The 4th Joint Session between

JDDW - KDDW - TDDW
Abstract Booklet
9:00 - 16:15 November 5, 2020
Kairaku 3 [Room 9], Waraku [Room 10]
Portopia Hotel

http://www.jddw.jp/

Welcome Address form Presidents

The 4th Joint Session between

JDDW - KDDW - TDDW

Tooru Shimosegawa
My name is Tooru Shimosegawa. I am president of the JDDW. It is a great pleasure for me to announce and host the 4th JKT joint symposium in Kobe. Due to awful spread of COVID-19 infection in theworld, we have been forced to host the JDDW 2020 in a hybrid-style in which audiences can select either
on-site attendance or web-site attendance. Unfortunately, because moving to and from foreign countries
is still strictly restricted in Japan and many other countries as well, it is currently hard for us to invite
foreign guests from Korea and Taiwan. Therefore, we have decided the 4th JKT joint symposium to beheld on the web by connecting Kobe, Seoul and Taipei through the inter-net. I want to express myheartfelt appreciation to the executive board members of the KDDW and TDDW, and the presenters,
moderators and discussants of this symposium for your kind understanding and warm support. This is
the first symposium to start the second round of JKT joint symposiums. Through the past three 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. Taking precious suggestions given by my friends at the business meeting of the 3rd
JKT joint symposium held in Kaohsiung last September into consideration, the 4th JKT joint symposium will be held as parallelsessions using two rooms in order to secure enough time for deeper discussions on the respective important topics of the upper
GI, lower GI, liver and pancreato-biliary categories. In addition, proceedings of the joint symposium will be prepared for the
first time so that the JKT joint symposium will become a precious opportunity to promote collaborations for clinical research
work among investigators of the 3 DDWs. It is very regrettable that we cannot see you, our important friends from the KDDW
and TDDW, on a face-to-face basis in Kobe, but I hope the new style JKT joint symposium will be successful and will help tomake our academic ties and friendships stronger.
President, Japan Digestive Disease Week

Joo Young Cho
On behalf of Organizing Committees of Korea Digestive Disease Week 2020, I would like to congratulate
your entire team for holding JDDW-KDDW-TDDW web symposium hosted by Japan Digestive Disease
Week 2020. JDDW is an academic meeting where gastroenterologists from all over the world gathering in
one place to discuss various issues of gastroenterology. The 4th Joint Session of JDDW-KDDW-TDDW will
be proposing high quality scientific sessions that will provide deeper knowledge and new perspectives ofdigestive diseases.
Every year, the joint session of JDDW-KDDW-TDDW have promoted development of global digestive science through continuous exchange of knowledge among Japan, Korea and Taiwan. At this joint session,scientific programs and presentations focused on the latest knowledge of digestive diseases have always
been innovative. We are very looking forward to unique programs that have enriched this conference. Considering the uncertainty of the current situation due to the global impact of COVID-19, the leadership of JDDW 2020 leading the global gastroenterology society is particularly important.
I hope the scientific communities in Japan, Korea and Taiwan will enjoy interacting and stimulating one another in the years tocome. I look forward to staying in touch for our close collaboration.
With sincere regards,
President, Organizing Committees of Korea Digestive Disease Week 2020
President, Korean Society of Gastrointestinal Endoscopy

Ming-Shiang Wu
On behalf of the Gastroenterological Society of Taiwan (GEST), I would like to extend my warmest
welcome to all of you participating in the joint meeting of JDDW-KDDW-TDDW. To cultivate and encourage young members who dedicate to digestive disease research, this meeting is held first in Japan in 2017with great success. Then Korea hosts the meeting in 2018 and Taiwan 2019. As always it has been, thescope encompasses the hepatobiliary system and gastrointestinal tract, from basic research, translational
medicine and clinical practice. This professional platform will provide the optimal venue for sharing andlearning cutting-edge knowledge and skills from young experts of three countries. I am sure the participants will have fruitful and rewarding exchange.
This year, COVID-19 pandemic results in unprecedented interruption of many academic activatesand international conferences. Many lectures will be forced to conduct virtually but what remains unchanged, is our passion toensure the success of the meeting and to explore the unmet clinical needs in digestive medicine. I am more than happy to invite
all of you from Japan, Korea and Taiwan to participate in this joint meeting.
Sincerely yours
President, The Gastroenterological Society of Taiwan
Distinged Professor & Superintendent,
National Taiwan University Hospital

CONTENTS
JKT1

Lower GI

Lower gastrointestinal functional disorders in Asia
Speaker
TRP channel is associated with regulating colonic peristalsis and visceral hypersensitivity in lower gastrointestinal
functional disorders.

Ken Inoue �������������������������������������������������������������������������������������������������������������������������������������������������������������� pg 8
Diagnosis and treatment of constipation in Korea
Moo In Park ����������������������������������������������������������������������������������������������������������������������������������������������������������� pg 9
Prevalence of small intestinal bacterial overgrowth (SIBO) and its association with the clinical manifestation in
Taiwanese patients with inflammatory bowel disease

Chia-Hung Tu ������������������������������������������������������������������������������������������������������������������������������������������������������ pg 10

Rising Star Program
Research Progress of Chronic Intestinal Pseudo-obstruction (CIPO) in Japan and Future Perspective
Hidenori Ohkubo ������������������������������������������������������������������������������������������������������������������������������������������������� pg 11
Diagnostic tools and management in patients with rectal evacuation disorder

Seon Young Park ������������������������������������������������������������������������������������������������������������������������������������������������ pg 12
Prevalence and clinical characteristics of irritable bowel syndrome in Taiwan: an update
Chia-Chu Yeh ������������������������������������������������������������������������������������������������������������������������������������������������������ pg 13

JKT2

Upper GI

Treatment strategy for gastroesophageal junction tumor
Speaker

Optimal extent of lymph node dissection for esophagogastric junction tumors
Yukinori Kurokawa ��������������������������������������������������������������������������������������������������������������������������������������������� pg 16
Treatment strategy for esophagogastric junction fistula or leakage after surgery
Jin Seok Jang ����������������������������������������������������������������������������������������������������������������������������������������������������� pg 17
Current diagnosis and endoscopic therapy of Barrett esophagus in Taiwan – A multi-center survey
Ching-Tai Lee ������������������������������������������������������������������������������������������������������������������������������������������������������ pg 18

Rising Star Program
Is minimal invasive surgery feasible for gastroesophageal junction tumor?

Masanori Tokunaga �������������������������������������������������������������������������������������������������������������������������������������������� pg 19
New endoscopic technology for gastroesophageal junction tumor treatment
Hyuk Soon Choi �������������������������������������������������������������������������������������������������������������������������������������������������� pg 20
Clinical significance of tissue acquisition of gastroesophageal junction submucosal tumor

Chen-Shuan Chung ��������������������������������������������������������������������������������������������������������������������������������������������� pg 21

JKT3

Biliary, Pancreas

Endoscopic biliary stenting-40th anniversary memorial symposiumSpeaker

History and current strategy of endoscopic stenting for unresectable malignant distal biliary obstruction
Hiroyuki Isayama ������������������������������������������������������������������������������������������������������������������������������������������������ pg 24
EUS-guided versus ERCP-guided biliary drainage with metal stenting for primary treatment of distal malignant biliary
obstruction
Do Hyun Park ������������������������������������������������������������������������������������������������������������������������������������������������������ pg 25
Optimal endoscopic biliary stenting for malignant biliary obstruction
Yu-Ting Kuo �������������������������������������������������������������������������������������������������������������������������������������������������������� pg 26

Rising Star Program
Novel EUS-guided therapeutic approach for postoperative bile duct stricture
Takeshi Ogura ���������������������������������������������������������������������������������������������������������������������������������������������������� pg 27
EUS-guided drainage for peripancreatic fluid collections; Which technique is better?
Se Woo Park ������������������������������������������������������������������������������������������������������������������������������������������������������� pg 28
Current Perspectives on Endoscopic Biliary Stents
Jung-Chun Lin ����������������������������������������������������������������������������������������������������������������������������������������������������� pg 29

JKT4

Liver

Changing Paradigm in Treatment Strategy for HCC: 2020 Update
Speaker

Evolving Treatment Paradigm and future landscape in systemic therapy for advanced hepatocellular carcinoma
Masafumi Ikeda ��������������������������������������������������������������������������������������������������������������������������������������������������� pg 32
Current Treatment Strategies for Hepatocellular Carcinoma in Korea

Bo Hyun Kim ������������������������������������������������������������������������������������������������������������������������������������������������������� pg 33
Changing landscape of HCC therapy in Taiwan
Yi-Hsiang Huang ������������������������������������������������������������������������������������������������������������������������������������������������� pg 34

Rising Star Program
Treatment strategy for unresectable hepatocellular carcinoma with a focus on maintaining hepatic reserve
Yuji Eso ��������������������������������������������������������������������������������������������������������������������������������������������������������������� pg 35
Paradigm change in intermediate and advanced HCC: Role of locoregional therapy in the rise of systemic therapy
Sun Young Yim ���������������������������������������������������������������������������������������������������������������������������������������������������� pg 36
Immune contexture of HCC: from Sorafenib to immune checkpoint inhibitors
Li-Chun Lu ����������������������������������������������������������������������������������������������������������������������������������������������������������� pg 37

Unauthorized reproduction of the abstracts in this booklet is prohibited

The 4th Joint Session between

JDDW - KDDW - TDDW
Abstract

JKT1

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

Lower gastrointestinal functional disorders in Asia

Chair:

Yasuhiro Fujiwara

Department of Gastroenterology, Osaka City University Graduate School of Medicine

Oh Young Lee

Hanyang University

Ching-Liang Lu

Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital

Discusser:

Tadayuki Oshima

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College ofMedicine

Kee Wook Jung

Asan medical center, Ulsan University

Ping-Huei Tseng

Department of Internal Medicine, National Taiwan University Hospital

Speaker:

JKT1-1

TRP channel is associated with regulating colonic peristalsis andvisceral hypersensitivity in lower gastrointestinal functional disorders.

