor and reducing distant metastasis.
The development of preoperative CRT for rectal cancer has resulted in an increase in cases achieving pathologicalcomplete response (CR). In 2004, Habr-Gama proposed the Watch & Wait approach, which involves avoiding immediate
surgery and observing patients who achieve clinical CR after preoperative treatment. This approach has been validated
as a safe and high-quality treatment primarily in Europe and the United States. It represents a significant shift from theconventional concept of surgery and is expected to increase the proportion of rectal cancer patients who can undergo
organ preservation by introducing TNT in the preoperative treatment.
Advances in molecular profiling and genetic testing have enabled the identification of specific genetic mutations orbiomarkers in rectal cancer. In particular, the patients with microsatellite satellite instability have merit to use immune
checkpoint inhibitors, since high clinical CR rate in extremely high rate and non-operative management can be achieved.
Overall, the evolution of lower rectal cancer treatment with a multidisciplinary approach has led to improved outcomes,
reduced morbidity, and enhanced quality of life for patients. Collaboration among surgeons, medical oncologists, radiation
oncologists, pathologists, radiologists, and other healthcare professionals is crucial in delivering optimal care and tailoring
treatments to individual patients.

Curriculum Vitae
Yuji Toiyama   

Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine,
Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
Name: Yuji Toiyama, MD, PhD, FACS
Date of Birth: July 25,1969
Present Academic Rank and Position:
Professor of both Department of Gastrointestinal& Pediatric Surgery and Innovative Surgery andSurgical Techniques Development, Division ofClinical Sciences, Mie University Graduate
School of Medicine in Japan.
Research Career and Experience

1. Education:
1997: MD. Mie University School of Medicine
2005: Ph.D. Mie University Graduate School of Medicine

2.Professional Training and Employment:
2007-2011: Associate Professor, Mie University Hospital
2007-2011: Assistant Professor, Mie University Hospital
2011-2013: V isiting Researcher, Post Doctor Fellow, Baylor Medical Center
at DALLAS
2013-2016: A ssociate Professor, Department of Gastrointestinal andPediatric Surgery
2018-2020: A ssociate Professor, Department of Gastrointestinal andPediatric Surgery
2020-: Professor, Department of Gastrointestinal &Pediatric Surgery, Divisionof Clinical Sciences, Mie University Graduate School of Medicine
2022-: P rofessor, Department of Innovative Surgery and Surgical Techniques
Development, Division of Clinical Sciences, Mie University Graduate
School of Medicine
3. Board certification
Japan Surgical Society
・The Japanese Society of Gastroenterological Surgery
・The Japanese Society for Coloproctology
・The Japanese Society of Gastroenterology
・The Japanese Gastroenterological Association
・The Japanese Society for Hereditary Tumors
・Japanese Society for Abdominal Emergency Medicine
・Japanese Board of Cancer Therapy
・Infection Control Doctor
・American College of Surgeons Fellow (FACS)

8

4. Research Fields
His attention has focused on colorectal surgery with bowel function and organ
preservation for the patients with colorectal cancer and inflammatory bowel
disease as well as perioperative management for the goal of decreasing
surgical complications.
Notable achievements of his research are the molecular biology of colorectal
cancer and inflammatory bowel disease to understand the genetic andepigenetic mechanisms involved in the development and progression of these
diseases. His work shed light on the underlying factors contributing to theaggressive nature of these diseases and pave the way for potential diagnostic
and therapeutic interventions.
5. Bibliography
English articles: 307 papers, First Author: 50 papers
Representative first author’s papers
・Changes in surgical therapies for rectal cancer over the past 100 years: A
review.
Ann Gastroenterol Surg. 2020 May 10;4(4):331-342.
・A Panel of Methylated MicroRNA Biomarkers for Identifying High-Risk
Patients With Ulcerative Colitis-Associated Colorectal Cancer
Gastroenterology. 2017 Dec;153(6):1634-1646.e8.
・Circulating microRNA-203 predicts prognosis and metastasis in humancolorectal cancer Gut. 2017 Apr;66(4):654-665.
Serum miR-200c is a novel prognostic and metastasis-predictive biomarker inpatients with colorectal cancer Ann Surg. 2014 Apr;259(4):735-43.
・Elevated serum angiopoietin-like protein 2 correlates with the metastatic
properties of colorectal cancer: a serum biomarker for early diagnosis andrecurrence
Clin Cancer Res. 2014 Dec 1;20(23):6175-86.
・Serum miR-21 as a diagnostic and prognostic biomarker in colorectal
cancer.
J Natl Cancer Inst. 2013 Jun 19;105(12):849-59.

November 2, 2023 Kobe Portopia Hotel

JKT1-2Long-term Outcomes of Endoscopic Resection in T1 Colorectal Cancer
and Strategies for Determining Additional Surgery

Yunho Jung       Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South
Korea

Introduction: Colorectal cancer (CRC) is the third or fourth commonest cancer worldwide. Some of the CRCs, which were treated only by surgery, are increasing in frequency of being
treated with endoscopic procedures such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). However, since Lymph node metastasis (LNM) is observedin some T1 CRC cases, it is essential to consider the possibility of LNM before deciding on endoscopic and surgical treatment. In this chapter, I’d like to discuss the long-term outcome
after endoscopic treatment in T1 CRC.
Histological classification and LNM: Depth of invasion into the submucosa and deeper colonic layers based on pathological assessment have been described according to different
classification methods such as TNM staging, Haggitt, and Kikuchi systems. According to “TNM staging” of CRC, T1 means the malignant cells invade through the muscularis mucosae into
the submucosa but do not breach the muscularis propria.1 The incidence of LNM was reported to be 6.8–17.8% in T1 CRC.2
Recommendation by current guidelines: The indication criteria for surgical resection as an additional treatment after endoscopic resection of T1 CRC have been defined in the Korean,3Japanese,4, and United States guidelines.5 Surgical resection with lymph node dissection is recommended if any of the following findings is observed: (1) positive vertical margin; (2) depthof submucosal invasion≥100µm; (3) positive lymphovascular invasion; (4) poorly differentiated adenocarcinoma, signet-ring cell carcinoma, or mucinous carcinoma; (5) Tumor budding(BD2/3).
Comparison of Outcomes of Endoscopic resection vs surgery: A population-based study of 13,157 patients reported no difference in the 5-year survival rate between endoscopic resection
and surgical treatment for early-stage colon cancers located in the left colon regardless of size and right-sided lesions that were <2 cm; however, surgical resection had greater survival incomparison to endoscopic resection (20–39 mm: 91.8 vs 74.2%; ≥40 mm: 92.4 vs 60%).6 Similarly, Mounzer et al also reported no difference in 5-year colorectal cancer-specific recurrencefree survival rates (97.6% vs 97.5%; p=0.75) between endoscopic resection and surgical resection of T1 colorectal tumors.7
Conclusions: When endoscopic removal was performed based on the current guidelines considering the possibility of L/N metastasis for T1 CRC, the long-term outcome does not appear to beinferior to surgical removal. After endoscopic removal of T1 CRC, it is considered important to establish additional surgery plans or appropriate follow-up plans based on histological results.
References
1. MB. A, SB. E. AJCC Cancer Staging Manual Springer 2017.
2. Saitoh Y, Inaba Y, Sasaki T, Sugiyama R, Sukegawa R, Fujiya M. Management of colorectal T1 carcinoma treated by endoscopic resection. Dig Endosc 2016;28:324-9.
3. Park CH, Yang DH, Kim JW, et al. Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer. Clin Endosc 2020;53:142-66.
4. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020;25:1-42.
5. Kaltenbach T, Anderson JC, Burke CA, et al. Endoscopic Removal of Colorectal Lesions-Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc
2020;91:486-519.
6. Gangireddy VGR, Coleman T, Kanneganti P, et al. Polypectomy versus surgery in early colon cancer: size and location of colon cancer affect long-term survival. Int J Colorectal Dis
2018;33:1349-57.
7. Mounzer R, Das A, Yen RD, et al. Endoscopic and surgical treatment of malignant colorectal polyps: a population-based comparative study. Gastrointest Endosc 2015;81:733-40 e2.

Curriculum Vitae
Yunho Jung   Department of Internal Medicine, Soonchunhyang University College of Medicine,
Cheonan, South Korea

Professional Career:
2009.5.– 2010.3. C linical fellowship in
Soonchunhyang University
Hospital (Division of
Gastroenterology)
2010.7.– 2012.6 R esearch fellowship in
Beth Israel Deaconess
Medical Center, Harvard
Medical School (Divisionof Gastroenterology)
2012.7. ~ P rofessor in Soonchunhyang University Cheonan
Hospital (Gastroenterology)
Main Interests:
Colorectal disease
Endoscopic resection techniques in gastrointestinal tract
Inflammatory bowel disease
Publications:
1. Jung Y, Kang SB, Yoon HJ, Cha JM. Improving the Tolerability
and Safety of 1L Polyethylene Glycol Plus Low-dose Ascorbic
Acid for Bowel Preparation in a Healthy Population: A Randomized,
Multicenter Clinical Trial. Gastrointest Endosc. 2022
Aug;96(2):341-350

2. Jung Y. A new band ligation device to treat colonic diverticular
bleeding. Clin Endosc. 2022 May;55(3):367-368
3. Jung Y, Kim JW, Im JP, Cho YK, Lee TH, Jang JY. Safety of
Gastrointestinal Endoscopy in Korea: A Nationwide Survey andPopulation-Based Study. J Korean Med Sci. 2022 Jan 24;37(4):e24
4. Yoon HJ, Sohn DK, Jung Y, Lee HS, Koo HS, Kim KO, Shin JE,
Kim HG, Chung IK, Hwangbo Y. Does precutting prior toendoscopic piecemeal resection of large colorectal neoplasias
reduce local recurrence? A KASID multicenter study. Surg
Endosc. 2022 May;36(5):3433-3441.
5. Jung Y, Masayuki Kato. Commentary on “Comparative Study ofNarrow-Band Imaging and i-scan for Predicting the Histology ofIntermediate-to-Large Colorectal Polyps: A Prospective,
Randomized Pilot Study” Clin Endosc. 2021 Nov;54(6):781-782.
6. Jung Y, Baik GH, Ko WJ, Ko BM, Kim SH, Jang JS, Jang JY, Lee
WS, Cho YK, Lim SG, Moon HS, Yoo IK, Cho JY. Diode Laser-Can
It Replace the Electrical Current Used in Endoscopic Submucosal
Dissection? (with Video). Clin Endosc. 2021 Jul;54(4):555-562.
7. Jung Y, Moon JR, Jeon SR, Cha JM, Yang HY, Park S, Ahn Y,
Byeon JS, Kim HG. Usefulness of narrow-band imaging for thedetection of remnant sessile-serrated adenoma (SSA) tissue
after endoscopic resection: the KASID multicenter study. Surg
Endosc. 2021 Sep;35(9):5217-5224

9

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT1-3

Adding bevacizumab to neoadjuvant chemoradiotherapy increases
pathological complete remission and survival in patients with locallyadvanced rectal cancer

Jason Chia-Hsien Cheng, Yun Chiang, Jin-Tung Liang
Department of Oncology, National Taiwan University Hospital, Taiwan

Purpose: This retrospective study investigated the impact of adding bevacizumab to neoadjuvant
chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).
Methods: This retrospective study enrolled patients with LARC undergoing NCRT with or without bevacizumab
followed by curative resection at National Taiwan University Hospital from 2009 to 2021. Locoregional
recurrence was defined as recurrence within the irradiated field and distant metastasis as outside theirradiated field. Associations between clinical factors and pathological complete remission (pCR), overall
survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) wereanalyzed using ANOVA and Cox proportional hazards model. Propensity score matching (PSM) analysis wasused to evaluate the effects of adding bevacizumab. Programmed death-ligand 1 (PD-L1) immunostaining on
rectal tumor biopsies taken at diagnosis was conducted to assess the correlation between PD-L1 expression
level and treatment response.
Results: A total of 200 patients were enrolled. Of these, 39 patients (18/54 vs. 21/146 without bevacizumab,
p=0.004) achieved pCR. Patients receiving bevacizumab had more T4 disease (p=0.005), low-lying rectal
tumor (p=0.047), concurrent oxaliplatin use (p<0.001), but less frequent adjuvant chemotherapy (p=0.005).
With a median follow-up of 71 months, 5-year OS, LRFS, and DMFS were 86%, 84%, and 79%, respectively.
Factors associated with pCR in univariate analysis were clinical N0 (cN0), gross tumor volume ≤70 ml, andadding bevacizumab. In multivariate analyses, cN0 and adding bevacizumab remained significantly associatedwith pCR, and pCR was the only independent factor for OS (HR=0.32, p=0.004), DMFS (HR=0.29, p<0.0001),
and LRFS (HR=0.32, p=0.002). In PSM cohort, adding bevacizumab was associated with better OS (p=0.034)
and DMFS (p=0.045). A high PD-L1 expression, as determined by the VENTANA PD-L1 (SP263) assay, wasassociated with pCR rate only in patients receiving the additional bevacizumab.
Conclusions: Adding bevacizumab to NCRT in LARC patients contributes to improved survival by increasing
pCR with tolerable toxicities. A correlation might exist between immunochemical PD-L1 expression level andthe response to bevacizumab.

Curriculum Vitae
Jason Chia-Hsien Cheng   Department of Oncology, National Taiwan University Hospital, Taiwan
Jason Chia-Hsien Cheng, M.D., M.S., Ph.D., FASTRO (成佳憲)
PRESENT POST
Professor, Graduate Institute of Oncology, National Taiwan
University College of Medicine, Taipei, Taiwan Attending
Physician, Division of Radiation Oncology, Department of
Oncology, National Taiwan University Hospital, Taipei,
TaiwanFellow of American Society for Radiation Oncology (FASTRO)
E-mail 1: jasoncheng@ntu.edu.tw;

EDUCATION
Sep 1987 - Jun 1994:	M .D. Degree in Medicine, National Yang-Ming University School of
Medicine, Taipei, Taiwan
Sep 2000 – Jun 2002:	Master degree in Health Care Organization Administration at School of
Public Health, National Taiwan University, Taipei, Taiwan
Sep 2002- Jan 2005:	Ph.D. degree in the Institute of Electrical Engineering at National Taiwan
University, Taipei, Taiwan
ACADEMIC APPOINTMENTS
Jul 1994 - Aug 1997:	Resident, Department of Radiation Oncology, Koo Foundation Sun Yat-Sen
Cancer Center, Taipei, Taiwan
Sep 1997 - Aug 1998:	Fellow, Radiation Oncology Center, Mallinckrodt Institute of Radiology,
Barnes-Jewish Hospital, Washington University Medical Center, St. Louis,
U.S.A.
Sep 1998:	Attending Physician, Department of Radiation Oncology, Koo Foundation Sun Yat-Sen
Cancer Center, Taipei, Taiwan
May 2000:	Research Award of the Year by the National Science Council, Taiwan
Feb 2001:	Instructor, Faculty of Medicine, National Yang-Ming University School of Medicine,
Taipei, Taiwan
April 2001:	Research Award of the Year by the National Science Council, Taiwan
December 2001: Fellowship Award of the 3rd Takahashi Memorial International Workshop on 3
Dimensional Conformal Radiotherapy
May 2002: Article Award of the Chinese Society for Therapeutic Radiology and Oncology
December 2004: Fellowship Award and Junior Investigator Award of the 4th Takahashi Memorial
International Workshop on 3 Dimensional Conformal Radiotherapy
August 2005: Travel Grant Award of the American Society for Therapeutic Radiology andOncology 2005 Translational Research in Radiation Oncology Symposium
February 2006: Assistant Professor, Graduate Institute of Clinical Medicine, National Taiwan
University College of Medicine, Taipei, Taiwan

10August 2007: Article Award of Professor Jue-Low Sung Academic Foundation, Taiwan
August 2007: Junior Investigator Award of the National Science Council, Taiwan
August 2009 – July 2013: Associate Professor, Graduate Institute of Oncology, National Taiwan
University
December 2011 – June 2012: Visiting Scholars Associate Professor, Department of Radiation
Oncology, Stanford University, California, USA
August 2013 – Now: Professor, Graduate Institute of Oncology, National Taiwan University
Award, Editorial Boards or Reviewers for Journals
Fellow Award of American Society for Radiation Oncology (FASTRO) (2018)
Outstanding Research Award of the Ministry of Science and Technology, Taiwan (2018)
International-US Scientific Award (team leader) News Briefing at 2014 ASTRO Annual Meetingfor the important research (2014)
Junior Investigator (Wu Ta You) Award of the National Science Council, Taiwan (2007)
Fellowship Award and Junior Investigator Award of the 4th Takahashi Memorial International
Workshop on 3 Dimensional Conformal Radiotherapy (2004)
Fellowship Award of the 3rd Takahashi Memorial International Workshop on 3 Dimensional
Conformal Radiotherapy (2001)
Council Member of Asia-Pacific Primary Liver Expert (APPLE) from September 2019
Founder of Asian Liver Radiation Therapy (ALRT) Special Interest Group (SIG) from 2015
Principal Investigator of Radiation Therapy Oncology Group (RTOG), NRG Oncology at National
Taiwan University Hospital (Affiliated Member) from July 2009
Committee member of NRG Oncology GI General Committee from January 2016
Panel Member of NCCN Asia Consensus Statement: Prostate Cancer from January 2010
Advisory Board of International Journal of Radiation Oncology, Biology, Physics
Associate Senior Editor of International Journal of Radiation Oncology, Biology, Physics
Editorial Board of Journal of Clinical and Translational Hepatology
Editorial Board of Biomedicines
Editorial Board of Journal of Radiation Oncology
Editorial Board of Therapeutic Radiology and Oncology
Reviewers of International Journal of Radiation Oncology, Biology, Physics, International Journalof Cancer, Scientific Reports, Radiotherapy and Oncology, American Journal of Clinical Oncology,
Liver Cancer, Journal of Gastroenterology and Hepatology, Liver International, Hepatology
International, Cancers, BMC Cancer, Radiation Oncology, Medical Dosimetry, Journal of
Biomedical Science, Journal of Medical and Biological Engineering, Breast Cancer Research andTreatment, Oncology, Journal of X-Ray Science and Technology, PLoS One, Journal of the
Formosan Medical Association, Journal of Chinese Medical Association, etc.