Ken Inoue

Kyoto Prefectural University of Medicine

JKT1-2

Diagnosis and treatment of constipation in Korea

Moo In Park

Division of Gastroenterology, Department of Internal Medicine, Kosin University Gospel Hospital

JKT1-3

Prevalence of small intestinal bacterial overgrowth (SIBO) and its
association with the clinical manifestation in Taiwanese patients with
inflammatory bowel disease

Chia-Hung Tu

National Taiwan University Hospital

Rising Star Program:

JKT1-RS1

Research Progress of Chronic Intestinal Pseudo-obstruction (CIPO) in
Japan and Future Perspective

Hidenori Ohkubo

Hepatology and Gastroenterology Division, Yokohama City University Hospital

JKT1-RS2

Diagnostic tools and management in patients with rectal evacuation
disorderSeon Young Park

Chonnam National University Medical School

JKT1-RS3

Prevalence and clinical characteristics of irritable bowel syndrome in
Taiwan: an update

Chia-Chu Yeh

Good Liver Clinic, Department of Internal Medicine, National Taiwan University Hospital

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT1-1

 RP channel is associated with regulating colonic peristalsis and visT
ceral hypersensitivity in lower gastrointestinal functional disorders.

Ken Inoue
Kyoto Prefectural University of Medicine

The patients with functional gastrointestinal disorders (FGIDs) have chronic unexplained gastrointestinal symptoms.
FGIDs include the irritable bowel syndrome (IBS) and functional dyspepsia (FD), currently classified by Rome IV. The
main symptom of IBS（irritable bowel syndrome：IBS）, which is a typical functional gastrointestinal disorder, chronicintermittent abdominal pain and associated diarrhea, constipation, or both. The pathology of IBS involves genome, cerebrointestinal peptides, gastrointestinal motility abnormalities, visceral hypersensitivity, gastrointestinal immunity, mucosal permeability, gut flora, psychosocial factors, etc.
The gastrointestinal tract has functions not only of digestion and absorption, but also of a sensor that senses various
chemical and physical stimulation. The digestive tract has a system for regulating immune function, endocrine function,and nerve function. Multimodal sensors of the digestive tract include TRP (Transient Receptor Potential) channels. TRP
channels respond to a wide variety of sensory stimuli, including temperature, nociceptive compounds, touch, osmolarity, and pheromones. It was reported that TRP channel expressed in the digestive tract. It has been reported that TRP
channels may be involved in the pathophysiology of various diseases, and research is progressing as a new drug discovery target. Since the mechanism of rectal hypersensitivity and faecal urgency seems to involve increased TRPV1,
drugs that target the mechanisms of this receptor should be assessed. TRPV2 may contribute to intestinal motility
through NO production, and TRPV2 is a promising target for controlling intestinal movement. It was reported that mildly
cool water and the cooling agent menthol activate same TRP channel, TRPM8. It was reported that TRPM8 agonist(menthol) suppressed gastrointestinal peristalsis. We also reported that TRPM8 agonist suppressed colonic peristalsis
and abdominal pain. However, how the menthol, TRPM8 agonist, works on the gastrointestinal peristalsis and visceral
hypersensitivity was poorly documented. We are studying the involvement of TRPM8 in regulating colonic peristalsis
using TRPM8 deficient mice. In the lower gastrointestinal tract, TRPA1 activation results in PGE2 release and consequently promotes colorectal contraction.
In the future, elucidation of this multimodal sensing function of the digestive tract may lead to the development of new
diagnosis and new drug discovery of FGIDs.

Curriculum Vitae
Ken Inoue

Kyoto Prefectural University of Medicine

Education:
2011
Ph.D. (Dr. of Medical Science), Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science (Thesis: Mechanism of intestinal fibrosis in inflammatory bowel disease)
2003
M.D., Kyoto Prefectural University of Medicine Professional Training and Employment:
2018Assistant Professor, Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto
2016-2018 Medical Staff in Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Kyoto
2013-2016 Center for Critical Illness Research, Lawson Health Research Institute, London, Ontario, Canada, Postdoctoral Fellow
2011-2013 Assistant Professor, Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto
2007-2011 Graduate School at Kyoto Prefectural University of Medicine
2005-2007 Medical Staff in Department of Gastroenterology and Hepatology, Nantan General Hospital, Kyoto
2003-2005 Resident in Internal Medicine, Kyoto Prefectural University of Medicine
2003
Passed the Examination of National Board
Societies:
Japanese Society of Internal Medicine
Japanese Society of Gastroenterology
Japanese Gastroenterological Association
Japanese Society of Gastroenterological Endoscopy

8

November 5, 2020 Portopia Hotel

JKT1-2

Diagnosis and treatment of constipation in Korea

Moo In Park
Division of Gastroenterology, Department of Internal Medicine, Kosin University Gospel Hospital

Constipation is a common gastrointestinal disease affecting approximately 16.5% of the population in Korea. Access toconstipation patients in Korea is almost the same compared to other countries, the actual diagnosis and treatment ofconstipation patients in Korea may be slightly different from that of other countries. Characteristics of Korean patientswith constipation may be different from those of western patients. Korean patients with constipation have a tendency
to delay an accurate diagnosis and treatment and to use folk remedies. According to a prospective nationwide multi-center questionnaire study using Rome III questionnaires in Korea, the overlap of GERD or FD was common in patients with constipation. Misconceptions by patients about the six constipation symptoms were relatively common in
Korea, which could be valuable for clinicians treating constipation patients. Treatment of chronic constipation basedon the underlying pathophysiology is generally successful. Lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments could be applied into patients withconstipation. Although systematic studies on constipation have been rarely conducted in Korea, three guidelines forchronic constipation have been developed based upon the adaptation method to help in clinical practice in Korea. In
this lecture, I will discuss diagnosis and treatment in Korea, focusing on research results and guidelines published in
Korea.

Curriculum Vitae
Moo In Park

Division of Gastroenterology, Department of Internal Medicine, Kosin University Gospel Hospital

MOO IN PARK, MD,PhD
Professor
Division of Gastroenterology, Department of Internal Medicine Kosin University Gospel Hospital Busan, Korea
EDUCATION
Doctor of Medicine (M.D.), Kosin University College of Medicine, Busan, Korea, 1984-1990
Master of Science (M.Sc) in Microbiology, Kosin University
College of Medicine, Busan, Korea, 1992-1994
Doctor of Philosophy (Ph.D.) in Microbiology, Kosin University College of Medicine, Busan, Korea, 1997-2000
Internship, Kosin University Gospel Hospital, Busan, Korea, 1990-1991
Residency Training, Internal Medicine, Kosin University
Gospel Hospital, Busan, Korea, 1991-1995
Fellowship, Gastroenterology, Asan Medical Center, Seoul,
Korea, 1998-1999
MILITARY SERVICE
Flight surgeon at Korean Air Force Academy, 1995-1998

ACADEMIC APPOINTMENTS
Instructor of Internal Medicine, Kosin University College ofMedicine, Busan, Korea, 1999-2000
Assistant Professor of Internal Medicine, Kosin University
College of Medicine, Busan, Korea, 2000-2004
Visiting scientist, Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Gastroenterology Research Unit, Mayo Clinic College of Medicine,
Rochester, MN, USA, 2003-2005
Certificate in Clinical and Translational Science at Mayo
ClinicAssociate Professor of Internal Medicine, Kosin University
College of Medicine, Busan, Korea, 2004-2009Professor of Internal Medicine, Kosin University College ofMedicine, Busan, Korea, 2009-present
RESEARCH INTERESTS
Pathogenesis and Treatments of Esophageal Motility Disorders
Epidemiology and Treatments of GERD
Pathogenesis and Treatments of IBS
Epidemiology and Treatments of constipationRole of Diet in the gastric motor and sensory functions andpathogenesis of FGIDs and Obesity

9The 4th Joint Session between

JDDW - KDDW - TDDW
JKT1-3

 revalence of small intestinal bacterial overgrowth (SIBO) and its
Passociation with the clinical manifestation in Taiwanese patients with
inflammatory bowel disease

Chia-Hung Tu
National Taiwan University Hospital

Curriculum Vitae
Chia-Hung Tu

National Taiwan University Hospital

10November 5, 2020 Portopia Hotel

JKT1-RS1

 esearch Progress of Chronic Intestinal Pseudo-obstruction (CIPO) in
R
Japan and Future Perspective

Hidenori Ohkubo
Hepatology and Gastroenterology Division, Yokohama City University Hospital