November 2, 2023 Kobe Portopia Hotel

JKT1-RS1Colonoscopy for colorectal cancer screening and management ofearly colorectal cancer

Masau Sekiguchi
Cancer Screening Center/Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

Screening, diagnosis, and treatment of precancerous lesions and early colorectal cancer (CRC) are essential
to lower the mortality of CRC, and colonoscopy plays an important role. Population-based CRC screening
using a fecal immunochemical test followed by colonoscopy has been implemented since 1992 in Japan;
however, CRC remains a leading cause of cancer-related deaths. Considering the potential effectivenessand cost-effectiveness of screening colonoscopy, discussions about more efficient use of colonoscopy in
CRC screening are warranted (Sekiguchi M, et al. Jpn J Clin Oncol. 2016;46:116-125). Risk-stratificationof the screening population and the possibility of using computer-aided detection systems for screeningcolonoscopy also warrant discussion (Sekiguchi M, et al. J Gastroenterol. 2018;53:1109-1119/ Sekiguchi
M, et al. Dig Endosc. 2023;10.1111 [published online ahead of print]). Regarding the treatment of early CRC,
endoscopic submucosal dissection (ESD) has become the standard treatment method for large cTis and T1acancers. Compared to piecemeal endoscopic mucosal resection, ESD is more acceptable for large lesionsin terms of effectiveness and cost-effectiveness (Sekiguchi M, et al. Dig Endosc. 2022;34:553-568). Despite
the remarkable development of endoscopic diagnosis, pT1b cancers occasionally occur after endoscopic
resection. The current standard management method for pT1b cancer is colectomy with lymphadenectomy;
however, whether surgical treatment should be performed in patients at risk for operative complications, suchas elderly patients, is difficult to determine. The optimal management of such patients requires discussion
among a multidisciplinary team (MDT). Data for prediction of the risk of lymph node metastasis from T1
CRC is useful for this decision (Kajiwara Y, et al. Gastrointest Endosc. 2023;97:1119-1128). A single-arm
confirmatory trial of adjuvant chemoradiation for patients with high-risk rectal submucosal invasive cancer(JCOG1612) is ongoing to establish less invasive management. A new clinical trial for pT1b colon cancer
is also warranted. A single-arm phase III confirmatory trial on indications of ESD for elderly patients withearly gastric cancer (JCOG1902) is being conducted, and it may also be meaningful to examine the potential
for expanding the indications of colorectal ESD for elderly patients (Sekiguchi M, et al. Jpn J Clin Oncol.
2022;52:425-432). The difficulty of managing rectal neuroendocrine tumors following endoscopic resection
is another hot topic, and an MDT approach and further investigations are key to solve this issue (Sekiguchi
M, et al. J Gastroenterol. 2022;57:547-558).

Curriculum Vitae
Masau Sekiguchi

Cancer Screening Center/Endoscopy Division, National Cancer Center Hospital, Tokyo,
Japan

Affiliation:
1. Cancer Screening Center, National Cancer Center
Hospital, Tokyo, Japan
2. Endoscopy Division, National Cancer Center Hospital,
Tokyo, Japan
3. Division of Screening Technology, National Cancer
Center Institute for Cancer Control, Tokyo, Japan
Educational Background:2014 April – 2017 March
Ph.D., Course of Advanced Clinical Research of Cancer, Juntendo University Graduate
School of Medicine (Partner graduate school of National Cancer Center)2000 April – 2006 March
M.D., Faculty of Medicine, The University of Tokyo
Professional Career:
2006 April – 2009 March
Department of Internal Medicine, Mitsui Memorial Hospital
2009 April – 2011 March
Department of Gastroenterology, NTT Medical Center Tokyo
2011 April – 2014 March
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Resident)
2014 April – 2015 March
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Chief resident)
2015 April – Present
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Staff doctor)
Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan (Staff doctor)
Division of Screening Technology, National Cancer Center Institute for Cancer Control,
Tokyo, Japan (Staff researcher)2021 February – 2022 January
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm,
Sweden (Specialized doctor)
Recent major publications:
1. Sekiguchi M, Igarashi A, Toyoshima N, et al. Cost-effectiveness analysis of computeraided detection systems for colonoscopy in Japan [published online ahead of print,
2023 Feb 8]. Dig Endosc. 2023;10.
2. Sekiguchi M, Westerberg M, Ekbom A, et al. Endoscopist Characteristics and Polyp
Detection in Colonoscopy: Cross-Sectional Analyses of Screening of Swedish Colons.
Gastroenterology. 2023; 164: 293-295.
3. Sekiguchi M, Westerberg M, Ekbom A, et al. Detection rates of colorectal neoplasia
during colonoscopies and their associated factors in the SCREESCO study. J
Gastroenterol Hepatol. 2022; 37: 2120-2130.
4. Sekiguchi M, Hotta K, Takeuchi Y, et al. Characteristics of colorectal neuroendocrine
tumors in patients prospectively enrolled in a Japanese multicenter study: a first reportfrom the C-NET STUDY. J Gastroenterol. 2022; 57: 547-558.
5. Sekiguchi M, Igarashi A, Mizuguchi Y, et al. Cost-effectiveness analysis of endoscopic
resection for colorectal laterally spreading tumors: Endoscopic submucosal dissection
versus piecemeal endoscopic mucosal resection. Dig Endosc. 2022; 34: 553-568.
6. Sekiguchi M, Kakugawa Y, Ikematsu H, et al. Risk Stratification Score Improves
Sensitivity for Advanced Colorectal Neoplasia in Colorectal Cancer Screening: The
Oshima Study Workgroup. Clin Transl Gastroenterol. 2021; 12: e00319.
7. Sekiguchi M, Kakugawa Y, Takamaru H, e al. Risk of metachronous neoplastic lesions
during post-polypectomy surveillance in individuals with advanced colorectal neoplasia
at initial screening colonoscopy. J Gastroenterol Hepatol. 2021; 36: 2230-2238.

11

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT1-RS2

Recent advances in multidisciplinary treatment for colorectal cancer

Hyun Seok Lee       Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook
National University, Kyungpook National University Chilgok Hospital, Korea

Colorectal cancer (CRC) is the third most common cancer type and the second cause of cancer-related mortality in the analysis of global
cancer statistics. Stage IV colorectal cancer (CRC) has heterogeneous characteristics in tumor extent and biology. The overall survivalof patients with metastatic CRC has improved with the development of multimodal treatments and new chemotherapeutic drugs.
Resection of metastatic CRC is recommended when the metastatic lesions are technically present for complete removal. Before
determining the resection of metastatic sites, the resectability and usefulness of locoregional surgical treatment for metastatic CRC
should be fully assessed with consideration of the radiologic evaluation and the patient’s condition. In addition, clear surgical margins
and technical assurance for complete resection of metastatic sites should be ensured before the surgery. Resection of metastatic CRC
is performed for liver, lung, or peritoneal metastases.
Synchronous liver and primary tumor resection can be considered in patients with adequate conditions. Treatment strategies forpatients with synchronous liver and CRC should be considered in conjunction with a thorough evaluation of metastatic lesions andprimary tumor stages.
Solitary pulmonary metastatic lesions can be considered for surgical resection using video-assisted thoracic surgery (VATS) or open
thoracotomy metastasectomy. Currently, VATS is commonly used to treat solitary pulmonary metastasis. Local ablation with radiotherapy
can be used to treat lung metastasis. With the development of modern systemic chemotherapy, the treatment of pulmonary metastasis
requires multidisciplinary approaches combined with surgical resection and radiotherapy and the use of accurate diagnostic imaging
tools.
In the treatment of patients with CRC with peritoneal metastasis, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
can be considered. Complete surgical resections and the development of adequate chemotherapeutic agents for use against peritoneal
metastatic lesions are required to prolong survival and increase treatment efficacy in patients with CRC with peritoneal metastases.
Surgical treatments should be performed in patients with symptomatic primary tumors with unresectable metastasis. However, primarytumor resection in patients with asymptomatic CRC with synchronous, unresectable metastases did not show overall survival benefits
in recent studies. Therefore, the treatment of metastatic CRC is challenging due to the variable tumor extent and heterogenous
characteristics. The location and extent of metastatic lesions should be considered to treat patients with stage IV CRC. Adequate
surgical treatments at the appropriate time can improve survival and prevent tumor-related complications. Tailored surgical treatments
and multidisciplinary approaches may improve survival and the quality of life in patients with metastatic CRC.

Curriculum Vitae
Hyun Seok Lee   

Division of Gastroenterology, Department of Internal Medicine, School of Medicine,
Kyungpook National University, Kyungpook National University Chilgok Hospital, Korea
PRESENT POSITION
Associate professor
Division of Gastroenterology
Department of Internal Medicine,
School of Medicine, Kyungpook National
University,
Kyungpook National University Chilgok Hospital
807, Hoguk-ro, Buk-gu, Daegu 41404, South
Korea

Tel: 82-53-200-3084
Fax: 82-53-323-3089
E mail : lhsworld@nate.com
https://orcid.org/0000-0001-9288-0321
Home Page: h ttp://med.knu.ac.kr/
http://www.knuch.kr/
EDUCATION
2016 Ph.D., Medical College of Yeungnam University, Daegu, Korea
2008: Master, School of Medicine, Kyungpook National University, Daegu,
Korea
2002: M.D., School of Medicine, Kyungpook National University, Daegu, Korea

POSTGRADUATE TRAINING
April 2018 – present:	Associate professor of Division of Gastroenterology
and Hepatology in Kyungpook National University
Hospital
Feb 2019 – Feb 2020:	Research Scholar, Inflammatory Bowel Disease Centerof Excellence, Digestive Disease Institute, Virginia
Mason Medical Center, Seattle, Washington
March 2013 – March 2018 : Assistant professor of Division of Gastroenterology
and Hepatology in Kyungpook National
University HospitalFeb. 2010 – March 2013: Fellowship of Gastroenterology & Hepatology inKyungpook National University Hospital
March 2006 – Feb. 2010: Residentship of Internal Medicine in Kyungpook
National University Hospital
March 2002 – Feb. 2003: Internship in Kyungpook National University
Hospital, Daegu, Korea

12

AWARD
2022, International Digestive Endoscopy Network, Young Investigator Award
2021, International Digestive Endoscopy Network, Distinguished PosterAward
2020, International Digestive Endoscopy Network, Distinguished PosterAward
2018, International Digestive Endoscopy Network, Distinguished Poster
Presentation Award
2017, Korea Digestive Disease Week, Best Poster Award
2016, Congress of the Korean Society of Gastrointestinal Endoscopy, Best
Oral Presentation Abstract Award
2016, Asian Pacific Digestive Week, Travel Award
2015, Congress of the Korean Society of Gastrointestinal Endoscopy, Best
Oral Presentation Abstract AwardRESEARCH INTERESTSInflammatory Bowel Disease
Cancer (Colorectal Cancer, Gastric Cancer, Esophageal Cancer), Cancer
Biomarker
Colorectal neoplasia
Diagnostic and Therapeutic Gastrointestinal Endoscopy
Capsule Endoscopy
SELECTED PUBLICATION (recent 20)
1: Joo HJ, Lee HS, Jang BI, Kim DB, Kim JH, Park JJ, Kim HG, Baek IH, Lee
J, Kim B. Sex-specific differences in colorectal cancer: A multicenter
retrospective cohort study. Cancer Rep (Hoboken). 2023 Jun 22:e1845.
doi: 10.1002/cnr2.1845. Epub ahead of print. PMID: 37348877.
2: Lee HS, Nam JH, Oh DJ, Ahn HJ, Lim YJ. Association between eupatilin andreduction in small bowel bleeding in aspirin users and aspirin plus acidsuppressant users. Korean J Intern Med. 2023 Jul;38(4):484-492. doi:
10.3904/kjim.2022.340. Epub 2023 May 19. PMID: 37198878; PMCID:
PMC10338255.
3: Lee J, Lee YJ, Seo JW, Kim ES, Kim SK, Jung MK, Heo J, Lee HS, Lee JS,
Jang BI, Kim KO, Cho KB, Kim EY, Kim DJ, Chung YJ; Daegu-Gyeongbuk
Gastrointestinal Study Group. Incidence of colonoscopy-related perforation
and risk factors for poor outcomes: 3-year results from a prospective,
multicenter registry (with videos). Surg Endosc. 2023 Aug;37(8):58655874. doi: 10.1007/s00464-023-10046-5. Epub 2023 Apr 17. PMID:

November 2, 2023 Kobe Portopia Hotel
37069430.
4: Choi CW, Lee SJ, Hong SN, Kim ER, Chang DK, Kim YH, Lim YJ, Shim KN,
Lee HS. Small Bowel Capsule Endoscopy within 6 Hours Following Bowel
Preparation with Polyethylene Glycol Shows Improved Small Bowel
Visibility. Diagnostics (Basel). 2023 Jan 27;13(3):469. doi: 10.3390/
diagnostics13030469. PMID: 36766574; PMCID: PMC9914394.
5: Lee JM, Lee KM, Kang HS, Koo JS, Lee HS, Jeong SH, Kim JH, Kim DB.
Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic
Acid in a Split Method for Bowel Preparation in Patients with Inactive
Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial.
Gut Liver. 2023 Jul 15;17(4):591-599. doi: 10.5009/gnl220202. Epub
2023 Jan 2. PMID: 36588527; PMCID: PMC10352068.
6: Kim KO, Kim EY, Lee YJ, Lee HS, Kim ES, Chung YJ, Jang BI, Kim SK, Yang
CH. Efficacy, safety and tolerability of oral sulphate tablet for bowel
preparation in patients with inflammatory bowel disease: A multicentre
randomized controlled study. J Crohns Colitis. 2022 Nov 23;16(11):17061713. doi: 10.1093/ecco- jcc/jjac080. PMID: 35689818.
7: Nam SY, Jeon SW, Lee HS, Lim HJ, Lee DW, Yoo SS. Demographic andClinical Factors Associated With Anti-SARS-CoV-2 Antibody Levels After 2
BNT162b2 mRNA Vaccine Doses. JAMA Netw Open. 2022 May
2;5(5):e2212996. doi: 10.1001/jamanetworkopen.2022.12996. PMID:
35587345; PMCID: PMC9121186.
8: Yasuda T, Lee HS, Nam SY, Katoh H, Ishibashi Y, Yamagata Murayama S,
Matsui H, Masuda H, Rimbara E, Sakurazawa N, Suzuki H, Yoshida H, Seto
Y, Ishikawa S, Jeon SW, Nakamura M, Nomura S. Non-Helicobacter pylori
Helicobacter (NHPH) positive gastric cancer. Sci Rep. 2022 Mar
21;12(1):4811. doi: 10.1038/s41598-022-08962-y. PMID: 35314746;
PMCID: PMC8938428.
9: Yu J, Park SJ, Kim HW, Lim YJ, Park J, Cha JM, Ye BD, Kim TO, Kim HS,
Lee HS, Jung SY, Kim Y, Choi CH. Effectiveness and Safety of Golimumabin Patients with Ulcerative Colitis: A Multicenter, Prospective, Postmarketing
Surveillance Study. Gut Liver. 2022 Sep 15;16(5):764-774. doi: 10.5009/
gnl210335. Epub 2021 Dec 27. PMID: 34959224; PMCID: PMC9474494.
10: Jo HH, Kim EY, Jung JT, Kwon JG, Kim ES, Lee HS, Lee YJ, Kim KO, Jang
BI; Crohn’s and Colitis Association in Daegu-Gyeongbuk. Value of Fecal
Calprotectin Measurement During the Initial Period of Therapeutic AntiTubercular Trial. Clin Endosc. 2022 Mar;55(2):256-262. doi: 10.5946/
ce.2021.061. Epub 2021 Nov 5. PMID: 34736314; PMCID: PMC8996000.
11: Yoon HJ, Sohn DK, Jung Y, Lee HS, Koo HS, Kim KO, Shin JE, Kim HG,
Chung IK, Hwangbo Y. Does precutting prior to endoscopic piecemeal
resection of large colorectal neoplasias reduce local recurrence? A
KASID multicenter study. Surg Endosc. 2022 May;36(5):3433-3441. doi:
10.1007/s00464-021-08664-y. Epub 2021 Aug 2. PMID: 34341906.
12: Kim ES, Kim KO, Jang BI, Kim EY, Lee YJ, Lee HS, Lee JS, Kim SK, Jung
YJ, Kang SB, Agrawal M, Ungaro R, Colombel JF. Comparison of 1-Year
Colectomy Risk Between the US and Korean Patients with Acute Severe
Ulcerative Colitis: A Propensity Score Matching Analysis. Dig Dis Sci.
2022 Jul;67(7):2866-2875. doi: 10.1007/s10620-021-07130-y. Epub
2021 Jul 14. PMID: 34263381; PMCID: PMC8758790.
13: Choe AR, Moon CM, Tae CH, Chun J, Bang KB, Lee YJ, Lee HS, Jung Y,
Park SC, Koo HS. Characteristics, Location, and Clinical Outcomes of
Gastrointestinal Bleeding in Patients Taking New Oral Anticoagulants
Compared to Vitamin K Antagonists. J Clin Med. 2021 Jun 18;10(12):2693.
doi: 10.3390/jcm10122693. PMID: 34207296; PMCID: PMC8234640.
14: Kang B, Lee HS, Jeon SW, Park SY, Choi GS, Lee WK, Heo S, Lee DH, Kim
DS. Progressive alteration of DNA methylation of Alu, MGMT, MINT2, and
TFPI2 genes in colonic mucosa during colorectal cancer development.
Cancer Biomark. 2021;32(2):231-236. doi: 10.3233/CBM-203259. PMID:
34092617.
15: Lee JS, Jeon SW, Lee HS, Kwon YH, Nam SY, Bae HI, Seo AN. Rebamipide
for the Improvement of Gastric Atrophy and Intestinal Metaplasia: A
Prospective, Randomized, Pilot Study. Dig Dis Sci. 2022 Jun;67(6):23952402. doi: 10.1007/s10620-021-07038-7. Epub 2021 May 30. PMID:
34052947.
16: Lee HS, Chiorean MV, Boden E, Lord J, Irani S, Kozarek R, Larsen M, Ross
A. Usefulness of Fluoroscopy for Endoscopic Balloon Dilation of Crohn’s
Disease- Related Strictures. Dig Dis Sci. 2022 Apr;67(4):1295-1302. doi:
10.1007/s10620-021-06935-1. Epub 2021 Mar 19. PMID: 33740171.
17: Chang JY, Moon CM, Shim KN, Cheung DY, Lee HS, Lim YJ, Jeon SR, Park
SJ, Kim KO, Song HJ, Jang HJ, Kim JH. Positive Fecal Occult Blood Test
is a Predictive Factor for Gastrointestinal Bleeding after Capsule
Endoscopy in Patients with Unexplained Iron Deficiency Anemia: A
Korean Multicenter CAPENTRY Study. Clin Endosc. 2020 Nov;53(6):719726. doi: 10.5946/ce.2019.149. Epub 2020 Nov 6. PMID: 33153246;
PMCID: PMC7719424.
18: Lee HS, Nagra N, La Selva D, Kozarek RA, Ross A, Weigel W, Beecher R,
Chiorean M, Gluck M, Boden E, Venu N, Krishnamoorthi R, Larsen M, Lin
OS. Nurse-Administered Propofol Continuous Infusion Sedation for
Gastrointestinal Endoscopy in Patients Who Are Difficult to Sedate. Clin
Gastroenterol Hepatol. 2021 Jan;19(1):180-188. doi: 10.1016/j.
cgh.2020.09.018. Epub 2020 Sep 12. PMID: 32931961.
19: Lee JS, Lee HS, Kim ES, Jung MK, Jung JT, Kim HG, Lee DW, Kim DJ, Lee
YJ, Yang CH; Daegu-Gyeongbuk Gastrointestinal Study Group (DGSG).
Comparison of different types of covered self-expandable metal stents formalignant colorectal obstruction. Surg Endosc. 2021 Aug;35(8):41244133. doi: 10.1007/s00464-020-07869-x. Epub 2020 Aug 13. PMID:
32789723.
20: Lee HS, Lim YJ, Jung JH, Nam JH, Park J, Kang SH, Kim KB, Chun HJ.
Magnetic Resonance Enterography and Capsule Endoscopy in Patients
Undergoing Patency Capsule for the Evaluation of Small Bowel Crohn’s
Disease: A Korean Clinical Experience. Gastroenterol Res Pract. 2020
Apr 4;2020:8129525. doi: 10.1155/2020/8129525. PMID: 32328099;
PMCID: PMC7160711.

13

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT1-RS3

Role of endoscopic muscular dissection for rectal cancer with clinicalcomplete response after concurrent chemoradiotherapy

Chao-Wen Hsu1), Chu-Kuang Chou2), Jen-Hao Yeh3)
Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Taiwan,
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical
Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan, 3)Department of Internal Medicine, E-Da
Hospital, Kaohsiung, Taiwan
1)
2)

BackgroundFor clinical T2N+/- or T3N+/- rectal cancer, concurrent chemoradiotherapy (CCRT) followed by radical
low anterior resection (LAR) +/- diversion stoma is the standard treatment modality. The clinical complete
response (cCR) rate after CCRT can achieve 10-20% based on the modern total neoadjuvant therapy (TNT)and neoadjuvant chemotherapy. Endoscopic muscular dissection (EMD) for cCR rectal cancer after CCRT,
may play a diagnostic role to decide watch & wait (WW) or radical LAR in carefully selected patients. We
retrospectively evaluated the technical feasibility and the short-term outcome of EMD for rectal cancer withcCR after CCRT.
Methods
A retrospective chart review of cases of EMD for rectal cancer with cCR after CCRT from Jan 2022 to Aug
2023 at our institution was performed. Clinical factors and imaging, procedural, and pathology results werecollected and analyzed.
Results
Eight EMD for rectal cancer with cCR were performed. Before CCRT, 6 of lesions were initially clinically staged
as T2-3N0 and 2 were T3N1. The en-bloc resection rates and R0 resection were 100% without complications.
Six lesions had pathologically complete response (pCR), 1 lesion had morphologically changed to adenoma
and 1 lesion had minimal residual ypT1. No patients received subsequent radical LAR in this cohort.
Conclusions
EMD for rectal cancer with cCR after CCRT is technically feasible with low complication rates. There may be
a diagnostic role in EMR in assessing pathologic response after CCRT and a potentially therapeutic role to
avoid radical LAR in carefully selected patients.

Curriculum Vitae
Chao-Wen Hsu   Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Taiwan

Chao-Wen Hsu, M.D.
Chief of Division of Colorectal Surgery, Kaohsiung
Veterans General Hospital, Taiwan
Associate professor, National Yang-Ming
University, Taiwan
Email: ss851124@gmail.com
EXPERIENCE
2022 Director of SOCIETY OF COLON AND RECTAL SURGEONS, Taiwan.
2023 Fellowship in NTT medical center, Tokyo
2014 Fellowship in University of Washington, Seattle, USA
2012 Fellowship in National cancer center, Tokyo
Acedemic qualifications
1996 – 2003 School of medicine, National Yang-Ming University, Taiwan
Certificate
Board of Surgery, Taiwan
Board of Colorectal surgery, Taiwan
Expertise
Advanced Endoscopic treatment
Endoscopic submucosal dissection
Minimal invasive colorectal surgery
Invited speaker
1. Invited speaker in international colorectal forum 2015, Taichung, Taiwan
2. Invited speaker in APDW 2016, Kobe, Japan
3. Invited speaker in international colorectal forum 2019, Taiwan

14

4. Invited speaker in international colorectal forum 2020, Taiwan
5. Invited speaker in international colorectal forum 2021, Taiwan
6. Invited speaker in APFCP 2021, Taiwan
7. Invited speaker in international colorectal forum 2022, Taiwan
8. Invited speaker in APFCP 2023, Taiwan
Publication
1. E ndoscope rotating technique is useful for difficult colorectal endoscopic
submucosal dissection. Hsu CW, Wu CC, Lee MH, Wang JH, Chen YH,
Chang MC Surg Endosc. 2020;34(2):1006‐1011
2. Snare Tip Is an Alternative Tool for Colorectal Endoscopic Submucosal
Dissection.Wu CC, Chang MC, Lee MH, Hsu CH, Hsu CW. Dis Colon Rectum.
2021 Feb 1;64(2):241-247.
3. A
 novel training model to simulate thread traction in colorectal endoscopic
submucosal dissection - a video vignette. Huang SF, Hsu CW. Colorectal
Dis. 2021 Apr;23(4):1012.
4. Step-by-step demonstration of tunnel creation endoscopic submucosal
dissection for a lateral spreading anal canal circumferential tumour - avideo vignette.Wen CY, Hsu CW. Colorectal Dis. 2021 Apr;23(4):10131014.
5. Rectal gastrointestinal stromal tumour removed by hybrid endoscopic
submucosal dissection-a video vignette.Chen WC, Yu HC, Tsay FW, Li YD,
Kao SS, Hsu CW. Colorectal Dis. 2021 Sep 24. Epub ahead of print.
6. R ubber band-clip traction for endoscopic submucosal dissection involving
the appendiceal orifice - a video vignette. Colorectal Dis. 2021 Oct 17
Chang MC, Tseng CL, Hsu CH, Chou CK, Hsu CW. Epub ahead of print.

JKT2

14:00-16:15
Kairaku 3[Room 9]Upper GI

Multimodal treatments for esophagogastric junction cancer

Chair (J):

Chair (K):

Chair (T):Discusser (J):

Discusser (K):Discusser (T):Speaker (J):

Hiroya Takeuchi

Hamamatsu University School of Medicine, Japan

Jae Gyu Kim

Department of Internal Medicine, Chung-Ang University College of Medicine, Korea

Chi-Yang Chang

Fu Jen Catholic University Hospital, Taiwan

Takaki Yoshikawa

National Cancer Center Hospital, Department of Gastric Surgery, Japan

Hwoon-Yong Jung

Department of Internal Medicine, University of Ulsan College of Medicine, Korea

Ching-Tai Lee

E-DA Hospital, Taiwan

JKT2-1

Neoadjuvant chemotherapy and conversion surgery for EGJ
adenocarcinoma

Yu Imamura

Dept. of Esophageal Surgery, The Cancer Institute Hospital of JFCR, Japan
Speaker (K):JKT2-2

Minimally invasive surgery for gastroesophageal junction adenocarcinoma

Jin-Jo Kim

Department of surgery, College of Medicine, The Catholic University of Korea, Korea
Speaker (T):JKT2-3

Exploring the feasibility of endoscopic management for T1b esophageal
cancer

Chu-Kuang Chou

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical
Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
Rising Star Program (J):JKT2-RS1

Approach and therapeutic value index for Siewert type 2 esophagogastricjunction adenocarcinoma

Eisuke Booka

Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
Rising Star Program (K):JKT2-RS2

Endoscopic treatment for esophagogastric junction carcinoma

Yang Won Min

Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
Rising Star Program (T):JKT2-RS3

Recent advances in perioperative treatment for esophagogastric junction
cancer

KuoHsing Chen

Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT2-1

Neoadjuvant chemotherapy and conversion surgery for EGJ
adenocarcinoma

Yu Imamura1), Keisho Chin2), Masayuki Watanabe1)
Dept. of Esophageal Surgery, The Cancer Institute Hospital of JFCR, Japan,
Dept. of Gastroenterology, The Cancer Institute Hospital of JFCR

1)
2)

Background and Aim: Adenocarcinoma of the esophagogastric junction (EGJ) is an aggressive tumor, andcurative resection (R0) rate is not sufficient. It has been unclear whether conversion surgery is beneficial in
the patient with initially unresectable tumor. Here, focusing on Siewert type I-II cases who needed thoracic
approach, and we report 1) a multicenter phase II study of SOX (S-1+ oxaliplatin) therapy as a NAC, and 2)
the clinical indication of conversion surgery.
Methods: 1) cT3/4a and/or cN+ cases with 3cm or longer esophageal invasion was eligible. The primary
endpoint was R0 resection rate, and the planned sample size was 50 cases based on an expected R0 resection
rate of 85% (at the threshold of 70%), with a one-sided alpha of 0.1 and power of 80%. 2) Among 438 caseswith Siewert type I /II tumors who were treated at our institution, 95 patients with initially unresectable
tumors were examined.
Results: 1) Fifty patients were enrolled between June 2016 and April 2020. The overall response rate (CR/PR
was 0/9, respectively) was 18% (95%CI, 8.6-31.4%). SOX-related grade 3-4 adverse events (AEs) occurredin 6 cases. R0 resection rate was 86.0% (95%CI, 73.3-94.2%). Histopathological examination revealed that
grades 3/2/1b/1a/0/not-evaluated was observed in 9/6/8/21/4/2 (due to R2 resection), and pathologicalcomplete response rate was 18% (95%CI, 8.6-31.4%). 2) Conversion surgery was successfully performedby transthoracic (N=12) or transhiatal approach (N=5), and remaining 60 cases continued chemotherapy(unresected cases). In conversion cases with thoracic approach (N=12), half of those were treated bychemotherapeutic regimen including Trastuzumab (N=5) or Nivolumab (N=1). Compared to the unresectedcases, trastuzumab was frequently administered in conversion cases (conversion 50%, unresected 27%),and conversion cases experienced favorable outcomes [3-yr overall survival (OS) after initial treatment;
conversion 81.5% vs. unresected 12.7%, P=0.0002].
Conclusions: Neoadjuvant SOX met the primary endpoint of R0 resection rate 86% (>70%), with acceptable
adverse events. Conversion surgery conferred prolonged overall survival in the patient with initiallyunresectable EGJ adenocarcinoma. HER2 overexpression may be a useful biomarker for conversion surgery.

Curriculum Vitae
Yu Imamura   

Dept. of Esophageal Surgery, The Cancer Institute Hospital of JFCR, Japan

Education:
2002 M.D.Kumamoto University School of
Medicine, Kumamoto, Japan
April 1996-March 20022010 Ph.D.Department of
Gastroenterological Surgery,
Graduate School of
Medical Sciences,Kumamoto
University
April 2006-March 2010
Professional Training and Employment:
April 2002	Department of Gastroenterological Surgery, Kumamoto
University
July 2003	Department of Surgery, Japanese Red Cross Kumamoto
hospital
July 2005	Department of Surgery, Kumamoto city hospital
April 2010	Resident in Department of Gastroenterological Surgery,
Kumamoto University
December 2010 R esearch Fellow in Department of Medical
Oncology, Dana-Farber Cancer Institute/Harvard
Cancer Center, U.S.A.
May 2013	Resident in Department of Gastroenterological Surgery,
Kumamoto University
June 2013	Assistant Professor in Department of Gastroenterological
Surgery, Graduate School of Medical Sciences,
Kumamoto University (→ May 2023 Visiting Associate
Professor)
April 2014	Assistant Professor in Department of Surgery and
Science, Graduate School of Medical Sciences, Kyushu

16

University
April 2015	Resident in Division of Esophageal Surgery, Department
of Gastroenterological Surgery, The Cancer InstituteHospital of Japanese Foundation of Cancer Research(JFCR)
May 2017	Associate in Division of Esophageal Surgery, Department
of Gastroenterological Surgery
and Center for
Development of Advanced Cancer Therapy, The Cancer
Institute Hospital of JFCR
June 2019	Head in Division of Esophageal Surgery, Department of
Gastroenterological Surgery, TheCancer InstituteHospital of JFCR
Awards:2014	JSGS Young Investigator of the Year 20142016	Poster Award, 88th Annual meeting of the Japanese Gastric
Cancer Association2017	Research Award, 89th Annual meeting of the Japanese
Gastric Cancer Association2018	Young Investigator Award, The 11th The International
Gastrointestinal Consensus Symposium(IGICS)
2019	Poster Walk, 2019ASCO-GI,
2021	Poster Highlight, 2021 ASCO-GI
2021	Reseachn Award, 10th Annual meeting of Japanese Society
for Gastroenterological Carcinogenesis
2021	The Best Citation Award, The Japanese Gastroenterological
Association
2022	15th Research Award, Japanese Society of ClinicalPharmacology and Therapeutics

November 2, 2023 Kobe Portopia Hotel

JKT2-2

Minimally invasive surgery for gastroesophageal junction
adenocarcinoma

Jin-Jo Kim
Department of surgery, College of Medicine, The Catholic University of Korea, Korea

Gastroesophageal junctional cancer (GEJc) is defined as adenocarcinoma with an epicenter within 5 cm of
the GEJ and extending into the esophagus. The incidence of GEJc has increased substantially in the pastfew decades, even in Eastern countries. GEJc is usually classified into 3 categories according to the Siewert
system, which is based on the location of the epicenter of the tumor. Among these, Siewert type II tumors,located 1 cm above to 2 cm below the GEJ, represent true carcinoma of the GEJ.
According to the recent prospective trial in Japan, lower mediastinal lymph node dissection (LND) should be
performed when the length of esophageal invasion is 2cm or more. If the length is more than 4cm middle andupper mediastinal LND should be performed, together. In the former case, Japanese researchers recommend
to perform number 110 lymph node (LN) only. However, the anatomical landmark among the lower mediastinal
LNs (No. 110, 111 and 112) is vague and it is difficult to differentiate one from the others. In my opinion,
it would be easier and better to dissect the lower mediastinal LN as a whole. Moreover, systematic lower
mediastinal LND would offer a clearer surgical view in later anastomosis in the lower mediastinum.
Recent laparoscopic transhiatal approach has some advantages over the open counterpart. Surgical view
and instrumentation are much better in laparoscopic approach. I think this approach will have a promising
future in this field.
In order to perform laparoscopic transhital LND, mobilization of Lt. lateral section of liver is essential to obtaina good surgical view. After full mobilization of Lt. lateral section, it is folded toward right side through a holemade in falciform ligament. An anterior midline incision is made on the diaphragm and the hiatal opening is
widely opened. Lower mediastinal LND is performed through this hole. First, supradiaphragmatic LN (No. 111)
is dissected and bilateral pulmonary ligaments (No. 112pul) and anterior side of the descending aorta (No.
112aoA) are dissected to the level of inferior pulmonary vein. After lower miediastinal LND, the esophagus is
cut at the level of 2cm above the upper border of the tumor and the proximal stomach and upper abdominal
LNs including No. 7, 8a, 9, 11p, 19 and 20 are resected. And then esophagogastrostomy using double flap
technique is proceeded in the lower mediastinum.