Chronic intestinal pseudo-obstruction (CIPO) is a rare and severe digestive disease characterized by long-term symptoms of intestinal obstruction without any mechanical cause. Sustained increased intra-bowel pressure often causes
small intestinal malabsorption and bacterial translocation, which leads to poor clinical outcomes. However, no clear diagnostic criteria had been established so far, and the recognition rate was quite low in Japan. Therefore, in 2012 ourResearch Group proposed diagnostic criteria for the first time in the world to facilitate the diagnosis of this rare diseaseby the general physician. The criteria are useful in clinical practice with a high sensitivity of 86.3% in Japanese cases.
In the Western countries, manometry, scintigraphy, and full-thickness biopsy are the major examination for the CIPO diagnosis; however, these examinations are generally invasive or expose the patient to ionizing radiation. Therefore, in
2013, our group developed non-invasive and radiation-free new modality cine-MRI. We compared small bowel motility inhealthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO using cine-MRI. As a result, cineMRI clearly detected the contractility impairment in CIPO patients by video motion.
In 2014, considering these research progress, the Japanese criteria have been revised, and the comprehensive criteria
from a child to an adult have been devised. Moreover, in 2015, CIPO is newly certified as Specified Rare and Intractable
Disease which is subsidized from public expense in Japan.
Regarding treatment, intestinal decompression plays a key role, but conventional method including a trans-nasal small
intestinal tube is invasive and painful. Therefore, a less invasive and tolerable new decompression method was urgently
desired. In 2017, we conducted a pilot study and assessed the efficacy and safety of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy in CIPO patients. We found that PEG-J can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. PEG-J has the potential to be a novel decompression therapy for CIPO available at home with a minimum invasion.
Most recently, in 2019, we started an investigator-initiated phase 2 trial, which assesses the efficacy and safety of rifaximin in patients with CIPO. Rifaximin is expected to reduce the small intestinal gas and improve the symptom of abdominal bloating.
In the future, oral antibiotics therapy may become a new non-invasive therapy for patients with this intractable disease.

Curriculum Vitae
Hidenori Ohkubo

Hepatology and Gastroenterology Division, Yokohama City University Hospital

POSITION:
Research Associate
EDUCATION:
2005 M.D., Niigata University School of Medicine
2014 PhD., Medical Science Yokohama City University
DEGREE:
M.D., Ph.D
CAREER:
2005-2007 Junior Resident, Niigata University Hospital, Niigata, Japan
2007-2011 Senior Resident, Chigasaki Municipal Hospital, Chigasaki, Japan
2011-2014 Gastroenterology Division, Yokohama City University, Japan
2014- Research Associate of Gastroenterology & Hepatology, Yokohama City University Hospital, Japan
CLINICAL SPECIALITY:
Neurogastroenterology and Motility
RESEARCH INTERESTS:
Chronic intestinal pseudo-obstruction, chronic constipation

11

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT1-RS2

 iagnostic tools and management in patients with rectal evacuation
D
disorderSeon Young Park
Chonnam National University Medical School

Rectal evacuation disorders account for about 30% of chronic constipation in tertiary referral centers. Rectal evacuation disorders include anorectal disorders of functional or structural abnormalities. If a patient fails to respond to medical treatment for control of constipation, a more detailed evaluation to understand the cause should be considered, especially regarding the evaluation of rectal evacuation disorder. There are several diagnostic methods to evaluate
anorectal structure and functioning tests in clinical practice.
For patients with rectal evacuation disorder who are unresponsive to conservative management, non-pharmacologicaltherapy such as biofeedback, colectomy, correction of underlying structural abnormalities or ileostomy need to be considered. Here, I will discuss the review or future perspectives of diagnostic tools and management in patients with rectal evacuation disorder.

Curriculum Vitae
Seon Young Park

Chonnam National University Medical School2020.3-Present Professor of Division of Gastroenterology
Chonnam national university hospital
2015.8–2017.5 Visiting scientist
Department of Gastroenterology and Hepatology Mayo Clinic

12November 5, 2020 Portopia Hotel

JKT1-RS3

 revalence and clinical characteristics of irritable bowel syndrome
P
in Taiwan: an update

Chia-Chu Yeh
Good Liver Clinic, Department of Internal Medicine, National Taiwan University Hospital

Irritable bowel syndrome (IBS) is a relapsing functional bowel disorder defined by symptom-based criteria, including recurrent abdominal pain, change of bowel habits, and symptomatic relief after bowel movement. Physicians should pay
attention to alarming clinical features and exclude organic diseases before reaching the diagnosis of IBS. It is important to carefully review the stool patterns to determine the predominant bowel symptoms and IBS subtypes so appropriate treatment could be initiated. The chronic and relapsing nature of the disease has a high impact on patient’s quality of life, resulting in frequent hospital visits and consumption of medical resources. The exact pathophysiology iscomplex and remains elusive, and previous studies suggested IBS to be multifactorial. Management of IBS includes regular exercise, diet control (low FODMAP diet), probiotics, and medical treatments.
The prevalence of IBS has been reported to be high in Taiwan, 22.1% and 17.5% as defined by the Rome II and I criteria, respectively, according to the 2003 survey of a population receiving physical check-ups at a medical center. However, the prevalence of IBS based on a later nation-wide survey in Taiwan during 2005-2008 was 4.4% using the Rome
III criteria. The difference may be explained by the stricter criteria of Rome III criteria on the frequency of abdominal
symptoms. Recently, we conducted a study to investigate the updated prevalence and clinical characteristics of IBS in
the Taiwanese population. From August 2019 to December 2019, we recruited 501 subjects (mean age 50.8 ± 10.5,
male 55.1%) receiving health examinations in National Taiwan University Hospital, and found a 6% prevalence of IBS
according to the Rome III criteria. Compared with the control group, the IBS group had higher scores on Brief Symptom
Rating Scale (BSRS-5) (4.83 ± 3.41 vs. 2.80 ± 2.82, p<0.001), suggesting a higher psychosocial stress. There was also
a higher prevalence of psychiatric morbidity (10% vs. 2.5%, P=0.020), as defined by the total BSRS-5 scores >=6. The
insomnia symptoms base on the Athens Insomnia Scale were also higher in the IBS group (7.35 ± 4.32 vs. 4.39 ± 3.72,
p<0.001). The severity of psychiatric and insomnia symptoms was positively correlated with the frequency of abdominal pain. Our study suggests the pivotal role of psychiatric stress and sleep disturbance on the rising prevalence of IBS
in Taiwan.

Curriculum Vitae
Chia-Chu Yeh

Good Liver Clinic, Department of Internal Medicine, National Taiwan University Hospital

Education:
・ M.D., School of Medicine, Fu Jen
Catholic University, Taiwan, June
2010
Current Position:
・Visiting staff, Good Liver Clinic, July 2017・ Adjunct visiting staff, Department of Internal Medicine,National Taiwan University Hospital, July 2017Previous position:
・Fellow, Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, July
2015-June 2017
・ Resident in Internal Medicine, Department of Internal
Medicine, National Taiwan University Hospital, July 2012June 2015

・Diplomate, National Board of Medical Examiners, 2010
Organizations:・The Digestive Endoscopy Society of Taiwan
・The Gastroenterological Society of Taiwan
・Taiwan Society of Internal Medicine
Publications:・ Yeh CC, Chen CC, Wu JF, Lee HC, Lee YC, Liu KL, et al.
Etiologies and clinical characteristics of non-obstructive
dysphagia in a Taiwanese population: A prospective study
based on high-resolution impedance manometry. J Formos
Med Assoc. 2019;118:1528-36. Epub 2019/01/13.
・ Yeh CC, Yao M, Su TH. Multiple Giant Mushroom-like Tumors Inside the Stomach. Gastroenterology. 2016;151:e9e10. Epub 2016/06/04.

Certification:
・Diplomate, Board of Digestive Endoscopy, 2018
・Diplomate, Board of Digestive Medicine, 2017
・Diplomate, Board of Internal Medicine, 2015

13

The 4th Joint Session between

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memo

14

JKT2

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

Treatment strategy for gastroesophageal junction tumor

Chair:

Hideaki Shimada

Department of Gastroenterological Surgery, Toho University Graduate School of Medicine

Joo Young Cho

CHA Bundang Medical Center, CHA University

Chi-Yang Chang

Fu-Jen Catholic University Hospital

Discusser:

Hiroya Takeuchi

Department of Surgery, Hamamatsu University School of Medicine

Gwang Ho Baik

Departement of Internal medicine, Gastroenterology Division, Chunchon Sacred Heart Hospital

Wen-Lun Wang

Department of Digestive Endoscopy, E-Da Hospital and I-Shou University

Speaker:

JKT2-1

Optimal extent of lymph node dissection for esophagogastric junction
tumorsYukinori Kurokawa

Department of Gastroenterological Surgery, Osaka University

JKT2-2Treatment strategy for esophagogastric junction fistula or leakage
after surgery

Jin Seok Jang

Gastroenteroly Department, Dong-A University Hospital

JKT2-3Current diagnosis and endoscopic therapy of Barrett esophagus in
Taiwan - A multi-center survey

Ching-Tai Lee

Department of Endoscopy, E-Da Hospital and I-Shou University

Rising Star Program:

JKT2-RS1

Is minimal invasive surgery feasible for gastroesophageal junction
tumor?