Curriculum Vitae
Jin-Jo Kim

Department of surgery, College of Medicine, The Catholic University of Korea, Korea

Name: Jin-Jo Kim, M.D.
Present Academic Appointments: Professor,
Department of Surgery, College of Medicine, The
Catholic University of Korea.
M.D. Degree
Korea.(1994)

Education:
College of Medicine, The Catholic University of Korea, Seoul,

Surgical Training:
Internship
Our Lady of Mercy Hospital,	College of Medicine, The Catholic University of Korea,
Incheon, Korea.
1994-1995
Residency
Department of Surgery, College of Medicine
The Catholic University of Korea, Seoul, Korea.
1995-1999
Professional Experience:
2002 - 2003 Fellowship in Surgery
Department of Surgery, Our Lady of Mercy Hospital,
The Catholic University of Korea, Incheon, Korea.
2003 - 2005 nstructor in Surgery
Department of Surgery, Our Lady of Mercy Hospital,
The Catholic University of Korea, Incheon, Korea.
2005 - 2010 Assistant Professor
Department of Surgery, Incheon St. Mary’s Hospital,
The Catholic University of Korea, Incheon, Korea.

2007 – 2008 Visiting Professor
University of Virginia
2008
Visiting professor
Fujita Health University
2011 – 2015 Associate Professor
Department of Surgery, Incheon St. Mary’s Hospital,
The Catholic University of Korea, Incheon, Korea.
2016 – present Professor
Department of Surgery, Incheon St. Mary’s Hospital,
The Catholic University of Korea, Incheon, Korea.
PROFESSIONAL SOCIETY MEMBERSHIP & CURRENT ACADEMIC ACTIVITY:
Chairman, Korean Esophageal and Junctional Cancer Study Group
Editor-in-Chief, Foregut Surgery
Chairman, Surgical Oncology Forum
Chairman, past (2011-2016), Korean Antireflux Surgery Study GroupDirector, Editorial Committee, The Korean Society of Gastrointestinal
SurgeryDirector, Ethical Committee, The Korean Society for Metabolic and BariatricSurgeons
Steering Committee, Korean Laparoscopic Gasstrointestinal Surgery StudyGroup
Member, The Korean Medical Association
Member, The Korean Surgical Society
Member, The Korean Gastric Cancer Association
Member, The Korean Society of Endoscopic and Laparoscopic Surgeons
Member, The Korean Society of Neurogastroenterology and Motility
Member, International Federation for the Surgery of Obesity and Metabolic
Disorders

17The 7th Joint Session between

JDDW - KDDW - TDDW
JKT2-3

Exploring the feasibility of endoscopic management for T1b
esophageal cancer

Chu-Kuang Chou
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical
Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

Based on data from the Taiwan cancer registry, the overall crude incidence rate of esophageal cancer in 2020
was reported to be 12.19, and this rate has remained stable over the past decade in Taiwan. The majority ofesophageal cancer cases are of squamous origin, while adenocarcinoma from the esophagogastric junction(EGJ) constitutes 4.21-4.79% of cases. Among all esophageal cancer cases, 9.24% were classified as clinicalstage 1, and 14.49% were categorized as pathologic stage 1.
The advancement and acceptance of endoscopic resection have led to a shift in the management of early EGJ
cancers, moving away from surgery or concurrent chemoradiation therapy (CCRT) and towards endoscopic
treatment. En-bloc resection using endoscopic submucosal dissection (ESD) has become a crucial approach
for EGJ lesions with suspected superficial invasive cancers.
The management of squamous cell carcinoma near the EGJ in Taiwan closely mirrors that of squamous cell
carcinoma at other sites in the esophagus.
As for adenocarcinoma, the en bloc resection rate for ESD in esophageal adenocarcinoma is higher than thatof endoscopic mucosal resection (EMR). ESD is considered the preferred treatment for elevated lesions andthose with potential invasive cancers, allowing endoscopists to obtain a definitive diagnosis. Nonetheless,managing submucosal invasion cancers remains challenging. The Japan Gastroenterological Endoscopy
Society 2020 guideline for Endoscopic submucosal dissection/endoscopic mucosal resection in esophageal
cancer suggests that pT1b esophageal adenocarcinoma should be considered for surgical resection. The
European Society of Gastrointestinal Endoscopy 2022 guideline suggests that Barrett’s esophagus-associatedsuperficial cancers with superficial submucosal invasion, showing well to moderate differentiation and lacking
lymphovascular invasion, can be effectively treated endoscopically. Additionally, a clinical update on T1b
Esophageal Cancer in the United States in 2019 reported a low risk (6% metastasis rate) of lymph nodemetastasis in esophageal adenocarcinoma with submucosal invasion <500 µm. The management of pT1b
esophageal adenocarcinoma should take into account the risk of lymph node metastasis and carefully weigh
the risks and benefits of additional surgery or concurrent chemoradiation therapy. Further research anddata collection are essential to strengthen the existing body of evidence. In this section, we aim to provide
an in-depth review of the current evidence and share our institution’s case experience concerning T1b EGJ
cancer.

Curriculum Vitae
Chu-Kuang Chou

Division of Gastroenterology and Hepatology, Department of Internal Medicine,
Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

English Name
Chu-Kuang Chou
Institution and Current Position
1. Director of gastroenterology andhepatology, Chiayi Christian
Hospital, Taiwan
2. Director of obesity center, Chiayi Christian Hospital,
Taiwan3. Visiting staff, gastroenterology and hepatology, Chiayi
Christian Hospital, Taiwan
Academic Degree
Medical doctor, College of Medicine, National Taiwan
University
Board Certisfication
Specialist, Internal Medicine Society of Taiwan
Specialist, Gastroenterological Society of Taiwan
Specialist, Digestive endoscopy Society of Taiwan
Publications
1. Chou CK, Chen CC, Tai CM, Tsai KF, Lee CY, Toh DE,
Chen SS. Defect closure with endoscopic suturing
improves endoscopic full-thickness resection of duodenal
gastrointestinal stromal tumors. Endoscopy
2023;55:E688-E689.
2. C hen MJ, Chen PY, Fang YJ, Bair MJ, Chen CC, Chen CC,
Yang TH, Lee JY, Yu CC, Kuo CC, Chiu MC, Chou CK,
Chen CY, Hu WH, Tsai MH, Hsu YC, Shun CT, Luo JC, Lin
JT, El-Omar EM, Wu MS, Liou JM, Taiwan Gastrointestinal

18

D, Helicobacter C. Molecular testing-guided therapy
versus susceptibility testing-guided therapy in first-line
and third-line Helicobacter pylori eradication: two
multicentre, open-label, randomised controlled, noninferiority trials. Lancet Gastroenterol Hepatol
2023;8:623-634.
3. Chang LC, Chang CY, Chen CY, Tseng CH, Chen PJ, Shun
CT, Hsu WF, Chen YN, Chen CC, Huang TY, Tu CH, Chen
MJ, Chou CK, Lee CT, Chen PY, Wu MS, Chiu HM. Cold
Versus Hot Snare Polypectomy for Small Colorectal
Polyps : A Pragmatic Randomized Controlled Trial. Ann
Intern Med 2023;176:311-319.
4. Chou CK, Tsai KF, Tseng CH, Lee CT, Yang KH, Chang
MC, Hsu CW. Novel Colorectal Endoscopic Submucosal
Dissection With Double-Endoscope and Snare-Based
Traction. Dis Colon Rectum 2022;65:936-945.
5. Chou CK, Chen CC, Chen SS, Lee CT, Tsai KF. Snare
traction and endoscopic suturing can improve endoscopic
management of gastrointestinal stromal tumors at thegastric greater curvature. Endoscopy 2022;55:E216-E217
6. Chou CK, Chen CC, Chen CC, Wu JF, Liao WC, Chiu HM,
Wang HP, Wu MS, Tseng PH. Positive and negative impactof anti-reflux mucosal intervention on gastroesophageal
reflux disease. Surg Endosc 2022.
7. S hieh TY, Chen CC, Chou CK, Hu TY, Wu JF, Chen MJ,
Wang HP, Wu MS, Tseng PH. Clinical efficacy and safetyof peroral endoscopic myotomy for esophageal achalasia:
A multicenter study in Taiwan. J Formos Med Assoc 2021.

November 2, 2023 Kobe Portopia Hotel

JKT2-RS1

Approach and therapeutic value index for Siewert type 2
esophagogastric junction adenocarcinoma

Eisuke Booka, Hirotoshi Kikuchi, Hiroya Takeuchi
Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan【Background】Based on the metastasis rate from a prospective observational study on esophagogastricjunction adenocarcinoma, the range of lymph node dissection and the surgical approach are recommended
according to esophageal involvement, however the therapeutic value index is unclear.
【Patients and Methods】From January 2016 to June 2022, 55 patients who underwent surgery for Siewert
type 2 esophagogastric junction adenocarcinoma were investigated for the metastasis rate of mediastinal/
abdominal lymph nodes, therapeutic value index = metastasis rate * 5-year OS rate in patients with metastasis,and short-term outcomes of right thoracic / transhiatal approach.
【Results】When divided into 41 cases of the right thoracic approach (Group A) and 14 cases of the transhiatal
approach (Group B), tumor size (50mm vs 24mm) and esophageal involvement (30mm vs 12.5mm) weresignificantly longer in Group A. The degree of progression (cStage1/2/3/4) was significantly higher in GroupA (7/6/26/2) compared to Group B (5/7/2/0). The operation time (524 minutes vs 359 minutes) and blood loss
(215ml vs 75ml) were significantly less in Group B, however there was no significant difference in pneumonia(9.8% vs 7.1%), anastomotic leakage (9.8% vs 0%), and pancreatic fistula (2.4% vs 0%) between the twogroups. The therapeutic value index was #1 (18.7), #2 (26.4), #3a (20.3), #7 (21.0), #8a (0), #9 (11.4), #11p
(4.2), #110 (8.5), #105 (0), #106recR (0), #108 (0), with the therapeutic value being high for abdominal lymph
nodes (#1, #2, #3a, #7, #9) and lower mediastinal lymph nodes (#110), however the therapeutic value was
low for #8a, #11p and upper mediastinal lymph nodes.
【Conclusion】For Siewert type 2 esophagogastric junction adenocarcinoma, the therapeutic value of upper
mediastinal lymph nodes dissection is low, and adequate lymph node dissection of the abdomen and lower
mediastinum and safe reconstruction according to the esophageal involvement are desirable.

Curriculum Vitae
Eisuke Booka   Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan

Eisuke BOOKA
1-20-1, Handayama, Higashi-ku,Hamamatsu,
Shizuoka, 431-3192/ (+81)-53-435-2279 / booka@hama-med.ac.jp
EDUCATION· March 2016: Graduated from Keio University
Graduate School of Medicine,
Ph.D. Program in Medical Science· March 2009: Graduated from Keio University School of Medicine
EXPERIENCE· April 2021 - Present: Assistant Professor, Department of Surgery, Hamamatsu
University School of Medicine· April 2019 - March 2021: Associate Chief, Esophageal Surgery, Shizuoka
Cancer Center· April 2017 - March 2019: Staff, Digestive Surgery, Saiseikai Yokohamashi
Tobu Hospital· April 2016 - March 2017: Assistant Professor (Limited Term), Department ofSurgery, Keio University School of Medicine· April 2015 - March 2016: Resident, Esophageal Surgery, Shizuoka Cancer
Center· April 2013 - March 2015: Graduate Student, Department of Surgery, Keio
University School of Medicine· March 2012 - March 2013:	Senior Resident, Surgery, Hiratsuka City Hospital· April 2011 - March 2012:	Senior Resident, Surgery, Nerima General Hospital· April 2009 - March 2011:	Junior Resident, Kiinan Hospital
Professional Affiliations and Activities
Japan Surgical Society (Certified Surgeon)	Japanese Society of Gastroenterological Surgery (Certified
Gastroenterological Surgeon, Instructor, Certified Gastroenterological
Cancer Surgeon)	Japanese Esophageal Society (Certified Esophageal Surgeon, Certified
Esophageal Specialist, Councilor, Guidelines Committee)	Japanese Society for Endoscopic Surgery (Certified Technique(Thoracoscopic Surgery for Esophageal Cancer))
Japanese Society of Medical Oncology (Certified Oncologist, Instructor)	Japan Gastroenterological Endoscopy Society (Certified
Gastroenterologist)
Japanese Board of Cancer Therapy (Certified Oncologist)	Japanese Gastric Cancer Association (Delegate, Member of the Patient
Advocacy Committee)	Japanese Association for Thoracic Surgery (Certified Surgeon, JATSNEXT Committee, JATS-Academy Committee, Guidelines Committee)	Japanese Society for Parenteral and Enteral Nutrition (Guidelines
Committee)
Japanese Society for Wound Healing (Guidelines Committee)
Awards2023: AGSurg Reviewer Award 2023 (Japanese Society of Gastroenterological
Surgery)2022: Esophagus 2021 Best Original Article Award (Japanese Esophageal
Society)2022: KINGCA WEEK 2022 Best Oral Presentation Award
2022: Esophagus Reviewer Award (Japanese Esophageal Society)2021: Esophagus Reviewer Award (Japanese Esophageal Society)2021: Toulin Encouragement Award (Department of Surgery, Keio University
School of Medicine)19The 7th Joint Session between

JDDW - KDDW - TDDW
JKT2-RS2

Endoscopic treatment for esophagogastric junction carcinoma

Yang Won Min
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea

Superficial esophageal cancer (SEC) is frequently detected by a screening endoscopy and the developmentof endoscopic imaging techniques facilitate the early diagnosis. Endoscopic resection (ER) has been used
for SEC when there is a negligible risk of lymph node metastasis (LNM). The majority of esophageal cancers
are squamous cell carcinomas (SCCs) in the Asia. SCC occurs more often in the upper and middle third of
the esophagus. Esophageal adenocarcinoma mainly develops in the lower third and at the esophagogastricjunction (EGJ). The global incidence of EGJ cancer has increased in recent years. From an anatomicaland histopathological point of view, EGJ represents the boundary between the esophagus and stomach.
Fortunately, ER is established as the first choice treatment for early EGJ carcinoma without histopathologic
risk factors of LNM.

Multiple studies and long-term analyses have demonstrated excellent efficacy andsafety of ER as an alternative to surgery for these lesions. Nevertheless, after ER of EGJ carcinoma withhistopathologic risk factors for LNM, optimal management is still unclear.

Curriculum Vitae
Yang Won Min

Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, South Korea

Country: Korea, Republic of
Affiliation: Department of Medicine, Samsung Medical
Center, Sungkyunkwan University School of
Medicine, Seoul, Korea
E-mail: yangwonee@gmail.com
Educational Background2003 B.S., Sungkyunkwan University School of Medicine, Seoul, Korea
2008 M.S., Graduate School, Sungkyunkwan University, Seoul, Korea
2015 Ph.D., Graduate School, Sungkyunkwan University, Seoul, Korea
Professional Career2015 - Assistant Professor	Sungkyunkwan University School of Medicine, Samsung Medical Center,Seoul, Korea
2021 - Associate Professor	Sungkyunkwan University School of Medicine, Samsung Medical Center,Seoul, Korea
Research Field
Endoscopic interventions
Esophageal cancer
Esophageal motility disorders
Recent Papers
1. Hypercontractile Esophagus: Clinical and Manometric Features From a
Multicenter Korean Cohort. J Neurogastroenterol Motil. 2023 Apr 30;29(2):166173.
2. Endoscopic vacuum therapy for the management of upper GI leaks and20

perforations: a multicenter retrospective study of factors associated withtreatment failure (with video). Gastrointest Endosc. 2022 Feb;95(2):281-290.
3. The effects of oral steroid duration on stricture prevention after extensive
endoscopic submucosal dissection for superficial esophageal cancer. J Thorac
Dis. 2022 Jun;14(6):2061-2070.
4. Close Observation versus Additional Surgery after Noncurative Endoscopic
Resection of Esophageal Squamous Cell Carcinoma. Dig Surg. 2021;38(3):247254.
5. Risk factors of metachronous recurrence after endoscopic submucosal
dissection for superficial esophageal squamous cell carcinoma. PLoS One. 2020
Sep 4;15(9):e0238113.
6. Comparison of endoscopic submucosal dissection and surgery for superficial
esophageal squamous cell carcinoma: A propensity score-matched analysis.
Gastrointest Endosc. 2018 Oct;88(4):624-633.
7. Endoscopic submucosal dissection under general anesthesia for superficial
esophageal squamous cell carcinoma is associated with better clinical outcomes.
BMC Gastroenterol. 2018 Jun 7;18(1):80.
8. Endoscopic Treatment for Esophageal Cancer. Korean J Gastroenterol. 2018
Mar 25;71(3):116-123.
9. Endoscopic prediction model for differentiating upper submucosal invasion (<200 μm) and beyond in superficial esophageal squamous cell carcinoma.
Oncotarget. 2018 Jan 3;9(10):9156-9165.
10. Efficacy and safety of endoscopic submucosal dissection in elderly patientswith esophageal squamous cell carcinoma. Surg Endosc. 2017 Oct;31(10):39053911.

November 2, 2023 Kobe Portopia Hotel

JKT2-RS3

Recent advances in perioperative treatment for esophagogastricjunction cancer

KuoHsing Chen       

Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan

The incidence of esophagogastric junction (EGJ) cancer is increasing worldwide. EGJ cancer is definedas the epicenter of adenocarcinoma locating within 5 cm of EGJ according to Siewert classification, or
any histology of cancer with epicenter withing 2 cm of EGJ based on the Nishi classification in Japan. The
prognosis of EGJ cancer is poor compared to gastric cancer and establishing optimal treatment strategies
is important.
Currently, few clinical trials are designed for EGJ cancer only because EGJ cancer is still a less frequently
occurring tumor type, especially in Asia. EGJ cancer patients are usually enrolled in clinical trials for esophageal
or gastric cancer patients. Thus, we can only try to identify the advance of anti-cancer treatments in EGJ
cancer from these trials. Recently, development of multimodal treatments with perioperative strategy has
improved the treatment outcomes in locally advanced EGJ and gastric cancer, such as novel chemotherapy
combinations, chemoradiation, targeted therapy and immune checkpoint inhibitors. A pivotal trial demonstrated
perioperative FLOT4 increased the survival outcomes compared to ECF in Western patients. The initial
results from two clinical trials (KEYNOTE 585 and MATTERHORN) show immune checkpoint inhibitor plus
chemotherapy is associated with higher pathological complete response rate compared to chemotherapy
alone. Biomarker-driven strategy has also been tested in several trials in Her2 amplified and mismatch repair
deficient or microsatellite instability-high tumors and the results are also encouraging. In this presentation, I
will have a mini-review of the recent advance of perioperative treatment in EGJ cancer.

Curriculum Vitae
KuoHsing Chen   

Department of Medical Oncology, National Taiwan University Cancer Center, Taipei,
TaiwanDepartment of Medical Oncology, National Taiwan
University Cancer Center
No.57, Ln. 155, Sec. 3, Keelung Rd., Da’an Dist.,
Taipei City 106, Taiwan
Tel: 886-2- 3366 8275
Email: jeff40537@gmail.com

EDUCATION
Taipei Medical University, Taipei, MD. July, 1998- June, 2005
Graduate Institute of Oncology, National Taiwan University College of Medicine,
July, 2015- Jan, 2023
PROFESSIONAL EXPERIENCES
Attending physician: Department of Medical Oncology, National Taiwan University
Cancer Center. March, 2019- present.
Attending physician: Department of Oncology, National Taiwan University Hospital,
Taipei, Taiwan. July, 2015- March, 2019
6th Clinical Research Skill Advancement Workshop (J-HOPE), Chiba, Japan, 2017
3rd Paul Carbone Academy, Taipei, 2013-2014
Attending physician: Oncology Department of National Taiwan University Hospital,
Yun-Lin Branch. July, 2013- June, 2015
Fellowship: Oncology Department of National Taiwan University Hospital. July,
2010- June, 2013
Resident: Internal Medicine Department of National Taiwan University Hospital.
July, 2007- June, 2010
LICENSES / CERTIFICATION License: National Board of Medicine, 2005
Certification: Board of Internal Medicine, 2010
Board of Medical Oncology, 2013

FIELDS OF INTERESTS
Colorectal Cancer, Gastric Cancer, Epigenetics, Immuno-oncology
PUBLICATIONS (within 5 years):
1. K
 H Chen, CL Hsu, YL Su, CT Yuan, LI Lin, JH Tsai, YH Liang, AL Cheng, KH Yeh.
Novel prognostic implications of complement activation in the tumor
microenvironment for de novo metastatic BRAF V600E mutant colorectal
cancer. Br J Cancer 2022;128(1):102-111. doi:10.1038/s41416-022-02010-2
2. Y H Liang, KH Chen, JH Tsai, YM Cheng, CC Lee, CH Kao, KY Chan, YT Chen,WL Hsu, KH Yeh. Proteasome inhibitors restore the STAT1 pathway andenhance the expression of MHC class I on human colon cancer cells. J Biomed
Sci. 2021 Nov 10;28(1):75. https://doi: 10.1186/s12929-021-00769-9.
3. K
 H Chen, LI Lin, CT Yuan, Tseng LH, YL Chao, YH Liang, JT Laing, BR Lin, AL
Cheng, KH Yeh. Association between risk factors, molecular features and CpG
island methylator phenotype colorectal cancer among different age groups in a
Taiwanese cohort. Br J Cancer 125, 48–54 (2021). https://doi.org/10.1038/
s41416-021-01300-5
4. Y H Liang, T JH sai, YM Cheng, KY Chan, WL Hsu, CC Lee, KH Chen, KH Yeh.
Chemotherapy agents stimulate dendritic cells against human colon cancer cells
through upregulation of the transporter associated with antigen processing. Sci
Rep. 2021 Apr 27;11(1):9080. doi: 10.1038/s41598-021-88648-z.
5. JH Tsai, YM Jeng, KH Chen, CH Lee, CT Yuan, JY Liau. An Integrative
Morphomolecular Classification System of Gastric Cancer Carcinoma with
Distinct Clinical Outcomes. Am J Surg Pathol. 2020; 44(8):1017-1030.
6. K
 H Chen, LI Lin, LH Tseng, YL Lin, JY Liau, JH Tsai, JT Liang, BR Lin, AL Cheng,
KH Yeh. CpG Island Methylator Phenotype May Predict Poor Overall Survival ofPatients with Stage IV Colorectal Cancer. Oncology. 2019;96(3):156-163. doi:
10.1159/000493387.

21

The 7th Joint Session between

JDDW - KDDW - TDDW
memo

22

JKT3

9:00-11:15
Waraku[Room 10]

Biliary, Pancreas

Current status and future perspectives of Interventional EUS in
Asia

Chair (J):

Chair (K):

Chair (T):Discusser (J):

Discusser (K):Discusser (T):Speaker (J):Takao Itoi

Dept. of Gastroenterology and Hepatology,Tokyo Medical University, Japan

Jin LeeDepartment of Internal Medicine, Hallym University College of Medicine, Korea

Wei-Chih Liao

National Taiwan University Hospital, Taiwan

Shomei Ryozawa

Department of Gastroenterology, Saitama Medical University International Medical Center, JapanTae Jun SongDepartment of Internal Medicine, University of Ulsan College of Medicine, Korea

Szu-Chia Liao

Taichung Veteran General Hospital, Taiwan

JKT3-1

Current status and future perspectives of Interventional EUS in Japan

Akio Katanuma

Center for Gastroenterology, Teine-Keijinkai hospital, Sapporo, Japan
Speaker (K):JKT3-2Development and Clinical Application of a Novel Stent for EUS-Guided
Transmural Drainage

Lee Sang Hyub

Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital,
Seoul National University College of Medicine, Seoul, Korea
Speaker (T):JKT3-3

Endoscopic ultrasound-guided gastroenterostomy with a lumen-apposing
metal stent : a multicenter prospective study

Yu-Ting Kuo

Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taiwan
Rising Star Program (J):JKT3-RS1

Clinical outcomes of EUS-guided antegrade stone removal for common
bile duct stones in patients with surgically altered anatomy

Shuntaro Mukai

Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
Rising Star Program (K):JKT3-RS2

Current status and future perspectives of Interventional EUS in Asia
focused on EUS-guided gallbladder drainage in South Korea

Se Woo Park

Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University
College of Medicine, Hwaseong, South Korea
Rising Star Program (T):JKT3-RS3

Radiofrequency ablation: A novel endoscopic focal treatment ofpancreatic cancer

Meng-Ying Lin

Department of internal medicine, National Cheng Kung University, Tainan, Taiwan

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT3-1

Current status and future perspectives of Interventional EUS in Japan

Akio Katanuma
Center for Gastroenterology, Teine-Keijinkai hospital, Sapporo, Japan

Interventional EUS has made dramatic progress in Japan since EUS-FNA was covered by insurance in 2010.
In Japan, there was a negative opinion about FNA due to the high level of trust in imaging diagnosis andthe risk of needle tract seeding caused by puncture of malignant tumors. After reports on the usefulnessof neoadjuvant treatment (NAT) for pancreatic cancer, there is a growing consensus that it is necessary toobtain histological confirmation by FNA. In addition, there have been many reports on the high histologicaldiagnostic capability of FNA, as well as biomarker and gene evaluation, and FNA has become a wellestablished technique. However, there are many reports from Japan of needle tract seeding after FNA, andmany institutions still consider that FNA is contraindication for cystic pancreatic tumors.
In terms of therapeutic indication, drainage of pancreatic cysts has been performed and the indications have
expanded to include drainage of the biliary tract and pancreatic ducts, etc. In 2019, the guideline for EUS-BD
was published in Japan, which have contributed greatly to the safe technique of interventional EUS. EUSguided drainage requires several steps such as puncture, dilation, and stent deployment. In the past, without
dedicated devices for interventional EUS made the procedure was challenging, and several serious adverse
events were reported. Recently, dedicated dilation devices such as mechanical dilators, cautery dilators,
and drill-type dilators, have been developed and are now available to use in Japan. In addition, specialized
stents that can be easily deployed are also commercially available. The development of specialized devices
is considered to have made it possible to perform the procedure more safely and reliably. Lumen apposing
metal stent (LAMS) is now covered by medical insurance for use in peri-pancreatic fluid collection (PFC) in
Japan. LAMS can be used only for PFC, and the indication has not been expanded to the gallbladder drainage.
Interventional EUS will continue to progress in Japan, but it is unlikely that all procedures will replace ERCP.
The education program is required to perform for the safe interventional EUS procedures.

Curriculum Vitae
Akio Katanuma

Center for Gastroenterology, Teine-Keijinkai hospital, Sapporo, Japan

Akio Katanuma M.D., Ph.D., FJGESPRESENT POSITION
Director,
Centerfor
Gastroenterology, Teine-Keijinkai
hospital, Sapporo, Japan
Visiting professor, Tokyo medical
university, Tokyo, JapanPERSONAL INFORMATION
Professional address and telephone:Center for Gastroenterology	1-40-1-12, Maeda, Teine-ku, Sapporo,
Japan 006-8555+81-11-681-8111
E-mail address: akatanuma@gmail.com
katanuma0420@yahoo.co.jp
EDUCATION
1985-1991 Sapporo Medical University, Sapporo,Japan
SOCIETY MEMBERSHIPSThe Japanese Society of Internal Medicine, The
Japanese Society of Gastroenterology (JSGE), Japan
Gastroenterological Endoscopy Society (JGES),
Japan Biliary Association, Japan Pancreas Society,
The Japan Society of Ultrasonic in Medicine, The
Japanese Society of Gastrointestinal Cancer
Screening, The American Society for Gastrointestinal

24

Endoscopy (ASGE)
BOARD CERTIFICATION
Board certified trainer of the Japanese Society of
Gastroenterology
Board certified trainer of the Japanese Society of
Gastroenterological endoscopy
Board certified trainer of the Japan Biliary Association
Board certified trainer of the Japan Pancreas Society
Board Certified fellow of the Japanese Society ofInternal Medicine
EDITORIAL BOARD
Associate editor, Digestive Endoscopy (2018.1-)
Associate editor, Journal of Hepato-Biliary-Pancreatic
Sciences (2021.11〜)
Associate editor, Journal of Abdominal Emergency
Medicine (2023.1〜)
Associate editor, Japan biliary association (2017.2〜2022.10)
Editorial board member, Endoscopic ultrasound(2016.10-)

November 2, 2023 Kobe Portopia Hotel

JKT3-2Development and Clinical Application of a Novel Stent for EUS-Guided
Transmural Drainage

Lee Sang Hyub
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital,
Seoul National University College of Medicine, Seoul, Korea
Endoscopic ultrasonography-guided transmural drainage in the pancreaticobiliary field is currently widely used for acute cholecystitis in peripancreatic fluid
retention, and has shown great progress in recent years. In the past, a dedicated stent for this procedure was not developed, so a plastic stent inserted into thebiliary tract or a tubular metal stent (tubular SEMS) was used. However, tubular SEMS has the disadvantage of low patency and technical difficulty in insertion,and tubular SEMS has the disadvantage of high risk of deviation and possible leakage. Recently, LAMS (Lumen Apposing Metal Stent) was developed as a stent forendoscopic ultrasound-guided transmural drainage to improve these disadvantages. LAMS is a barbell-shaped stent with a very large diameter and short length,
and has the advantage of lowering the risk of stent detachment or leakage by bringing the two structures into close contact. It is considered to be superior toconventional stents in pancreatic fluid retention with solid debris as it is advantageous for endoscopic debridement. (1,2) However, for endoscopy beginners withinsufficient experience, LAMS procedures are technically difficult, and when stents are placed for a long period of time, there is a risk of adverse reactions such as
bleeding or buried LAMS syndrome (3). In the 2018 European Society of Gastrointestinal Endoscopy (ESGE) guidelines, when LAMS is inserted in pancreatic duct
break syndrome, it is recommended to remove it within 4 weeks to prevent adverse reactions (4). Tornado stent was developed to overcome these disadvantages.
The Tornado stent® is a self-expanding, self-expanding, self-expanding metal stent with a double pigtail structure, and is composed of a silicon coating with a metalthread of nitinol (5). The characteristic pig tail structure on both ends is in the form of a flexible spiral, which is designed to minimize the risk of proximal or distal
stent detachment. The diameter of the stent is 8 mm, and the length is 22 cm when inside the delivering catheter, 14 cm when the outer sheath is removed during
deployment, and 6 cm after the stent is fully deployed and has a spiral shape. Through this design, it is expected that the disadvantages of existing stents canbe supplemented. Compared to plastic stents, it has a wider diameter, enabling effective drainage. Compared to tubular SEMS, the flexible spiral pigtail structure
reduces the risk of stent detachment. Compared to LAMS, the stent is more flexible, making it easier to remove the stent after fistula formation and the risk of serious
adverse events such as buried LAMS syndrome or hemorrhage is expected to be low. Recently, an animal experiment was conducted to evaluate the feasibility
and safety of ultrasound-guided transmural drainage using a tornado stent. Eight mini pigs (Sus Scrofa) underwent gastro-cholecystectomy using Tornado stentunder ultrasound endoscopic guidance, and were followed up for 28-49 days. Technical success was confirmed in all 8 test animals, and patency of the stent was
confirmed in all 8 animals in follow-up endoscopy after 28-49 days, and the stent could be easily removed using a snare. There were no adverse reactions suchas stent detachment, and a microscopic endoscope was inserted through the fistula to enter the gallbladder. Recently, the use of the Tornado stent has begun inclinical practice, and in the near future, it is expected that the range of use will be expanded to clinical studies to prove its role as a stent in lowering the risk ofcomplications in ultrasound-guided transmural drainage.
References
1. S hah RJ, Shah JN, Waxman I, Kowalski TE, Sanchez-Yague A, Nieto J, et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid
collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol. 2015;13(4):747-52.
2. S
 iddiqui AA, Kowalski TE, Loren DE, Khalid A, Soomro A, Mazhar SM, et al. Fully covered self-expanding metal stents versus lumen-apposing fully covered selfexpanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc.
2017;85(4):758-65.
3. B
 ang JY, Hasan M, Navaneethan U, Hawes R, Varadarajulu S. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not bebusiness as usual. Gut. 2017;66(12):2054-6.
4. A
 rvanitakis M, Dumonceau JM, Albert J, Badaoui A, Bali MA, Barthet M, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of
Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018;50(5):524-46.
5. H
 uh G, Choi JH, Lee SH, Paik WH, Ryu JK, Kim YT, et al. Innovation of EUS-guided transmural gallbladder drainage using a novel self-expanding metal stent.
Sci Rep. 2020;10(1):11159.