Masanori Tokunaga

Tokyo Medical and Dental University

JKT2-RS2

New endoscopic technology for gastroesophageal junction tumor
treatment

Hyuk Soon Choi

Korea University College of Medicine

JKT2-RS3

Clinical significance of tissue acquisition of gastroesophageal junction
submucosal tumor

Chen-Shuan Chung

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern
Memorial Hospital

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT2-1

 ptimal extent of lymph node dissection for esophagogastric junction
O
tumorsYukinori Kurokawa
Department of Gastroenterological Surgery, Osaka University

Although the incidence of esophagogastric junction (EGJ) tumors has gradually increased in recent years, the optimal
extent of lymph node dissection for EGJ tumors has been unclear. Japanese gastric surgeons have traditionally performed open total gastrectomy and lower esophagectomy for EGJ tumors with esophageal involvement of less than 3
cm from the evidence of JCOG9502 trial (Lancet Oncol 2006). Recently, the Japanese Gastric Cancer Association and
the Japan Esophageal Society have conducted a nationwide prospective study to elucidate the accurate incidence oflymph node metastasis from cT2-T4 EGJ tumors, and reported that total gastrectomy was not needed for EGJ tumors(Ann Surg 2020). In addition, subtotal esophagectomy with dissection of upper mediastinal station 106recR (right recurrent laryngeal nerve) was recommended if esophageal involvement exceeded 4 cm. Lower mediastinal station 110(para-esophageal) should be dissected if esophageal involvement exceeded 2 cm. In this Symposium, we will show ourrecent procedure of minimally invasive surgery for EGJ tumors.

Curriculum Vitae
Yukinori Kurokawa

Department of Gastroenterological Surgery, Osaka University

Japan

Current position: Associate Professor
Organization: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine,- Education 1991-1997: MD, School of Medicine, Keio University, Tokyo, Japan
2001-2005: PhD, Graduate School of Medicine, Osaka
University, Osaka, Japan- Post-graduate Career 1997-1998: Resident, Department of Gastroenterological
Surgery, Osaka University Hospital, Osaka, Japan
1998-2001: Resident, Department of Surgery, Osaka National Hospital, Osaka, Japan
2004-2005: Fellow, Department of Gastroenterological
Surgery, Osaka University Hospital, Osaka, Japan
2005-2007: Postdoctoral Fellow, Cancer Information and
Epidemiology Division, National Cancer Center, Tokyo, Japan

16

2007-2010: Attending Surgeon, Department of Surgery,
Osaka National Hospital, Osaka, Japan
2010-2020: Assistant Professor, Department of Gastroenterological Surgery, Osaka University Graduate School of
Medicine, Osaka, Japan
2020-present: Associate Professor, Department of Gastroenterological Surgery, Osaka University Graduate
School of Medicine, Osaka, Japan- International Experiences 1996: Externship medical student, US Navy Hospital in
Yokosuka, USA
1996: Medical student rotation, Department of Colorectal
Surgery, Cleveland Clinic, Ohio, USA
2003: Visiting Observer, Division of Liver and GI Transplant, University of Miami, Florida, USA
2009: Honorary Observer, Department of Surgery andCancer, St Mary’s Hospital, Imperial College, London, UK

November 5, 2020 Portopia Hotel

JKT2-2Treatment strategy for esophagogastric junction fistula or leakage
after surgery

Jin Seok Jang
Gastroenteroly Department, Dong-A University Hospital

Curriculum Vitae
Jin Seok Jang

Gastroenteroly Department, Dong-A University Hospital

17

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT2-3

 urrent diagnosis and endoscopic therapy of Barrett esophagus inC
Taiwan – A multi-center survey

Ching-Tai Lee
Department of Endoscopy, E-Da Hospital and I-Shou University

Although Barrett esophagus (BE) is an uncommon diagnosis in Taiwan, adenocarcinoma due to progression of BE remained a problem not to be ignored. In the past decades, the incidence of BE increased gradually in proportional to thatof reflux esophagitis. In 2016, Asia-Pacific consensus on the management of GERD and BE was revised; however, thediagnosis and endoscopic therapy of BE are still challenging in Taiwan. Standardization of diagnosis and management
for BE are crucial.
In early July 2020, one-day conference for a multi-center survey focusing on current diagnosis and endoscopic therapy of BE was done on behalf of the digestive endoscopy society of Taiwan (DEST). Sixty endoscopists with specialization of BE attended the meeting. Pre questionnaire surveys of the current status about the diagnosis and endoscopic
therapy of BE in Taiwan were taken. After pre questionnaire surveys, literature reviews of currently updated guidelines were performed by experts, including American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), British Society of Gastroenterology (BSG), Japan Esophageal Society (JES), Asia-Pacificconsensus, and European Society of Gastrointestinal Endoscopy (ESGE). After literature reviews, the post questionnaire surveys with similar questions were performed followed by detail discussion.
Only half participants agreed IM as an essential feature for the diagnosis of BE. However, IM was regarded as a diagnostic criteria of BE by pathologists in real world practice. This remained the major dispute in Taiwan. Seldom endoscopists followed the Seattle protocol but almost all participants preferred to use Plaque C & M criteria to describe the extension of BE. Controversies existed between the top of gastric fold and lower border of palisading vessel as alandmark of ECJ. Participants suggested proton-pump inhibitor for non-dysplastic Barrett patients with reflux-related
symptoms. More than one third participants would like to take aggressive measures to manage BE with low-grade dysplasia. Endoscopic resection still is the 1st choice of treatment for Barrett mucosa with high-grade dysplasia. Additional
therapy with radio-frequency ablation (RFA) for remaining Barrett mucosa is strongly recommended after eradicationof dysplastic part.
This survey demonstrated the real-world condition of the diagnosis and treatment for Barrett disease in Taiwan. Further communication between the endoscopists and the pathologists will be arranged to make a consensus by DEST in
the future.

Curriculum Vitae
Ching-Tai Lee

Department of Endoscopy, E-Da Hospital and I-Shou University

Dr. Lee was graduated from department and college of medicine, National Taiwan University in Jun
2000 and became a physician of internal medicine. He finished his fellowship training of gastroenterologist in Jun 2005 and became a visiting staff of E-Da hospital since Jul 2005. He is a clinical-investigator and gastroenterologist and had been appointed as the lecturer of I-Shou University
since 2009. His major research exposure and interests include 1) endoscopic diagnosis and treatment of early gastrointestinal neoplasia, 2) screening for esophageal cancer, 3) peroral endoscopic myotomy (POEM) for
achalasia, and 4) endoscopic retrograde cholangiopancreatography (ERCP). He is a member of the GastroenterologicalSociety of Taiwan (GEST), the Digestive Endoscopy Society of Taiwan (DEST), Taiwan Pancreas Society, and is also aninternational member of American Society of Gastrointestinal Endoscopy (ASGE).

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November 5, 2020 Portopia Hotel

JKT2-RS1Is minimal invasive surgery feasible for gastroesophageal junction
tumor?

Masanori Tokunaga
Tokyo Medical and Dental University

Background: The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing in Japan,
and a current standard treatment for resectable AEG is gastrectomy with lower esophageal resection through the transhiatal approach. Minimally invasive surgery (MIS) for advanced gastric cancer is widely practiced, and the non-inferiority of MIS to the open approach was confirmed in patients with lower two-thirds gastric cancer in two Asian studies.
However, the feasibility of MIS for AEG still remains unclear, and thus in this report, potential advantages and disadvantages of MIS for AEG are summarized and introduced.
Potential advantages: MIS for AEG can be performed with less bleeding and earlier recovery, as reported in previous
studies comparing MIS with open surgery. Another potential advantage is that MIS will facilitate a better surgical fieldin the lower mediastinum which includes deep and narrow areas. In open surgery, surgeons’ hands and devices are obstacles to making the surgical field viewable for assistants, while in MIS, a laparoscopic camera can approach close to
the surgical field, resulting in surgical field images which can be shared with the operator and assistants performing
procedures like low anterior resection for rectal cancer. This can result in more meticulous surgery with fewer postoperative complications.
Potential disadvantages: MIS may result in slightly longer operation times than open approach. In addition, conflictamong devices including laparoscopic cameras is one of the possible drawbacks, but this has been partially overcomeby the advent of robotic surgery with articulated devices. However, lack of robust evidence which supports the superiority of MIS should be taken into account, and well-designed trials, ideally randomized controlled trials, are needed for
MIS for AEG to be accepted more broadly.
Surgical procedure: The transhiatal approach is selected in cases with esophageal infiltration of 3cm or less. Lower
mediastinal lymph node dissection is performed while exposing the pericardium, aorta, and both sides of the pleural
membrane. The esophagus is transected under the guidance of intra-operative endoscopy. Overlap reconstruction is
primarily selected for esophagojejunostomy, and the entry-hole is closed with either interrupted or running sutures.
Summary: MIS for AEG will be more widely accepted when newly developed devices, such as robots, are available tofacilitate the procedures. We should commence planning clinical trials to demonstrate the superiority of MIS.