Curriculum Vitae
Lee Sang Hyub

Department of Internal Medicine and Liver Research Institute, Seoul National University
Hospital, Seoul National University College of Medicine, Seoul, Korea

Sang Hyub LEE, M.D., Ph.D.
Professor
Pancreatic and Biliary Cancer
CenterDivision of Gastroenterology,
Department of Internal Medicine
Seoul National University Hospital
Seoul National University College of Medicine
101, Daehak-ro Jongno-gu Seoul 03080, Republic of
Korea
Tel 02-2072-4892
Email gidoctor@snu.ac.kr
Education and Training
2005– 2007: Ph.D. in Medicine
Seoul National University College of Medicine
Graduate School, Seoul, Korea
2000– 2002: M.S. in Medicine
Seoul National University College of Medicine
Graduate School, Seoul, Korea
1990– 1997: M.D. & B.S. in Medicine
Seoul National University College of Medicine
Graduate School, Seoul, Korea
2005–2007: Fellowship in Division of Gastroenterology
and Department of Internal Medicine,

Seoul National University Hospital, Seoul, Korea
1998 – 2002: Resident in Department of Internal
Medicine,
Seoul National University Hospital, Seoul, Korea
1997 – 1998: Internship in Seoul National University
Hospital, Seoul, Korea
Professional Experiences
2019 – current: Professor
Division of Gastroenterology and Department ofInternal Medicine
Seoul National University Hospital, Seoul, Korea
2013 – 2018: Associate professor
Division of Gastroenterology and Department ofInternal Medicine
Seoul National University Hospital, Seoul, Korea
2015-2016: Visiting Scholar
Moores Cancer Center, University of California, San
Diego
2012 – 2013: Assistant professor
Division of Gastroenterology and Department ofInternal Medicine
Seoul National University Hospital, Seoul, Korea

25

The 7th Joint Session between

JDDW - KDDW - TDDW
2007 – 2012: Assistant professor
Division of Gastroenterology and Department ofInternal Medicine
Seoul National University Bundang Hospital,
Seongnam, Korea
2002 – 2005: Director
Division of Gastroenterology and Department ofInternal Medicine
Cheju Halla General Hospital, Cheju, Korea
Field of expertise:
I am a gastroenterologist and an endoscopist of
pancreaticobiliary disease such as acute pancreatitis,
chronic pancreatitis, pancreatic cancer, gallstone
and bile duct cancer. I assumed my present
appointment in 2019 and currently share responsibility
for the provision of specialist for medical
gastroenterological services in the Seoul National
University Hospital. These include the full range ofdiagnostic procedures, clinics including chemotherapy
and consultations appropriate to a large teaching
hospital. I have had particular responsibility for biliary
and pancreatic diseases. I have performed the clinicaland translational study for biliary and pancreaticdiseases. I am trying to develop the new type stents
for the intervention and new therapeutic agent for the
pancreato-biliary malignancy.
My research topics:-Pancreas and Bile Duct Cancer-Cholangitis, Pandreatitis, Choledocholithiasis-Therapeutic Endoscopy using ERCP and EUS-Development of New Device and Stent-Translational Research using Pancreatic Cancer
Organoid
Publications:
109 international journal as 1st and Corresponding
Author120 international journal as Co-author
Recent published articles in the international journal
as 1st author or corresponding author (2022~2023)
1.	Son JH, Choi YH, Lee SH, et al. Flavokawain B
Inhibits Growth of Cholangiocarcinoma Cells by
Suppressing the Akt Pathway. In Vivo2023;37:1077-1084.
2.	Park JM, Park N, Lee SH, et al. A population-based
cohort study on risk factors for acute pancreatitis:
A comparison by age group. Pancreatology 2023.
3.	Paik WH, Jang DK, Cho S, et al. Acute Pancreatitis
and the Risk of Dementia in Diabetes: A Nationwide
Cohort Study Using Korean Healthcare Claims
Database. J Alzheimers Dis 2023;94:205-216.
4.	Lee SH, Choe JW, Cheon YK, et al. Revised Clinical
Practice Guidelines of the Korean Pancreatobiliary
Association for Acute Pancreatitis. Gut Liver
2023;17:34-48.
5.	Lee MW, Paik WH, Lee SH, et al. Usefulness of
Liquid-Based Cytology in Diagnosing Biliary Tract
Cancer Compared to Conventional Smear andForceps Biopsy. Dig Dis Sci 2023;68:274-283.
6.	Lee JM, Han KD, Lee SH, et al. The association
between smoking, changes in smoking behavior,
and acute pancreatitis: A population-based cohort
study in Korea. J Gastroenterol Hepatol
2023;38:451-459.
7.	Lee JH, Lee SH, Lee SK, et al. Antiproliferative
Activity of Krukovine by Regulating
Transmembrane Protein 139 (TMEM139) in
Oxaliplatin-Resistant Pancreatic Cancer Cells.
Cancers (Basel) 2023;15.
8.	Kim JS, Paik WH, Lee SH, et al. Clinical Significanceof Venous Thromboembolism in Patients with
Advanced Cholangiocarcinoma. Gut Liver 2023.
9.	Chun JW, Woo SM, Han M, et al. Prolonged patencyof fully covered self-expandable metal stents withan externally anchored plastic stent in distal
malignant biliary obstruction. Endoscopy
2023;55:563-568.
10.	C hoi JH, Lee J, Lee SH, et al. Analysis ofultrasonographic images using a deep learningbased model as ancillary diagnostic tool for
diagnosing gallbladder polyps. Dig Liver Dis 2023.
11.	Choi JH, Cho IR, Lee SH, et al. Efficacy and safety

26

of novel hemostatic gel in endoscopic
sphincterotomy or endoscopic papillectomy: A
multicenter, randomized controlled clinical trial.
Dig Liver Dis 2023.
12.	Cho IR, Lee SH, Choi JH, et al. Development ofnovel biliary metal stent with coil-spring structure
and its application in vivo swine biliary stricture
model. Frontiers in Oncology 2023;13.
13.	Cho IR, Han KD, Lee SH, et al. Association between
glycemic status and the risk of acute pancreatitis:a nationwide population-based study. Diabetol
Metab Syndr 2023;15:104.
14.	Lee JH, Kim H, Lee SH, et al. Establishment ofPatient-Derived Pancreatic Cancer Organoids
from Endoscopic Ultrasound-Guided Fine-Needle
Aspiration Biopsies. Gut Liver 2022;16:625-636.
15.	K im JS, Lee SH, Park N, et al. The effect ofnafamostat mesilate infusion after ERCP for postERCP pancreatitis. BMC Gastroenterol
2022;22:271.
16.	J ang DK, Choi JH, Paik WH, et al. Risk ofcardiovascular disease and mortality in patientswith diabetes and acute pancreatitis history: anationwide cohort study. Sci Rep 2022;12:18730.
17.	Chun JW, Woo SM, Lee SH, et al. A real-world
analysis of nanoliposomal-irinotecan with
5-fluorouracil and folinic acid as third- or later-line
therapy in patients with metastatic pancreatic
adenocarcinoma. Ther Adv Med Oncol
2022;14:17588359221119539.
18.	Choi YH, Han K-D, Cho IR, et al. Underweight Is
Associated with a Higher Risk of Acute Pancreatitis
in Type 2 Diabetes: A Nationwide Cohort Study.
Journal of Clinical Medicine 2022;11:5641.
19.	C hoi JH, Paik WH, Jang DK, et al. Acute
Pancreatitis Increases the Risk of Gastrointestinal
Cancer in Type 2 Diabetic Patients: A Korean
Nationwide Cohort Study. Cancers (Basel)2022;14.
20.	C hoi JH, Nam GH, Hong JM, et al. CytokineInduced Killer Cell Immunotherapy Combined With
Gemcitabine Reduces Systemic Metastasis in
Pancreatic Cancer: An Analysis Using PreclinicalAdjuvant Therapy-Mimicking Pancreatic Cancer
Xenograft Model. Pancreas 2022;51:1251-1257.
21.	Choi JH, Lee SH, Kim JS, et al. Combinatorial
Effect of Prophylactic Interventions for PostERCP Pancreatitis among Patients with Risk
Factors: A Network Meta-Analysis. Gut Liver
2022.
22.	Choi JH, Kim MK, Lee SH, et al. Proper adjuvant
therapy in patients with borderline resectable andlocally advanced pancreatic cancer who hadreceived neoadjuvant FOLFIRINOX. Frontiers in
Oncology 2022;12.

November 2, 2023 Kobe Portopia Hotel

JKT3-3

Endoscopic ultrasound-guided gastroenterostomy with a lumenapposing metal stent : a multicenter prospective study

Yu-Ting Kuo1), Hsiu-Po Wang2)
Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taiwan,
Department of Internal Medicine, National Taiwan University Hospital, Taiwan

1)
2)

Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction
in a patient’s quality of life. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using
a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable
endoscopic treatment for GOO. EUS-GE has the advantage of being minimally invasive as an endoscopic
procedure and EUS-GE could provide long-lasting effects with lower recurrence rates. Moreover, a recent
study suggests that EUS-GE has similar technical and clinical success rates compared to laparoscopic
gastroenterostomy. Interestingly, EUS- intervention seems to reduce the length of stay and incidence ofAEs, suggesting possible advantages compared to surgery.
In our prospective study including 139 patients, technical and clinical success was achieved in 136 patients(97.8%) and 129 (92.8%), respectively. The mean change in the gastric outlet obstruction scoring system(GOOSS) after EUS-GE was 2.2. During a mean follow-up of 131 days, 10 patients (7.4%) need reintervention.
Adverse events, including stent mal-displacement, bleeding and migration, occurred in 16 patients (13.1%).
EUS-GE is an emerging and minimally invasive procedure that has efficacy and safety comparable with thoseof current therapies for the management of malignant GOO.

Curriculum Vitae
Yu-Ting Kuo   Department of Integrated Diagnostics & Therapeutics, National Taiwan University
Hospital, Taiwan

Dr. Yu-Ting Kuo is attending physician at theDivision of Endoscopy of National Taiwan
University Hospital. He graduated from theMedical school of Tzu-Chi University and got
Master of Science degree in Epidemiology andPreventive Medicine (MSc) at National Taiwan
University. He completed Internal Medicine and Gastroenterology training at
the National Taiwan University Hospital. He was also a visiting staff ofbiliopancreatic department at The University of Tokyo Hospital in 2014. His
main interests are all kinds of therapeutic endoscopy, especially endoscopic
retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound(EUS)/ Interventional EUS in hepato-pancreato-biliary area.
He has been an instructor of EUS education programs in digestive endoscopysociety of Taiwan (DEST) since 2016. In addition, he attended different Asia
EUS Group (AEG) EUS training programs, including 2nd Prince of Wales
Hospital AEG Train the Trainer (TTT) EUS Course in Hong Kong, in 2015, 3rd
Focused Interventional Workshop on EUS-guided Drainage of Peri-pancreatic
Fluid Collections in Hong Kong, in 2015 and Asian EUS Summit 2016 Interventional EUS in Seoul Korea, in 2016, respectively. He also completed
the training program of 1st WEO International School of EUS (WISE) in 2018.
Education:
M.D., Tzu-Chi University, Taiwan, June 2007
M.S., Institute of Epidemiology and Preventive Medicine, National Taiwan
University, January 2017

Current Position:	Attending physician, Division of Endoscopy, Department of Integrated
Diagnostics & Therapeutics, National Taiwan University Hospital, August
2017 till now
Previous position:	Attending physician, Division of Gastroenterology, Department ofInternal Medicine, National Taiwan University Hospital Bei-Hu Branch,
July 2014－July 2017
	Fellow, Division of Gastroenterology, Department of Internal Medicine,National Taiwan University. Hospital, July 2012－June 2014	Resident in Internal Medicine, Department of Internal Medicine, National
Taiwan University Hospital, July 2009－June 2012
Certification:
Diplomate, National Board of Medical Examiners, 2007
Diplomate, Board of Internal Medicine, 2012
Diplomate, Board of Gastroenterology, 2014
Diplomate, Board of Digestive Endoscopy, 2015
	Diplomate, Board of Therapeutic Endoscopic Retrograde
Cholangiopancreatography, 2017
Organizations:Taiwan Society of Internal Medicine
Gastroenterological Society of Taiwan
Digestive Endoscopy Society of Taiwan

27

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT3-RS1

Clinical outcomes of EUS-guided antegrade stone removal for common
bile duct stones in patients with surgically altered anatomy

Shuntaro Mukai, Takayoshi Tsuchiya, Takao Itoi
Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan

Background and Aims: Although balloon enteroscopy–assisted ERCP (BE-ERCP) is an effective and safe
treatment technique for common bile duct (CBD) stones in patients with surgically altered anatomy (SAA), BEERCP is not always successful. Recently, EUS- guided antegrade stone removal (EUS-ASR) by using a 1-stepor 2-step procedure has been developed for BE-ERCP failure cases. The aim of this study was to evaluate
the clinical outcomes of EUS-ASR for CBD stones in patients with SAA.
Methods: In 29 of 217 patients [14.4%, mean 79 years old, post total or distal gastrectomy with Roux-en-Y
reconstruction (n=27), post distal gastrectomy with Billroth-II reconstruction (n=2)] in whom BE-ERCP failed,
EUS-ASR was attempted for difficult CBD stones from January 2014 to December 2022.
Results: The overall technical success of the creation of the hepatoenteric tract was 96.6% (28/29, HGS/
HJS=13/15). The mean diameter of punctured bile duct was 2.8mm (1.5-4.7). 19-gauge puncture needle wasused in 8 cases and 22-gauge in 20 cases（two-step puncture technique was required in 3 cases）. In one
failure case, it was difficult to puncture the non-dilated bile duct. Adverse events were observed in only onecase（3.6%,1/28, bleeding at the puncture line）. Regarding stone removal, 1-stage EUS-ASR was performedin 10 cases（mean stone size 7mm）and complete stone removal was succeeded in all cases with mean 23
minutes procedure time. In another 18 cases (mean stone size 13mm), 2-stage EUS-ASR was performed mean
51 days after EUS-HGS/HJS. In 14 cases complete antegrade stone removal was succeeded and in 3 casesstone removal was succeeded by antegrade rendezvous technique and BE-ERCP with low adverse event rate
5.6%（1/18, cholangitis 1）. The final clinical success rate of EUS-ASR was 93.1% (27/29, intention to treat
analysis). After EUS-ASR in 26 cases the stent placed at the hepatoenteric tract was removed finally andstent-free was achieved. In one case, the fistula was kept due to the patient’s desire.
Conclusions: 1-step or 2-step EUS-ASR depending to the situation of CBD stones in patients with SAA appears
to be an effective and safe alternative procedure after BE-ERCP failure.

Curriculum Vitae
Shuntaro Mukai

Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan

Professional experience:
2008-2010 N ational Center for
Global Health andMedicine, JuniorResident
2010-2012 N ational Center for
Global Health andMedicine,Dept. of
Gastroenterology
and Hepatology,
Senior Resident
2012-2016 T okyo Medical University, Dept. of
Gastroenterology and Hepatology,
Medical Doctor
2016-2020 T okyo Medical University, Dept. of
Gastroenterology and Hepatology,
Assistant Professor
2021-2023 T okyo Medical University, Dept. of
Gastroenterology and Hepatology, SeniorLecturer
2023- T o k y o M e d i c a l U n i v e r s i t y , D e p t . o f
Gastroenterology and Hepatology, Associate
professor
Research experience:
2012-present
Research Associate at dept of Gastroenterology andHepatology, Tokyo Medical University

28

2014-2015
Research Fellow at dept of biochemistry, Tokyo
Medical University
Professional memberships:
Japanese Society of Internal Medicine —Fellow
Japanese Society of Gastroenterology (JSGE) —Fellow
Japan Gastroenterological Endoscopy Society (JGES)—Fellow
Japan Biliary Association (JBA) —Fellow
Japan Pancreas Society (JPS) —Councilor
Japanese Society of Abdominal Emergency Medicine—Councilor
American Society Gastroenterological Endoscopy(ASGE) - International Membership
Public work (Members in Japan)
Committee member of Tokyo Guidelines for acutecholangitis and cholecystitis
Committee member of JPN Guidelines for the
management of acute pancreatitis
Committee member of Guidelines for post ERCP
pancreatitis
Committee member of Guidelines for walled-off
necrosis

November 2, 2023 Kobe Portopia Hotel

JKT3-RS2

Current status and future perspectives of Interventional EUS in Asia
focused on EUS-guided gallbladder drainage in South Korea

Se Woo Park       Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University
College of Medicine, Hwaseong, South Korea

Laparoscopic cholecystectomy is considered the standard and preferred treatment for acute cholecystitis(AC). However, this surgical option may not be suitable for certain patients who are not ideal candidates
for surgery due to various factors. Recently, endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage(EUS-GBD) represents a potentially disruptive technology, as it offers a less invasive alternative to traditional
surgical approaches. As a result, therapeutic strategies are experiencing a notable paradigm shift, leaning
towards minimally invasive treatments. While the field is continuously evolving, several devices andtechniques are currently being developed to facilitate easier and safer procedures for EUS-GBD. Indeed,
recent innovations in the field of EUS-GBD, such as the lumen-apposing metal stents (LAMSs) with bidirectionalanchoring flanges, have significantly improved outcomes for patients requiring drainage. Additionally, theuse of LAMS has proven to be not only safe and reliable for cases of acute cholecystitis but also beneficial
in enhancing the quality of life for patients who may not be ideal candidates for surgical treatment.
As an endosonographer performing EUS-GBD, there are several questions and uncertainties surrounding thisprocedure. Some of the key questions include:
1. Optimal Patient Selection: What are the specific criteria for identifying the most suitable candidates for
EUS-GBD? Which patients are likely to benefit the most from this procedure compared to other treatment
options?
2. Long-term Management: What are the long-term outcomes and potential complications associated with
EUS-GBD?
3. Stent Selection: What factors should be considered when selecting the appropriate stent for EUS-GBD?
4. Comparisons with Surgical Options: How do the outcomes of EUS-GBD compare to traditional surgicalinterventions, such as laparoscopic cholecystectomy, in terms of efficacy, safety, and patient satisfaction?
5. Timing of Intervention: In what situations is EUS-GBD best utilized as a definitive treatment, and when is it
more appropriate as a bridging therapy until surgical options become feasible?
6. Complication Management: How should potential complications, such as bile reflux, stent migration, or food
impaction, be managed in patients undergoing EUS-GBD?
7. Future Developments: What ongoing research and technological advancements are being pursued tofurther improve the efficacy, safety, and overall outcomes of EUS-GBD?
Addressing these questions through further research, collaboration among endosonographers, and sharedexperiences will contribute to a deeper understanding and optimization of EUS-GBD as a valuable therapeutic
option for patients.