Curriculum Vitae
Masanori Tokunaga

Tokyo Medical and Dental University

EDUCATIONAL AND PROFESSIONAL HISTORY
A.Higher Education
4/1994-3/2000 M.D. College of Medicine, Kyushu University, Fukuoka, Japan
B.Post-Graduate Education
2000-2006 Dept. of Surgery, Aso-Iizuka Hospital, Fukuoka, Japan
2006-2009 Dept. of Gastroenterological surgery, Cancer Institute Hospital, Tokyo, Japan
2009-2017 Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan2017-2019 Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan
2019-present Dept. of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
C.Certification & Licenses
May, 2000 Japanese Medial License

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The 4th Joint Session between

JDDW - KDDW - TDDW
JKT2-RS2

 ew endoscopic technology for gastroesophageal junction tumorN
treatment

Hyuk Soon Choi
Korea University College of Medicine

Choosing treatment for gastroesophageal junction tumor (GEJ) has been one of the most difficult decisions for gastroenterologist since the quality of patients varies depending on the treatment. In case of GEJ cancer, it can be treatedwith either total gastrectomy, esophagectomy or proximal gastrectomy depending on the severity of disease, and if
GEJ cancer is diagnosed at early stage, endoscopic treatment may be the curative treatment option. If there is certainty of complete removal of tumor, endoscopic treatment would be the best option for patients in the aspect of patient’s
quality of life.
The very first step is to make accurate diagnosis and depth of cancer invasion should be measured with endoscopic ultrasound (EUS), one of the most accurate diagnostic tools. However, it may be difficult to obtain accurate information
depending on the types of malignancies and how experienced operators are, since EUS is an operator-dependent method. There have been several attempts to make up for the weakness. Confocal endoscopy and Optical Coherence Tomography (OCT) have been used, and our research team is currently working on photoacoustic endoscopy, whichshows the possibility of developing new modality which can determine depth of invasion more accurately.
Currently, endoscopic treatment of choice for GEJ tumor is the endoscopic submucosal dissection (ESD). Recently,
submucosal tunneling endoscopic resection of SET or wide circular esophageal cancer is considered as one of thetreatment options. However, because tumors are located in curved area which makes it difficult for operators, newmethods have been proposed to overcome these obstacles. Recently, our research team has tried to overcome the previous difficulties by using robot assisted endoscopy. Robot endoscopy is still a new field, but it has shown tremendous
potentials. Also, electrical ablation therapy can be another option. Previously, tumors in EGJ were removed by endoscopic mucosal resection (EMR) and electrical ablation therapy was applied, which showed satisfying results. Our research team also showed good results such as irreversible electroporation in animal experiments using by new electrical ablation therapy.
New endoscopic diagnosis and treatment for EGJ tumors is still challenging but showing great progress. If minimally invasive therapy for GEJ tumors with endoscopic modalities is established, we can expect to complete cure of the EGJ
tumor as well as improving patient’s quality of life.

Curriculum Vitae
Hyuk Soon Choi

Korea University College of Medicine
Professor Choi graduated from Korea
University, College of Medicine, Seoul,
Korea in 2004. He was appointed as Assistant professor of Internal Medicine at
2015. Now prof. Choi is an Associate
Professor of Internal Medicine at College of Medicine Korea University,
South Korea. He is gastroenterologist and endoscopist. His major clinical interest is mainly gastrointestinal disease and therapeutic endoscopic procedure.
Prof. Choi serves a committee member of several scientific societies such as vice secretary general of Korean Society of
Gastrointestinal Endoscopy (KSGE), secretary general of Korean Innovative Medical Technology society(previous K-NOTES),
Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Society of Gastrointestinal Cancer(KSGC). He
is also a member of many international gastroenterology societies, including the European Society of Gastrointestinal Endoscopy (ESGE), the European Society of Digestive Oncology(ESDO), the European The American Gastroenterological
Association (AGA), and American Society of Gastrointestinal
Endoscopy (ASGE).
Prof. Choi has been conducting various national research projects related to endoscopic device development, and holds numerous patents related to endoscopic diagnostic and therapeutic devices. He also performs several clinical investigations
dealing with endoscopic procedure and surgery.
His contributions to the medical sciences and academic advancement have been recognized with many domestic and in-20

ternational academic awards.
Crystal Award(American Society of Gastrointestinal Endoscopy,
ASGE, 2013)
Best Presentation Award(2017.11 KDDW, 2018 K-NOTES)Best Poster Award(2016, 2012, International Digestive Endoscopy Network, IDEN)Best oral Presentation(2015, IDEN)Best paper Award(2013, KUCMAA)
Top Poster(UEGW, 2011)
UEGW Travel grant(2013, 2014)
Best oral Presentation(2011, KSGE) etc.
He holds numerous patents related to endoscopic diagnostic
and therapeutic devices, He also performs several clinical investigations dealing with endoscopic procedure and surgery.
He is a reviewer of Korean journal of Gastroenterology, Gut
and Liver, Korean journal of gastrointestinal endoscopy, Worldof Gastroenterology. He is the first, corresponding author or
co-author of numerous journal including t op class Journals
such as Gastroenterology, Gastrointestinal Endoscopy, Endoscopy. He has also delivered many lectures and presentation at
gastroenterology meetings and international scientific conference such as American Society of Gastrointestinal Endoscopy,
Japanese Society of Gastrointestinal Endoscopy (JGES) andUnited European Gastroenterology (UEG).
Recently, he focuses on endoscopic device development for
not only gastrointestinal diseases but also metabolic obesity
diseases. He also performs several clinical investigations dealing with endoscopic procedure and surgery.

November 5, 2020 Portopia Hotel

JKT2-RS3

 linical significance of tissue acquisition of gastroesophageal juncCtion submucosal tumor

Chen-Shuan Chung
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital

Submucosal tumors or subepithelial tumors (SETs) of gastrointestinal (GI) tract are mesenchymal neoplasms arisingfrom cells beneath epithelium. The etiologies of SETs include gastrointestinal stromal tumor, leiomyoma, lipoma, lymphangioma, aberrant pancreas, schwannoma, and even mucosal malignancy infiltrating as a submucosal mass. The histology is difficult to be determined by merely endoscopy, endoscopic ultrasound (EUS) or cross-sectional images. Traditionally, for undetermined SETs smaller than 2 cm, regular surveillance was suggested based on weak and low quality
evidence. However, the cut-off value of tumor size for malignant potential is inconclusive and the accuracy of histology
prediction by EUS morphology is unsatisfactory. Therefore, tissue acquisition is important to stratify risk of patientswith GI SETs. There is no consensus for gastroesophageal junction (GEJ) SETs. Conventionally, the techniques for tissue acquisition of GEJ SETs include stacked/bite-on-bite/mucosa incision with forceps biopsy, and EUS-guided fineneedle aspiration or biopsy. Nevertheless, diagnostic yield is not high and higher risk for bleeding is noticed by forceps
biopsy and the diagnostic yield of EUS-guided tissue acquisition is influenced by many factors. Recently, significant advances in endoscopic resection technique have been made, particularly the application of third-space endoscopy, submucosal tunneling endoscopic resection (STER), for SETs removal. By such procedures, GEJ SETs could be retrievedfor definite pathological diagnosis with curative intents. The adverse event rate from STER is not high and most of thegas related complications could be managed conservatively by needle puncture for carbopneumoperitoneum. In thislecture, I will discuss about the importance and technique of tissue acquisition for GEJ SETs and provide possible approaching algorithm as well.

Curriculum Vitae
Chen-Shuan Chung

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern
Memorial Hospital
Education:
1. Taipei Medical University
2. Graduate Institute of Clinical Medicine,College of Medicine, National Taiwan University
Present Position:
1. Attending physician, Department of Internal Medicine, Far Eastern
Memorial Hospital, New Taipei City, Taiwan
2. Director of Ultrasonography and Endoscopy Center, Far Eastern
Memorial Hospital, New Taipei City, Taiwan
3. Lecturer, College of Medicine, Fu Jen Catholic University, New
Taipei City, Taiwan
Speciality:
1. Therapeutic endoscopy (EMR/ESD/POEM/STER)
2. ERCP / EUS
3. Enteroscopy
Publication (over 60)
1. Chen-Shuan Chung, Yi-Chia Lee, Cheng-Ping Wang et al. Strategies to Prevent Esophageal Squamous Cell Carcinoma in Areas
where Smoking, Alcohol, and Betel Quid Chewing are Prevalent.
JFMA 2010;109(6):408-21.
2. Chen-Shuan Chung, Hsiu-Po Wang. Screening for Precancerous
Lesions of Upper Gastrointestinal Tract: From the Endoscopists’Viewpoint. Gastroenterology Research and Practice. Volume
2013,Article ID 681439, 18 pages.
3. Chen-Shuan Chung, Li-Jen Liao, Wu-Chia Lo, et al. Risk factors forsecond primary neoplasia of esophagus in newly diagnosed headand neck cancer patients: a case-control study. BMC Gastroenterology 2013;13:154
4. Chung, Chen-Shuan; Lee, Yi-Chia, Liou; Jyh-Ming, Wang et al. Tag
Single Nucleotide Polymorphisms of Alcohol Metabolizing Enzymes
Modify the Risk of Upper Aerodigestive Tract Cancers: HapMap Database Analysis. Diseases of the Esophagus, 2014 Jul;27(5):493503 (NSC98 － 2314 － B － 002 － 089 － MY3)
5. Chung CS, Lo WC, Lee YC, et al. Image-enhanced endoscopy for
detection of second primary neoplasm in patients with esophageal
and head and neck cancer: A systematic review and meta-analysis.
Head Neck.2016 Apr;38 Suppl 1:E2343-9.
6. Chung CS, Lo WC, Wen MH, et al.. Long Term Outcome of Routine
Image-enhanced Endoscopy in Newly Diagnosed Head and Neck
Cancer: a Prospective Study of 145 Patients. Sci Rep.
2016;6:29573. doi: 10.1038/srep29573.
7. Chen-Shuan Chung, Cho-Lun Tsai, Yin-Yi Chu, et al. Clinical Features and Outcomes of Gastric Neuroendocrine Tumors After Endoscopic Diagnosis and Treatment: a Digestive Endoscopy Society of
T ai w an (DE S T ) Mult ic en t er S t ud y . Me dicine (B alt imor e )2018;97(38):e12101.
8. Chen-Shuan Chung, Wu-Chia Lo, Kuan-Chih Chen, et al. Clinicalbenefits from endoscopy screening of esophageal second primarytumor for head and neck cancer patients: Analysis of a hospital-based registry. Oral Oncology 2019;96:27-33.
9. Chen-Shuan Chung , Kuo-Hsin Chen , Kuan-Chih Chen, et al. Peroral endoscopic tumor resection (POET) with preserved mucosa technique for management of upper gastrointestinal tract subepithelial
tumors. Surg Endosc. 2020 Aug 13. Online ahead of print.

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memo

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JKT3

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

Biliary, Pancreas

Endoscopic biliary stenting-40th anniversary memorial symposium-

Chair:

Ichiro Yasuda

Third Department of Internal Medicine, University of Toyama

Young Soo Moon

Division of Gastroenterology, Department of Internal Medicine, Seoul Red Cross Hospital

Hsiu-Po Wang

Dpartment of Internal Medicine, National Taiwan University Hospital

Discusser:

Shomei Ryozawa

Department of Gastroenterology, Director, Endoscopy Center, Saitama Medical University
International Medical Center

Tae Hoon Lee

Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University

Wei-Chih Liao

Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan
University Hospital

Speaker:

JKT3-1

History and current strategy of endoscopic stenting for unresectable
malignant distal biliary obstruction

Hiroyuki Isayama

Department of Gastroenterology, Graduate School of Medicine, Juntendo University

JKT3-2

EUS-guided versus ERCP-guided biliary drainage with metal stenting forprimary treatment of distal malignant biliary obstruction

Do Hyun Park

Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center

JKT3-3

Optimal endoscopic biliary stenting for malignant biliary obstruction

Yu-Ting Kuo

Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan
University Hospital

Rising Star Program:

JKT3-RS1

Novel EUS-guided therapeutic approach for postoperative bile duct
stricture

Takeshi Ogura

2nd Department of Internal Medicine, Osaka Medical College

JKT3-RS2

EUS-guided drainage for peripancreatic fluid collections; Whichtechnique is better?

Se Woo Park

Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred
Heart Hospital, Hallym University College of Medicine

JKT3-RS3

Current Perspectives on Endoscopic Biliary Stents

Jung-Chun Lin

Tri-Service General Hospital, National Defense Medical Center

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT3-1

 istory and current strategy of endoscopic stenting for unresectableHmalignant distal biliary obstruction

Hiroyuki Isayama
Department of Gastroenterology, Graduate School of Medicine, Juntendo University

Introduction: Obstructive jaundice should be managed by effective and low invasive procedure. Developing of endoscopic biliary stenting was beneficial on QOL and survival in the patients with unresectable malignant biliary obstruction (MBO).
Stent development: Initially, only plastic stent had been available, and occlusion with biliary sludge and migration were themain cause of recurrence biliary obstruction (RBO). Uncovered self-expandable metallic stent (USEMS) has larger diameter(10mm) and showed low incidence of migration. However, because of mesh structure, occlusion due to tumor ingrowth was
not able to prevent. Covered SEMS (CSEMS) had been developed to prevent tumor ingrowth, and removability was the additional advantage. Initial RCT comparing covered and uncovered SEMS showed superiority of CSEMS in time to RBO (TRBO).
However, some RCT failed to show the superiority because of high incidence of migration.
Complications and mechanical properties of SEMS: There are 2 types of mechanical properties: radial and axial force (RF and
AF). RF is well known expansion force which related with dilation of stricture. On the other hand, AF is newly proposed by theauthor. AF is straightening force when the stent vended, and SEMS with strong AF may cause kinking and injury of the bileduct. Strong AF may cause pancreatitis and cholecystitis as well. Each complication has particular cause, non-pancreatic cancer for pancreatitis and tumor involvement of orifice of cystic duct for cholecystitis.
Effort to prolong time to RBO: Prevention of migrations was the unresolved issue for CSEMS, and the identified risk factors
were weak RF and chemotherapy. Recent development of effective chemotherapy for pancreatic and bile duct cancer may increase the incidence of migration. Flaps, flare and square flares were tried, but there was no ideal CSEMS with anti-migration.
Other efforts were larger diameter SEMS (12 mm), anti-reflux system, drug eluting CSEMS, etc., but these were under development status.
Endoscopic ultrasonography (EUS)-guided biliary drainage (EUS-BD): EUS-BD was indicated for the cases with difficult/impossible/failed biliary access required biliary drainage. However, recent development of the procedures and equipment, EUS-BD
is tried to perform as primary drainage procedure. Evaluation of superiority of EUS-BD to the ERCP-related biliary drainage
was the next decade issue after establishment of EUS-BD.
Conclusions: There was no-ideal stent and procedure for the cases with unresectable MBO, and continuous effort was required

Curriculum Vitae
Hiroyuki Isayama

Department of Gastroenterology, Graduate School of Medicine, Juntendo University

Dr. Isayama is professor in the Department of Gastroenterology, Graduate School of Medicine, Juntendo University. He had graduated from Tokyo Jikei University, School of Medicine in 1982, andawarded MD. He had graduated post graduate School, Tokyo University and awarded PhD in 2002.
He has published more than 421 peer-reviewed English articles (>2107.5 IF). He has special interest in therapeutic ERCP, interventional EUS, and has many experiences of live demonstration. He is
the pioneer of biliary covered self-expandable metallic stent (SEMS). He is also specialized in the chemotherapy for the
pancreato-biliary malignancies. He is the committee member of clinical guidelines of both pancreas cancer and cholangiocarcinoma. He is chief of making GL of EUS-BD and Primary sclerosing cholangitis. He is a president of T-CAP (Tokyo
Conference of Asian Pancreato-biliary Interventional Endoscopy), is international workshop and annually held in Tokyo.

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November 5, 2020 Portopia Hotel

JKT3-2

 US-guided versus ERCP-guided biliary drainage with metal stentingEfor primary treatment of distal malignant biliary obstruction

Do Hyun Park
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center

ERCP is the standard care for the primary palliation of distal malignant biliary obstruction. However, ERCP is not always successful because of the anatomical alterations or inaccessibility to the major papilla. When ERCP fails, percutaneous transhepatic biliary drainage (PTBD) has been the standard method as a rescue therapy.1 EUS-guided biliary
drainage (EUS-BD) has emerged as an alternative procedure to PTBD after failed ERCP. Theoretically, EUS-BD hassome advantages over ERCP and PTBD. EUS-BD is possible in surgically altered anatomy or inability to access the papilla. One of the major concerns of ERCP is post-ERCP pancreatitis, which occurs at a rate of 5 to 15%. In EUS-BD, because traumatic papillary manipulation may be avoided, the risk of procedure-related pancreatitis may be extremely
low.1 The stent patency could be longer in EUS-BD than in ERCP-BD because the stents are not needed to be placed
across the stricture site; therefore, the risk of tumor ingrowth or overgrowth would be less common. EUS-BD shows
similar efficacy compared to PTBD when performed by expertise and may be more comfortable and physiologic to thepatients than PTBD because of internal drainage.1 In addition, EUS-BD can be performed by a same operator in a samesession of failed ERCP.1
Recently, three prospective randomized clinical trials comparing EUS-BD with ERCP-BD for the primary palliation of
distal malignant biliary obstruction have been published simultaneously. Although the study design and primary outcomes were different, the conclusion of theses prospective studies were similar that the efficacy and safety of EUS-BD
were not inferior to those of ERCP-BD. After the above three prospective clinical trials were published, several meta-analyses for supporting these results were published. In this lecture, preparation before the procedures, technicalaspects, indications, efficacy, and safety between ERCP-BD and EUS-BD will be compared and discussed based on the
results of recent randomized clinical trials and meta-analysis for the primary treatment of distal malignant biliary obstruction.
Reference
1. Paik WH, Park DH. EUS-Guided Versus ERCP-Guided Biliary Drainage for Primary Treatment of Distal Malignant Biliary Obstruction Current Treatment Options in Gastroenterology volume 2020 vol. 18, pages188–199

Curriculum Vitae
Do Hyun Park

Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center

Mar. 2005 - Feb. 2008 Full-time instructor, Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
Jul. 2010 - Aug. 2011 Clinical instructor, University of California, Irvine Medical Center, UnitedStatesAug. 2011
Visiting professor, Washington University, St. Louis, United States
Mar. 2008 - Mar. 2013 Assistant Professor, Division of Gastroenterology, Department of Internal Medicine, University of
Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
Apr. 2013 2018 Associate Professor, Division of Gastroenterology, Department of Internal Medicine, University of
Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
2019- Present Professor of Medicine, Division of Gastroenterology, Department of Internal Medicine, University of
Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

25

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT3-3

Optimal endoscopic biliary stenting for malignant biliary obstruction

Yu-Ting Kuo
Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital

Curriculum Vitae
Yu-Ting Kuo

Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan
University Hospital

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November 5, 2020 Portopia Hotel