Curriculum Vitae
Se Woo Park   

Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital,
Hallym University College of Medicine, Hwaseong, South Korea

NAME: Se-Woo Park, M.D. & Ph.D. (Associate
Professor)
ADDRESS: Division of Gastroenterology,
Department of Internal Medicine, Hallym
University Dongtan Sacred Heart Hospital,
Hallym University College of Medicine, 7,
Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Korea
Phone: +82-31-8086-2858
Fax: +82-31-8086-2029
E-mail: mdsewoopark@gmail.com

Sacred Heart Hospital, Hallym University College of Medicine,
Gyeonggi-do, Korea
2015 – 2020: Assistant Professor, Division of Gastroenterology, Department
of Internal Medicine, Hallym University Dongtan Sacred Heart
Hospital, Hallym University College of Medicine, Gyeonggi-do,
Korea
2020 – current: A ssociate Professor, Division of Gastroenterology,
Department of Internal Medicine, Hallym University Dongtan
Sacred Heart Hospital, Hallym University College ofMedicine, Gyeonggi-do, Korea

EDUCATION:
1998 – 2004 M.D. Hanyang University College of Medicine, Seoul, Korea
2007 – 2011 M.S. (Internal Medicine), Department of Internal Medicine,
Hanyang University College of Medicine, Seoul, Korea
2015 – 2019 Ph.D. (Gastroenterology), Department of Internal Medicine,
Chungbuk University College of Medicine, Chungbuk, Korea

FIELDS OF INTEREST:
Interventional EUS and ERCP for Pancreatic cancer and Bile duct cancer
Development of medical device for Interventional EUS and ERCP
Clinical Research and Trials in Pancreatic cancer and Bile duct cancer

PROFESSIONAL ACTIVITIES:
2004 – 2009: Intern & Resident Trainee in Department of Internal Medicine,
Hanyang University Hospital, Hanyang University College ofMedicine, Seoul, Korea
2012 – 2013: Clinical Fellowship, Division of Gastroenterology, Department
of Internal Medicine, Yonsei University College of Medicine,
Seoul, Korea
2014 – 2015: Clinical Assistant Professor, Division of Gastroenterology,
Department of Internal Medicine, Hallym University Dongtan

SOCIETIES:
1. The Korean Association of Internal Medicine
2. Korean Society of Gastroenterology
3. Korean Society of Gastrointestinal Endoscopy
4. Korean Pancreatobiliary Association
5. Korean Association for the Study of the Liver
PUBLICATIONS IN RECENT YEARSSCI (E)as First author or Corresponding author (N): 47 papers
SCI (E)as co-author (N): 19 papers

29The 7th Joint Session between

JDDW - KDDW - TDDW
JKT3-RS3

Radiofrequency ablation: A novel endoscopic focal treatment ofpancreatic cancer

Meng-Ying Lin, Yao-Sheng Wang, Wei-Lun Chang
Department of internal medicine, National Cheng Kung University, Tainan, Taiwan

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death worldwide. Surgery is the only
possible complete treatment for these patients. However, there is no effective screening tool, and patients
often present with nonspecific symptoms, resulting in early diagnosis of resectable disease in only 10-15% ofcases. The lack of new systemic treatment agents and an immunosuppressive tumor microenvironment haveresulted in a persistently low 5-year survival rate of around 10% for pancreatic adenocarcinoma, which isfar behind other malignant diseases. In the near future, pancreatic cancer is expected to become the leading
cause of cancer-related mortality.
Several attempts, such as neoadjuvant chemotherapy and radiation therapy, have been applied in thetreatment of pancreatic adenocarcinoma for decades. However, these approaches have only resulted in a
dismal improvement in survival.
Radiofrequency ablation (RFA) is a thermal ablation technique that has been used for a long time in thetreatment of liver and thyroid tumors. It employs an alternating RF current to generate heat and induce
coagulation inside the tumor. RFA has been reported to induce an antigen-presenting effect and amplify
weak tumor-related immunity which is crucial in cancer treatment. In addition, the technical success rate
and procedure-related complication rate are acceptable, with complications usually being manageable
non-surgically according to literature reviews. Although the overall survival benefit of combining RFA withPDAC treatment remains controversial, several existing studies have revealed better outcomes when RFA iscombined with neoadjuvant chemotherapy.
In this retrospective single-center experience review, RFA was found to enhance treatment response in somepatients, while others did not benefit. Further investigation into the potential benefits of RFA for patients isessential.

Curriculum Vitae
Meng-Ying Lin   

Department of internal medicine, National Cheng Kung University, Tainan, Taiwan

Meng-Ying, Lin M.D
Attending physician in National Cheng Kung
University Hospital, Department of internal
medicine, Gastrointestinal and hepatology
Branch.
Assistant professor in College of Medicine
National Cheng Kung University

Education
2002 ~ 2009 School of medicine, National Cheng Kung University
2016 ~ 2018 Institute of Clinical Medicine, College of Medicine National
Cheng Kung University Board
2010 ~ 2015
Resident Physician, Department of Internal medicine National Cheng Kung
University Hospital
2015 ~ present
Attending physician, Department of Internal medicine National Cheng Kung
University Hospital
2023 ~ present
Assistant professor, College of Medicine, National Cheng Kung University
2017
Trainee, Kitasato University, Kanagawa, Japan2019
Trainee, Tokyo Medical University, Tokyo, Japan

Publication
Meng-Ying Lin, Wei-Lun Chang, Hsiao-Bai Yang, Wen-Lun Wang, Bor-Shyang
Sheu, Genetic polymorphisms of the X‐linked transcription factor forkhead
box P3 predispose to synchronous secondary primary malignancy (SPM) of
esophagus in head and neck squamous cell carcinoma patients. Advances in

30

Digestive Medicine 8(2), 91-97, 2021
Meng-Ying Lin, CL Wu, M Kida, WL Chang, BS Sheu
Confirming Whether Fine Needle Biopsy Device Shortens the Learning Curveof Endoscopic Ultrasound-Guided Tissue Acquisition Without Rapid Onsite
Evaluation
Clinical Endoscopy 54 (3), 420-427, 2021
Meng-Ying Lin, CT Lee, MT Hsieh, MC Ou, YS Wang, MC Lee, WL Chang,Endoscopic ultrasound avoids adverse events in high probability
choledocholithiasis patients with a negative computed tomography. BMC
gastroenterology 22 (1), 1-8, 2022
HC Chiang, Meng-Ying Lin, FC Lin, NJ Chiang, YC Wang, WW Lai, WL Chang
Transferrin and prealbumin identify esophageal cancer patients withmalnutrition and poor prognosis in patients with normal albuminemia: a cohort
study. Nutrition and Cancer 74 (10), 3546-3555, 2022
Meng-Ying Lin, CL Wu, YY Su, CJ Huang, WL Chang, BS Sheu
Tissue Quality Comparison Between Heparinized Wet Suction and Dry
Suction in Endoscopic Ultrasound-Fine Needle Biopsy of Solid Pancreatic
Masses: A Randomized Crossover Study. Gut and Liver 17 (2), 318-327,
2023
Meng-Ying Lin, YY Su, YT, Yu, CJ Huang, BS Sheu, WL Chang
Investigation into the content of red material in EUS-guided pancreaticcancer biopsies. Gastrointestinal Endoscopy 97 (6), 1083-1091, 2023
YH Chang, Meng-Ying Lin, MT Hsieh, MC Ou, CR Huang, BS Sheu
Multiple Field-Of-View Based Attention Driven Network For WeaklySupervised Common Bile Duct Stone Detection. IEEE Journal of Translational
Engineering in Health 11, 394-404, 2023

JKT4

14:00-16:15
Waraku[Room 10]

Liver

Tailoring multiple lines of systemic therapy for advanced HCC

Chair (J):

Chair (K):

Chair (T):Discusser (J):

Discusser (K):Discusser (T):Speaker (J):Naoya Kato

Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan

Kyung-Suk Suh

Department of Surgery, Seoul National University College of Medicine,, Korea

Chiun Hsu

National Taiwan University Hospital, Taiwan

Takahiro Kodama

Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine,Japan

Do Young Kim

Department of Internal Medicine, Yonsei University College of Medicine, Korea

Yu-Yun Shao

National Taiwan University Hospital, Taiwan

JKT4-1

Tailoring systemic treatment based on tumor burden for advanced
hepatocellular carcinoma.

Tatsuya Yamashita

Department of Gastroenterology, Kanazawa University Hospital, Japan
Speaker (K):JKT4-2

Surgical Conversion in Locally Advanced Hepatocellular Carcinoma
Through Multimodal Systemic Therapy

Su Jong Yu

Department of Internal Medicine and Liver Research Institute, Seoul National University College ofMedicine, Seoul, Republic of Korea
Speaker (T):JKT4-3

Proton Therapy for Hepatocellular Carcinoma

Huang Bing-Shen

Department of Radiation Oncology, Chang Gung Memorial Hospital, Taiwan
Rising Star Program (J):JKT4-1-RS1

Importance of preclinical rationales to establish appropriate treatment
sequences in the era of chemo-diversity for HCC

Hideki Iwamoto

Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Japan
Rising Star Program (K):JKT4-1-RS2

Tailoring multiple lines of systemic therapy for advanced HCC

Cho YuriCenter for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Republic of Korea
Rising Star Program (T):JKT4-1-RS3

Role of liver-directed therapy for advanced hepatocellular carcinoma inthe era of combination immunotherapy

Yung-Yeh Su

National Institute of Cancer Research, National Health Research Institutes, Taiwan

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT4-1

Tailoring systemic treatment based on tumor burden for advanced
hepatocellular carcinoma.

Tatsuya Yamashita, Takeshi Terashima, Taro Yamashita  
Department of Gastroenterology, Kanazawa University Hospital, JapanThe systemic therapy for advanced hepatocellular carcinoma (HCC) has shifted from molecular target
agents to immunotherapy. Globally, six immunotherapies, including atezolizumab + bevacizumab, STRIDE(tremelimumab + durvalumab), atezolizumab + cabozantinib, durvalumab monotherapy, tislelizumab, andpembrolizumab, have shown positive results in clinical trials. In Japan, three immunotherapies, including
atezolizumab + bevacizumab, STRIDE, and durvalumab monotherapy, as well as five molecular target agents(sorafenib, lenvatinib, regorafenib, cabozantinib, and ramucirumab), can be used as systemic treatments forunresectable HCC. Following the insurance coverage of STRIDE and durvalumab, the Japanese guidelines
for hepatocellular carcinoma treatment were revised. STRIDE is recommended as one of the first-line
treatments, and durvalumab is recommended as one of the treatments when combination immunotherapies
are not suitable. The treatment algorithm for systemic therapy in the guidelines was also revised. Afterthe approval of atezolizumab + bevacizumab, the first-line systemic therapy shifted from lenvatinib toatezolizumab + bevacizumab, and most of the second-line treatment after atezolizumab + bevacizumab waslenvatinib, based on the results of the HERITAGE study, which analyzed real-world data of systemic therapy
for hepatocellular carcinoma in Japan. In real practical settings in Japan, STRIDE is used as the secondline systemic therapy after atezolizumab + bevacizumab. However, the efficacy and safety of STRIDE after
atezolizumab + bevacizumab remain unclear. The emergence of these immunotherapies has changed thetreatment target to the objective response rate (ORR) because the ORR correlates with overall survival.
Several ongoing clinical trials in Japan aim to achieve a higher ORR. One of the treatments is lenvatinib
combined with intrahepatic arterial infusion of cisplatin (LEN + CDDP), which has shown an ORR of more than
50%. The ORR of Atezolizumab + bevacizumab and STRIDE is 30% and 20%, respectively. Meanwhile, STRIDE
showed a higher rate of progressive disease (PD) although it showed longer durable response. Considering
these ORRs and the PD rate, one idea is tailoring systemic treatment based on tumor burden. STRIDE can beselected as the first-line treatment in cases of low tumor burden, and LEN + CDDP can be selected in casesof high tumor burden. Comprehensive genome profiling (CGP) was approved in Japan for second or later
treatment selection. We have experienced some cases where treatment was selected based on CGP.

Curriculum Vitae
Tatsuya Yamashita   Department of Gastroenterology, Kanazawa University Hospital, Japan

Name: Tatsuya Yamashita, MD, PhD
Current Position, Department,
Affiliation:
Associate Professor, Advanced
preventive medical sciences research
center, Kanazawa University, Japan
Director, WHO Collaborating Centerfor Chronic Hepatitis and Liver Cancer, Kanazawa
University, Japan
Area of interest:
1. Diagnosis and Treatment of Hepatocellular carcinoma
2. Diagnosis and Treatment of Viral Hepatitis
Education:
1993 G raduate from Kanazawa University School of
Medicine (MD)1998 G raduate from Graduate School of Medicine,
Kanazawa University (PhD)
Career Experiences:
January 1 2018~Now
Associate Professor, Advanced preventive medical
sciences research center, Kanazawa University
April 1 2016~December 31 2017
Lecture, Department of Gastroenterology, Kanazawa
University Hospital

32

April 1 2009~March 2016
Research Professor, Center for Education in Community
Medicine (Department of Community Medicine and Medical
Education), Kanazawa University Hospital
June 1 2014~Novmber 30 2014
Secondment, Global Hepatitis Programme, Department ofHIV, World Health Organization
April 1 2001~July 31 2009
Assistant Professor, Department of Gastroenterology,
Kanazawa University Hospital
October 1 1999~March 31 2001
Medical staff, Department of Gastroenterology, Kanazawa
University Hospital
Professional Memberships:
Japanese Society of Medical Oncology, American Societyof Clinical Oncology, Japan Society of Clinical Oncology,
European Society for Medical Oncology, Japanese Cancer
Association, Japan Liver Cancer Association, Japan
Association of Molecular Targeted Therapy for HCC, The
Japan Society of Hepatology, American Association for the
Study of Liver Diseases, Asian Pacific Association for the
Study of the Liver, The Japanese Society of Internal
Medicine, The Japanese Society of Gastroenterology,
Japan Gastroenterological Endoscopy Society, The Japan
Society of Ultrasonics in Medicine, The Japan Society for
Portal Hypertension, Japanese Society of Implantable

November 2, 2023 Kobe Portopia Hotel

JKT4-2

Surgical Conversion in Locally Advanced Hepatocellular Carcinoma
Through Multimodal Systemic Therapy

Su Jong Yu
Department of Internal Medicine and Liver Research Institute, Seoul National University College ofMedicine, Seoul, Republic of Korea
In recent years, advanced Hepatocellular Carcinoma (HCC) management has seen remarkable advancements. The combination of atezolizumab and bevacizumab in
immunotherapy achieved a groundbreaking 12% Complete Response (CR) rate, potentially transforming the treatment landscape for previously deemed incurable
HCC(1). Even in cases where programmed cell death protein-1/ programmed cell death ligand-1 antibody therapy had failed, promising outcomes were observed withlenvatinib monotherapy(2).
However, a significant challenge arises when patients achieve radiologically favorable responses through multimodal systemic therapy. The optimal course of action
becomes uncertain—should they undergo aggressive interventions like surgery or transplantation, continue with maintenance therapy, or simply be closely monitored?
Research led by Mazzaferro has shed light on this complex dilemma(3). Liver transplantation emerged as a significant contributor to improved survival, with a medianOverall Survival (mOS) of 14.5 months. Notably, an important distinction emerged: patients achieving a partial response after downstaging and conversion experienced
a substantially prolonged mOS of 26.5 months, whereas those with CR who did not proceed to transplantation had a lower mOS of 9.9 months. This underscores thatradiologically favorable responses may not consistently align with pathologically favorable responses, and some patients with radiologically favorable responses may
still face disease progression, often due to refusing transplantation.
Furthermore, other studies have underscored that some patients who initially respond to treatment may eventually experience disease progression(4). This underscores
the significance of considering curative options such as conversion surgery or local ablation for individuals achieving radiologically favorable responses throughimmunotherapy, potentially extending their survival(5).
On a different front, research has illuminated the possibility of surgical conversion in initially unresectable HCC through systemic or local therapies. Previous attempts
with two-drug combinations yielded discouraging conversion rates, typically around 15-20%(6). Current studies are focused on comprehensive combination therapies
that merge hepatic arterial infusion chemotherapy (HAIC)-based locoregional therapy with targeted therapy and immunotherapy(7). This innovative approach aims tobolster surgical conversion rates and achieve more favorable objective responses by harnessing synergistic effects.
While data on combination immunotherapy for downstaging and conversion to surgery remain limited and require further research, these breakthroughs herald a new
era in HCC treatment. They offer fresh opportunities and improved outcomes for patients with advanced disease, holding the promise of a brighter future for individuals
who were once considered untreatable.
References
1.	Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, Kim TY, et al. Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med.
2020;382(20):1894-905.
2.	Aoki T, Kudo M, Ueshima K, Morita M, Chishina H, Takita M, et al. Exploratory Analysis of Lenvatinib Therapy in Patients with Unresectable Hepatocellular
Carcinoma Who Have Failed Prior PD-1/PD-L1 Checkpoint Blockade. Cancers (Basel). 2020;12(10).
3.	Mazzaferro V, Citterio D, Bhoori S, Bongini M, Miceli R, De Carlis L, et al. Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a
randomised, controlled, phase 2b/3 trial. Lancet Oncol. 2020;21(7):947-56.
4.	Kudo M. A New Treatment Option for Intermediate-Stage Hepatocellular Carcinoma with High Tumor Burden: Initial Lenvatinib Therapy with Subsequent Selective
TACE. Liver Cancer. 2019;8(5):299-311.
5.	Kudo M, Ueshima K, Chan S, Minami T, Chishina H, Aoki T, et al. Lenvatinib as an Initial Treatment in Patients with Intermediate-Stage Hepatocellular Carcinoma
Beyond Up-To-Seven Criteria and Child-Pugh A Liver Function: A Proof-Of-Concept Study. Cancers (Basel). 2019;11(8).
6.	Goto Y, Hisaka T, Sakai H, Takagi K, Fukutomi S, Akagi Y, et al. Salvage Surgery for Initially Unresectable Locally Advanced Hepatocellular Carcinoma Downstaged
by Hepatic Arterial Infusion Chemotherapy. Anticancer Res. 2020;40(8):4773-7.
7.	Zhang T, Merle P, Wang H, Zhao H, Kudo M. Combination therapy for advanced hepatocellular carcinoma: do we see the light at the end of the tunnel? Hepatobiliary
Surg Nutr. 2021;10(2):180-92.