JKT3-RS1

 ovel EUS-guided therapeutic approach for postoperative bile ductN
stricture

Takeshi Ogura
2nd Department of Internal Medicine, Osaka Medical College[Background and aim]
A hepaticojejunostomy anastomotic stricture (HJS) is a rare complication after pancreatoduodenectomy (PD). However, therate of HJS may may increase as operative indications expand to include more conditions such as intraductal papillary mucinous neoplasm. HJS is commonly treated under percutaneous transhepatic or enteroscopic guidance. However, there areseveral disadvantages in these procedures such as prolong procedure time, low technical success rate, or self-tube removal.
Recently, EUS-guided biliary drainage (EUS-BD) is indicated for malignant biliary obstruction. EUS-BD for benign biliary stricture has been reported, however, the evidence of EUS-BD for HJS is not sufficient. The aim of this study is to evaluate the feasibility and efficacy of interventional endoscopy under EUS guidance for HJS.
[Patients and Method]
Between January 2017 and May 2019, a total 38 HJS patients were enrolled. First, EUS-BD was performed using covered
metal stent. After 1 week, cholangioscope inserted into the biliary tract through the HGS stent. Then, HJS was evaluated, anddilated using balloon catheter. Finally, HGS was performed using plastic stent. After 3 months, if HJS was still presence, antegrade metal stent deployment (M-Intraductal stent) was attempted.
The primary endpoint in this study is to evaluate the technical success rate, and adverse events were secondary evaluated.
[Results]
The 38 patients underwent EUS-BD. Indications for EUS-BD comprised obstructive jaundice (n = 12) and frequent cholangitis(n = 26). Among them, intrahepatic bile duct stones were complicated in 14 patients. Technical success of EUS-BD was obtained in 36 patients (94.7%). HJS dilation was attempted in 35 patients except one patient who was diagnosed as recurrenceof cholangiocarcinoma at HJS site. HJS was resolved in 22 patients (median follow-up period 188 days). Antegrade metal
stent deployment were attempted in 16 patients, and stent deployment was successfully performed in all patients. In addition,
after 1 month, stent removal via HGS route could be successfully performed in all patients. During clinical follow up (median
132 days), recurrence of HJS were seen in three patients (recurrence rate, 18.8%). These patients continuously underwent
scheduled EUS-HGS stent exchange. Finally, severe adverse events were not seen in any patients.
[Conclusion]
Transluminal treatment including antegrade stent deployment for HJS under EUS-guidance appears feasible and safe, although further study with a larger sample size and longer follow-up is warranted.

Curriculum Vitae
Takeshi Ogura

2nd Department of Internal Medicine, Osaka Medical College

Dr.Takeshi Ogura has strong interests in EUS-related procedures, on which he has published over
100 articles (first author only). In 2018, he won JGES Award. He also serves as an associated editor for BMC Gastroenterology and DEN Open, an editorial board member for JHPBS, Endoscopic
Ultrasound, as well as many other English journals. He has recently been promoted to the associated professor at the 2nd Department of Internal Medicine, Osaka Medical College this year.

27

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JKT3-RS2 US-guided drainage for peripancreatic fluid collections; Which techEnique is better?

Se Woo Park
Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital,
Hallym University College of Medicine

Endoscopic ultrasonography (EUS)-guided drainage has emerged as the treatment of choice for peripancreatic fluid
collections (PFC) which recent innovations such as lumen apposing metal stent (LAMS) have improved results in patients with walled-off necrosis (WON). In the early days of EUS-guided PFC, drainage was performed using plastic stents
with double pigtail shape for minimizing migration risk. However, endoscopists have recognized the limitations of plastic stents (PS), which have a small-caliber diameter and require placement of multiple stents to ensure appropriate
drainage. Placement of multiple PSs into the PFC is technically difficult and time-consuming, especially when usinglarge-caliber stents. Small-caliber PS may be frequently exposed to stent occlusion, inefficient drainage, secondary infection, and the need for subsequent reinterventions. To overcome the limitations of PS, a fully covered self-expanding
metal stent (FCSEMS) was developed, with the theoretical objective of facilitating wider-caliber drainage, which would
improve stent patency, prevent secondary infections and the need for reintervention by reducing stent occlusion, andmaintain fistula tract for further sessions of direct endoscopic necrosectomy (DEN). Despite the theoretical advantages of FCSEMS over PS, several studies have demonstrated that there was no significant difference in clinical efficacy
or adverse events between FCSEMS and PS. More recently, a LAMS with bidirectional anchoring flanges has been
demonstrated to be both safe and effective. In addition, it allows DEN of WON after stent deployment by passage of theendoscope through the stent lumen, which may improve efficacy and decrease adverse events associated with
EUS-guided PFC drainage. However, superiority of LAMS in terms of clinical efficacy to PS was not identified in recent
studies. Therefore, the debate regarding appropriate stent for EUS-guided PFC drainage has again come into the spotlight although the field of dedicated stent for interventional EUS is rapidly advancing and many more innovations arebeing continuously added. Furthermore, some important questions remain unaddressed such as which stent improvesclinical outcomes and safety in EUS-guided PFC drainage. In this lecture, the current status and problems of available
stent in the market are reviewed, including technical review and clinical data of previous studies, applicable indication,and long-term clinical outcomes, and their future prospects are discussed.

Curriculum Vitae
Se Woo Park

Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred
Heart Hospital, Hallym University College of Medicine
Se-Woo Park, M.D. & Ph.D. (Associate Professor)
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
PROFESSIONAL ACTIVITIES:
2004 - 2009 Intern & Resident Trainee in Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, 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
2015 - 2019 Assistant Professor
2019 - current Associate Professor, Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, 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

28

PUBLICATIONSNeurologic Safety of Etomidate-Based Sedation during Upper Endoscopy
in Patients with Liver Cirrhosis Compared with Propofol: A Double-Blind,
Randomized Controlled Trial. J. Clin. Med 2020, 9
Identification of risk factors for obstructive cholecystitis following placement of biliary stent in unresectable malignant biliary obstruction: a 5-year
retrospective analysis in single center. Surg Endosc. 2020 Jun
A rare cause of obstructive jaundice: Is surgery the only option? Gastroenterology. 2020 Jan
Comparative efficacy of stents in EUS-guided peripancreatic fluid collection drainage: A systematic review and network meta-analysis. J Gastroenterol Hepatol. 2020 Jun
Clinical outcomes of sedation during emergency endoscopic band ligationfor variceal bleeding: A multicenter cohort study. Dig Endosc. 2019 Dec
An unusual cause of abnormal weight loss. Gastroenterology. 2020 Mar
The diagnostic performance of novel torque technique for EUS-guided tissue acquisition in solid pancreatic lesions: A prospective randomized controlled trial. J Gastroenterol Hepatol. 2020 Mar
Safety and efficacy of early feeding based on clinical assessment at 4hours after endoscopic retrograde cholangiopancreatography: A prospective randomized controlled trial. Gastrointest Endosc. 2018 Apr
Comparative efficacy of various endoscopic techniques for the treatmentof common bile duct stones: A network meta-analysis. Gastrointest Endosc.
2018 Jan
Efficacy and safety of etomidate-based sedation compared with propofol-based sedation during ERCP in low-risk patients: a double-blind, randomized, noninferiority trial. Gastrointest Endosc. 2018 Jan
Etomidate versus propofol sedation for complex upper endoscopic procedures: a prospective double-blinded randomized controlled trial. Gastrointest Endosc. 2017 Sep

November 5, 2020 Portopia Hotel

JKT3-RS3

Current Perspectives on Endoscopic Biliary Stents

Jung-Chun Lin
Tri-Service General Hospital, National Defense Medical Center

Although endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay for palliation of biliary obstruction
resulting from both malignant and benign etiologies, a therapeutic endoscopist must have a complete discernment of
the etiologies, demographics, risk factors, and diagnostic techniques to develop different tailored approached to variable clinical scenarios. Benign biliary strictures have a broad extent of etiologies, most of which result in obstruction
due to underlying inflammation, ischemia, and fibrosis. Malignant biliary obstruction is most commonly seen in pancreatic adenocarcinoma and cholangiocarcinoma, and the approach to stenting may be different depending on the presentation, location of the mass, and therapeutic aims. Moreover, the feasibility of ERCP for biliary drainage is not always
applicable due to anatomical alterations. In addition to percutaneous transhepatic biliary drainage has been considered
the alternative to this situation, endoscopic ultrasonography-guided biliary drainage typifies a reasoned choice when
ERCP flunks. This content covers the access to patients with benign and malignant biliary obstruction with a focus on
the optimal strategy, technical and procedural aspects of biliary stenting.