Curriculum Vitae
Su Jong Yu

Department of Internal Medicine and Liver Research Institute, Seoul National University
College of Medicine, Seoul, Republic of Korea

Educational Background
1.	Doctor of Medicine, College of Medicine, Dept. of Medicine, Seoul National University(March 1, 1997 - February 26, 2001)
2.	Master of Science in Medicine, Graduate School, Seoul National University (March 1,
2004 - February 24, 2006)
3.	Doctor of Philosophy in Medical Science, Graduate School, Seoul National University (March 1, 2010 February 24, 2012)
Professional Experience1) Clinical Professor, Department of Internal Medicine & Liver Research Institute, SNU College of Medicine(2011.03 ~ Present)2) Visiting Scientist, NCI, NIH (Bethesda, MD, USA) (2016 ~ 2018)3) Seoul National University College of Medicine, Doctor of Medicine (2010 ~ 2012)4) Seoul National University College of Medicine, Master of Medicine (2004 ~ 2006)5) Seoul National University College of Medicine, Bachelor of Medicine (1997 ~ 2001)
Other Experience and Professional Memberships1) Academy Affairs Director, KLCA (2022.07 ~ Present)2) Associate Editor, Gut and Liver (2021.12 ~ Present)3) Vice Secretary General & Director of the Liaison Committee, KASL (2019.12 ~ 2021.12)

33

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT4-3

Proton Therapy for Hepatocellular Carcinoma

Huang Bing-Shen       

Department of Radiation Oncology, Chang Gung Memorial Hospital, Taiwan

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. Most HCC patients have
impaired liver function because of hepatitis or liver cirrhosis, and only approximately 20-40% of patientsare candidates for resection. Maximal preservation of normal liver volume and function is an importantconsideration in the choice of treatment.
Proton beam therapy (PBT) for HCC treatment has been applied for decades, and many clinical results
have shown excellent 3-year to 5-year local control (LC) rate ranging from 85-95% and nearly no majorcomplications.
From 2015 to 2023, more than 6000 patients were treated with PBT at Chang-Gung Memorial Hospital. Morethan a quarter of patients have liver cancers. The PBT was considered in the patients that were not suitable
for surgery or radiofrequency (RFA) and discussed in the multidisciplinary conference. The PBT dose were
72.6CGE/22fx and 66CGE/10fx, depending on tumor location. The largest tumor diameter was more than
5 cm, and more than 30% of tumors are larger than 10 cm in diameter. More than 40% were major tumor
vascular invasion. The in-field control rate was was more than 90%.
According to previous clinical results and our experiences, PBT can be a good alternative treatment forpatients unsuitable for surgery.

Curriculum Vitae
Huang Bing-Shen   

Department of Radiation Oncology, Chang Gung Memorial Hospital, Taiwan

Name: Huang, Bing-Shen 黃炳勝
Sex：Male
Education：
June 2004, Department ofMedicaine, Chung Shan Medical
University, Taichung City, Taiwan
Post-Graduate Education：
June 2023, Graduate Institute of Clinical
Medicine,Chang Gung University
Employment Record：
Augest 2004 ~ Augest 2005:
Residentship, Department of Radiation Oncology,
Mackay Memorial Hospital, Taipei, Taiwan.
September 2005 ~ June 2006:
Residentship, Department of Radiation Oncology,
Chang Gung Memorial Hospital, Linkou branch,
Taoyuan, Taiwan.
July 2006 ~ Augest 2008:
Chief Residentship, Department of Radiation
Oncology, Chang Gung Memorial Hospital, Linkou
branch, Taoyuan, Taiwan.

34

September 2008 ~ Now:
Attending physician, Department of Radiation
Oncology, Chang Gung Memorial Hospital, Linkou
branch, Taoyuan, Taiwan.
July 2018 ~ June 2021
Assistant professor, Department of Radiation
Oncology, Chang Gung Memorial Hospital, Linkou
branch, Taoyuan, Taiwan.
May 2019 ~ Now
Vice chair, Department of Radiation Oncology,
Chang Gung Memorial Hospital, Kaohsiung branch,
Kaohsiung, Taiwan.
August 2019 ~ Now
Assistant professor, Department of Medical Imaging
and Radiological Sciences, Chang Gung University,
Taoyuan, Taiwan.
July 2021 ~ Now
Associate professor, Department of Radiation
Oncology, Chang Gung Memorial Hospital, Linkou
branch, Taoyuan, Taiwan.

November 2, 2023 Kobe Portopia Hotel

JKT4-1-RS1

Importance of preclinical rationales to establish appropriate treatment
sequences in the era of chemo-diversity for HCC

Hideki Iwamoto, Koga Hironori, Kawaguchi Takumi
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Japan

Introduction
Nowadays, we have multiple lines of systemic therapy for hepatocellular carcinoma (HCC). We also have multiple conventional
locoregional treatments. In the era of chemo-diversity, we face a new unmet medical need of difficulty in tailoring appropriate treatment
sequences. In this point of view, the balance between preclinical rationale and clinical relevance is important to find appropriate
treatment sequences. The purpose of this study is to accumulate preclinical rationales to establish appropriate treatment sequencesby clarifying the change of tumor immune microenvironment (TIME) and molecular patterns in approved molecular targeted agents (MTA)
and locoregional treatment, hepatic arterial infusion chemotherapy (HAIC) using cisplatin and 5-fluorouracil.
Methods
We established immune syngeneic orthotopic HCC mouse models and treated them with each approved MTA (sorafenib, lenvatinib,
regorafenib, ramucirumab, and cabozantinib) to evaluate the change of TIME in each drug. We also compared the therapeutic effects of
atezolizumab plus bevacizumab (AB) with and without the pretreatment of HAIC. Moreover, we evaluated the influence of HAIC on HCC
using the resected specimens in clinical samples.
Results
All MTAs commonly reduced infiltration of regulatory T cells and macrophages, which suggested that these changes were induced by the
inhibition of VEGF signaling. Cabozantinib particularly induced the infiltration of dendritic cells, and lenvatinib significantly increased theinfiltration of cytotoxic T cells and granzyme B-positive cells, which suggested that TIME has altered to a “hot” environment. To clarify
why lenvatinib altered the TIME to “hot”, experiments using a pan-FGF receptor inhibitor were conducted. The FGF receptor inhibitor
also increased the infiltration of cytotoxic T cells and granzyme B-positive cells. Taken together, these results suggest that inhibitionof the FGF signal is important to the alteration of TIME to “hot”.
The therapeutic response (objective response rate: with or w/o pretreatment HAIC; 60.8% v.s. 29.7%, p<0.001), progression-freesurvival (median; 5.5 months v.s., 5.2 months, p<0.05), and overall survival (median; 12.7 months v.s. 9.9 months, p<0.05) of patientstreated with AB were superior in the pretreatment HAIC group. The expression of PD-L1 was significantly increased in HCC specimens
treated with HAIC before hepatic resection. Cisplatin and 5-fluorouracil directly induced the expression of PD-L1 in human hepatoma
cell lines.
Conclusions
Lenvatinib had promising effects to alter TIME to an immune “hot” environment and HAIC might have another role as a neo-adjuvant
treatment to enhance the therapeutic effects of treatments using immune checkpoint inhibitors.
Accumulation of preclinical rationales leads to establishing appropriate sequential treatments in the era of chemo-diversity for HCC.

Curriculum Vitae
Hideki Iwamoto   

Division of Gastroenterology, Department of Medicine, Kurume University School of
Medicine, Japan

Name: Hideki Iwamoto
Current Position: Assistant Professor
Affiliation: Division of Gastroenterology, Department of Medicine, Kurume University
School of Medicine
Areas of interestLiver Cancer, Molecular Targeted Agent, Transcatheter arterial therapy,
Tumor angiogenesis
Educational and Career Experiences: M.D. (Doctor of Medicine): March/2005, Kurume University School of
Medicine, 2005: Resident, Kurume University Hospital, 2007: Fellow, Department of Gastroenterology, Divisionof Medicine, Kurume University School of Medicine, 2008-2011, Graduate School of Medicine, Kurume
University (Ph.D.), 2012: Postdoc fellow, Department of Microbiology Tumor and Cell Biology, Karolinska
Institutet, 2015 until now: Assistant Professor, Division of Gastroenterology, Department of Medicine, Kurume
University School of Medicine
Honors and Awards: 2012 Young Researcher’s Award – Kurume University School of Medicine, 2017 Excellent
poster award of AASLD, 2019 Special Award of Kurume University School of Medicine, Department of
Gastroenterology Alumni, 2021 Best presentation award of Reservoir-Port Research Society, 2022 APASL
Oncology investigator award
Peer-reviewed articles: Total 106 (first or corresponding author: 24)
Impact factor (2021): Total 681.419 (first or corresponding author: 178.272)
Citations: Total 2,737 (first or corresponding author 506)
h-index: 29

35

The 7th Joint Session between

JDDW - KDDW - TDDW
JKT4-1-RS2

Tailoring multiple lines of systemic therapy for advanced HCC

Cho Yuri, Kim Bo Hyun, Park Joong-Won  
Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Republic of Korea

The management of hepatocellular carcinoma (HCC) has been transformed by the emergence of multitargeted kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICI). Recently conducted phase III trials
have shown that combination therapy, which includes ICI, has surpassed sorafenib as the primary treatment
choice for advanced HCC. This shift is due to the higher response rate and improved survival benefits offeredby combination therapy. Currently, as the first line treatment for the advanced HCC patients atezolizumab
and bevacizumab combinations or tremelimumab and durvalumab combination are recommended. For those
who are not feasible to those immune check inhibitor combinations, such as underlying moderate to severe
autoimmune disease or HCC recurrence after liver transplantation, TKIs such as lenvatinib or sorafenib arerecommended as alternative first line options. So far, there is only evidence for second line treatment after
sorafenib treatment including regorafenib, nivolumab plus ipilimumab, or pembrolizumab. The developmentof multiple lines of systemic therapy might lead to improving overall survival and quality of life for patientswith advanced HCC. However, determining the optimal sequencing and tailoring of these therapies remains
a complex task due to the heterogeneity of the disease and the limited understanding of individual patientcharacteristics that drive treatment responses. Examining a comprehensive set of clinical, molecular, andgenetic factors might be needed to identify predictive biomarkers and treatment response indicators thatcan guide personalized therapeutic approaches. These approaches will provide insights into the evolving
landscape of HCC treatment and contribute to the development of evidence-based guidelines for tailoring
therapy in advanced HCC, which might shed light on the potential of targeted therapies, immunotherapies,
and combination regimens in the management of advanced HCC.

Curriculum Vitae
Cho Yuri   Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Republicof Korea

Yuri Cho, M.D., Ph.D.
Center for Liver and Pancreatobiliary Cancer,
Research Institute and Hospital, National Cancer
Center
323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do,
10408, Republic of Korea

EDUCATION
Seoul National University College of Medicine, 2008
Master’s degree of Medicine, 2013, Seoul National University
Doctor’s degree of Medicine, 2017, Seoul National University

HOSPITAL AND RESEARCH APPOINTMENTS
Medical Internship, Seoul National University Hospital, 2008-2009
Residency in Internal Medicine, Seoul National University Hospital, 2009-2013
Research Fellow, Department of Internal Medicine and Liver Research Institute,
Seoul National University College of Medicine, 2013-2016
Assistant Professor, Center for Liver and Pancreatobiliary Cancer, ResearchInstitute and Hospital, National Cancer Center, Goyang, Republic of Korea, 2021~
RECENT PUBLICATIONS
1. Cho Y et al, Tumor-stroma crosstalk enhances REG3A expressions that drive
the progression of hepatocellular carcinoma. Int. J. Mol. Sci. 2020 Jan 11;21(2).
pii: E472.
2. Cho Y et al, Point shear wave elastography predicts fibrosis severity andsteatohepatitis in alcohol-related liver disease. Hepatol Int. 2020;14:270-280.
3. Cho Y et al, Reactive oxygen species-induced activation of YAP-1 through thec-Myc pathway is a therapeutic target in hepatocellular carcinoma. World J
Gastroenterol. 2020 Nov 14;26(42):6599-6613.
4. Kang SH, Cho Y (co-first) et al, From nonalcoholic fatty liver disease to metabolicassociated fatty liver disease: Big wave or ripple? Clin Mol Hepatol. 2021 Mar

36

22.
5. Cho Y et al, Association between lipid profiles and the incidence of hepatocellular
carcinoma: a nationwide population-based study. Cancers. 2021, 13, 1599.
6. Kim MA, Cho Y (co-corresponding) et al, The FIB-4 index is a useful predictor forthe development of hepatocellular carcinoma in patients with coexisting
nonalcoholic fatty liver disease and chronic hepatitis. Cancers 2021, 13, 2301.
7. Kang SH, Lee HW, Yoo JJ, Cho Y (co-first) et al, KASL clinical practice guidelines:
Management of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2021 Jun 22.
8. Kim TS, Cho Y(co-corresponding) et al, Metformin and Dichloroacetate Suppress
Proliferation of Liver Cancer Cells by Inhibiting mTOR Complex 1. Int. J. Mol. Sci.
2021 Sep 17;22(18):10027.
9. Kim SW, Cho Y et al. Toward a complete cure for chronic hepatitis B: Noveltherapeutic targets for hepatitis B virus. Clin Mol Hepatol. 2022;28(1):17-30.
10. Choi SI, Cho Y (co-first) et al, Better survival of patients with hepatitis B virusrelated hepatocellular carcinoma in South Korea: Changes in 16-years cohorts.
PLoS One. 2022 Mar 24;17(3):e0265668.
11. Cho Y et al, The Importance of Metabolic Syndrome Status for the Risk of NonViral Hepatocellular Carcinoma: A Nationwide Population-Based Study. Front
Oncol. 2022 May 4;12:863352.
12. Lee D, Cho Y(co-corresponding) et al, Entry inhibition of hepatitis B virus using
cyclosporin O derivatives with peptoid side chain incorporation. Bioorg Med
Chem. 2022 Aug 15;68:116862.
13. Cho Y, Kim BH, Park JW. The emerging age-pattern changes of patients with
hepatocellular carcinoma in Korea. Clin Mol Hepatol. 2023 Jan;29(1):99-101.
14. Cho Y, Kim BH, Park JW. Preventive strategy for nonalcoholic fatty liverdisease-related hepatocellular carcinoma. Clin Mol Hepatol. 2022 Nov 10.

November 2, 2023 Kobe Portopia Hotel

JKT4-1-RS3

Role of liver-directed therapy for advanced hepatocellular carcinoma
in the era of combination immunotherapy

Yung-Yeh Su1), Chiun Hsu2), Li-Tzong Chen3)
National Institute of Cancer Research, National Health Research Institutes, Taiwan,
National Taiwan University Hospital, 3)Kaohsiung Medical University Hospital

1)
2)

Surgery remains the primary method for curing hepatocellular carcinoma (HCC), although determining
resectability is a complex issue that depends on tumor factors and the remnant liver function. It is estimatedthat approximately 60-70% of HCC cases are considered unresectable at the time of diagnosis. In unresectable
HCC, systemic therapies such as multikinase inhibitors and immune checkpoint inhibitors (ICIs) are currently
the standard treatment, but they primarily provide disease control rather than a cure.
Liver-directed therapy (LDT) can offer potential benefits to patients with advanced HCC in various scenarios.
Firstly, the combination of LDT with ICIs may lead to a synergistic effect through the stimulation of systemic
immune response by releasing neoantigens into the bloodstream and augmenting the proliferation of tumorspecific T cells. Several pilot studies had demonstrated promising results using the combination of ICIs
and LDT, including ablation, Y90-radioembolization, hepatic arterial infusion chemotherapy, transarterial
chemoembolization and stereotactic body radiation theray in unresectable HCC.
Combination immunotherapy has shown promising results with higher objective response rates, including
anti-VEGF plus ICIs, multikinase inhibitors plus ICIs, or dual ICIs. Following the successful combination ICI
treatment, which results in significant tumor shrinkage, applying LDT to the remaining lesion offers theopportunity for cure even in advanced HCC cases.
As combination ICIs have resulted in significantly higher tumor responses, several studies have investigatedtheir application in the neoadjuvant setting, and the results are very promising. Of note, a proportion ofpatients achieved complete pathological responses after neoadjuvant ICIs, which raises a new question
regarding the necessity of adding LDT in such exceptional responders.
In summary, current evidence highlights the importance of combination immunotherapy and LDT in improving
treatment outcomes and potentially offering a chance of cure for advanced HCC patients.

Curriculum Vitae
Yung-Yeh Su   National Institute of Cancer Research, National Health Research Institutes, Taiwan

Dr. Su completed his medical education at the School of Medicine, Kaohsiung Medical
University, in 2012. He subsequently obtained board certifications in internal medicine in2017 and oncology in 2019. Currently, Dr. Su holds the position of Assistant Investigatorat the National Health Research Institutes and serves as a visiting staff physician at the
Department of Oncology in the National Cheng Kung University Hospital.
Dr. Su’s primary research focus lies in the field of clinical and translational researchpertaining to the development of new drugs and clinical trials for hepatobiliary and pancreatic cancers.
Additionally, he actively participates in real-world data manipulation and employs next-generation sequencing
techniques, such as whole exome sequencing, cell-free DNA analysis, whole transcriptome sequencing, singlecell RNA sequencing, and metagenomics. In recognition of his research contributions, Dr. Su has been honoredwith prestigious awards, including the Japanese Society of Medical Oncology (JSMO) Young InvestigatorAward in 2022 and 2023, the JSMO-Rising Stars in Asia workshop Award in 2023, and the Taiwan Joint
Cancer Conference (TJCC) Best Poster Award in 2022 and 2023.
Dr. Su takes on additional roles within the medical community, serving as the executive secretary of the Taiwan
Liver Cancer Association (TLCA) Research Group, the chief staff of the core measure development committees
for pancreatic cancer under the Ministry of Health and Welfare in Taiwan, and the executive secretary of theconsensus development committees in pancreatic cancer within the Taiwan Pancreas Society. Throughout his
career, Dr. Su has published over 20 articles in esteemed peer-reviewed journals, including the International
Journal of Surgery, Gastrointestinal Endoscopy, and the British Journal of Cancer.

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