Curriculum Vitae
Jung-Chun Lin

Tri-Service General Hospital, National Defense Medical Center

Jung-Chun Lin graduated from the School of Medicine, National Defense Medical Center (NDMC),
Taipei, Taiwan in 2003. He completed his clinical training in the Department of Internal Medicine
and Division of Gastroenterology at the Tri-Service General Hospital (TSGH) between 2005 and2010 and got a Ph.D. degree at the Graduate Institute of Medical Sciences at NDMC in 2016. He
has been an Assistant Professor in the School of Medicine, NDMC since 2016, and an attending
physician at TSGH since 2011. In addition to liver research, he focused his clinical technique on ERCP and interventional EUS. He has been awarded the grant of the Japanese Society of Gastroenterology to study pancreatic & biliary endoscopy with Prof. Tetsuya Mine and Dr. Yoshiaki Kawaguchi at Tokai University School of Medicine Hospital, Kanagawa, Japan. He also obtained the Asian Young Endoscopist Award 2016 to learn advanced ERCP from Prof. Kyo Sang
Yoo at Hanyang University Guri Hospital, Guri, Republic of Korea. He is also a member of a few professional bodies, including the Taiwan Society of Internal Medicine, the Gastroenterological Society of Taiwan, the Digestive Endoscopy Society of Taiwan, and the Taiwan Association for the Study of the Liver. Dr. Lin has published some articles in SCI journals
among the field of gastroenterology and hepatology. He also serves as the reviewer of Digestive Disease and Sciences,
PLoS One, BMC Gastroenterology, and Journal of Medical Sciences.

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memo

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JKT4

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

Liver

Changing Paradigm in Treatment Strategy for HCC: 2020 Update

Chair:

Masatoshi Kudo

Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine

Jaeseok Hwang

Division of Gastroenterology & Hepatology,Department of Internal Medicine, Keimyung University
Dongsan Medical Centeｒ

Jia-Hong Kao

Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan
University Hospital

Discusser:

Hiroshi Aikata

Department of Gastroenterology and Metabolism, Hiroshima University

Chang Wook Kim

Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Mary’s Hospital,
Catholic University

Shi-Ming Lin

Department of Gastroenterology and Hepatology, Chang-Gung University and Chang Gung
Memorial Hospital, Linkuo and Taipei

Speaker:

JKT4-1

Evolving Treatment Paradigm and future landscape in systemic therapy
for advanced hepatocellular carcinoma

Masafumi Ikeda

National Cancer Center Hospital East

JKT4-2Current Treatment Strategies for Hepatocellular Carcinoma in Korea

Bo Hyun Kim

Center for Liver and Pancreatobiliary Cancer, National Cancer Center

JKT4-3

Changing landscape of HCC therapy in Taiwan

Yi-Hsiang Huang

Taipei Veterans General Hospital, National Yang-Ming University

Rising Star Program:

JKT4-RS1Treatment strategy for unresectable hepatocellular carcinoma with afocus on maintaining hepatic reserve

Yuji Eso

Department of Gastroenterology and Hepatology, Kyoto University Hospital

JKT4-RS2

Paradigm change in intermediate and advanced HCC: Role oflocoregional therapy in the rise of systemic therapy

Sun Young Yim

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Hospital

JKT4-RS3

Immune contexture of HCC: from Sorafenib to immune checkpoint inhibitors

Li-Chun Lu

National Taiwan University Hospital

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT4-1

 volving Treatment Paradigm and future landscape in systemic therE
apy for advanced hepatocellular carcinoma

Masafumi Ikeda
National Cancer Center Hospital East

Systemic therapy is one of the most important treatment modalities for advanced hepatocellular carcinoma (HCC), and,in recent years, it has made rapid progress. On the basis of the results of two pivotal phase III placebo-controlled studies, sorafenib has been acknowledged worldwide as the standard therapeutic agent for advanced HCC. Following the
introduction of sorafenib for the treatment of HCC, phase III trials of numerous other agents have been conducted as
first-line or second-line treatment. Until now, lenvatinib and atezolizumab plus bevacizumab demonstrated positive results in first-line treatment, and regorafenib, ramucirumab (patients only with 400 ng/ml or over of α-fetoprotein), andcabozantinib in second-line treatment. In Japan, use of sorafenib, regorafenib, lenvatinib, ramucirumab and atezolizumab plus bevacizumab for patients with advanced HCC became eligible for coverage by the national health insurance in2009, 2017 2018, 2019, and 2020, respectively, and cabozantinib will be reimbursed in second or third line treatment
until the end of this year. Especially, atezolizumab plus bevacizumab has been reported to be clinically meaningful improvement in overall survival in patients with advanced HCC, and is expected as a practice-changing treatment. Thus,
promising outcomes have also been reported in advanced HCC with combination therapy of immune-oncologic agent
plus VEGF inhibitor, and various combination therapy such as ipilimumab plus nivolumab, tremelimumab plus durvalumab, lenvatinib plus pembrolizumab, bezacizumab plus durvalumab and cabozantinib plus atezolizumab are underway inglobal phase III trials. In the near future, triplet or quarto regimen may be developed. These combination regimens havebeen reported to be higher objective response rate, around 30-50%, which was comparable to those of transarterial
chemoembolization (TACE). In 2015, the criteria of “TACE refractory” was presented as a good indication for systemic
therapy. Then, in Apple Consensus Meeting 2019, the concept of “TACE unsuitable” has been proposed. The indications
for systemic therapy has been expanded to the intermediate stage, which is a good indication for TACE. In the future,
the advent of favorable systemic regimens that offer superior survival benefit to TACE are expected in patients with intermediate stage HCC.

Curriculum Vitae
Masafumi Ikeda

National Cancer Center Hospital East

Academic background1994-1995 Trainee, Third department of Internal Medicine, Kumamoto University School of Medicine
1996-2001 Resident & Chief resident, Hepatobiliary and Pancreatic Oncology Division, National
Cancer Center Hospital
2001-2002 Medical staff, Third department of Internal Medicine, Kumamoto University School of Medicine
2002-2008 Medical staff, Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital
2008-2011 Section head, Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East
2011-Present Chief, Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East
Affiliation society
Japan Society of Hepatology
Japanese Society of Medical Oncology
Liver Cancer Study Group of Japan, etc.

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November 5, 2020 Portopia Hotel

JKT4-2Current Treatment Strategies for Hepatocellular Carcinoma in Korea

Bo Hyun Kim
Center for Liver and Pancreatobiliary Cancer, National Cancer Center

Primary liver cancer is the second most common cause of cancer mortality in South Korea.1 Approximately 16,000 patients are diagnosed with primary liver cancer each year and about 11,000 patients still die from primary liver cancer
every year.2 Hepatitis B virus (HBV) is the predominant etiology of hepatocellular carcinoma (HCC), accounting for approximately 70% of cases.2
The Korean Liver Cancer Association-National Cancer Center practice guidelines for the management of hepatocellular
carcinoma were firstly released in 2003 and have been revised three times in 2009, 2014, and 2018. The Korean
practice guideline for HCC adopts the modified UICC stages as a primary staging system and recommends the best andalternative options for each modified UICC stage (Figure 1).3 These recommendations are primarily for patients withgood liver function (e.g. Child-Pugh class A) and performance status since the treatment may vary depending on underlying liver disease and performance status as well as the patient’s tumor status.
Nowadays, evidence for new drugs and treatments regarding HCC is accumulating and the current strategies are modifying on the basis of new evidence.

Curriculum Vitae
Bo Hyun Kim

Center for Liver and Pancreatobiliary Cancer, National Cancer Center

Dr. Bo Hyun Kim graduated from the College of Medicine, Hanyang University, and received a master’s degree and Ph.D. from Seoul National University. Following the internship at Asan Medical
Center, she completed the internal medicine residency and hepatology fellowship training at Seoul
National University Hospital until 2009. After spending 3 years at the department of internal medicine and hepatology center, Bundang Jesaeng General Hospital, she has been working at the Center for Liver and Pancreatobiliary Cancer, National Cancer Center since 2012. She was a visiting scholar at the Divisionof Gastroenterology, Stanford University in Palo Alto, California, USA in 2017. She is currently a senior scientist and an
adjunct associate professor at National Cancer Center and actively involved in translational, investigator-initiated, andindustry-sponsored clinical studies on hepatocellular carcinoma. She is a member of the Korean Association for the
Study of the Liver (KASL), the Korean Liver Cancer Association (KLCA), and the International Liver Cancer Association(ILCA). Dr. Kim served as a member of multiple KASL and KLCA committees, including the scientific committee and the
KLCA-NCC clinical practice guideline for the management of hepatocellular carcinoma.

33

The 4th Joint Session between

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JKT4-3

Changing landscape of HCC therapy in Taiwan

Yi-Hsiang Huang
Taipei Veterans General Hospital, National Yang-Ming University

Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer related deathworldwide that constitutes a major global health problem. Despite improvement in surveillance and hepatitis B vaccination, hepatitis C treatment, a large number of patients still present with unresectable, advanced-stage disease and require systemic therapy. Recently, several promsing results from the phase 2/3 trials of first or second line settings en-able HCC patients access to more treatment options, including multikinase inhibitors and immunotherapy. Manipulationof immune checkpoints by targeted antibodies against programmed cell death-1 (PD-1), or programmed death-ligand 1(PD-L1) axis, have recently emerged as an effective anticancer strategy for many types of cancers, including HCC. In
Taiwan, all the currently FDA approved TKI and immunotherapy for HCC are available in market, but only sorafenib, len-vatinib as the first line, and regorafenib for sorafenib failed are reimbursed by Taiwan National Health Insurance.
Nivolumab is the first FDA-approved immune checkpoint inhibitor for HCC, yielded an objective response rate (ORR) of
14% and 9-month survival rate of 74% in second line setting. From May 2019 to March 2020, nivolumab had been once
covered by Taiwan NHI, with the ORR of 16.1% and DCR of 21.7%. This reimbursement was terminated since the first
April, 2020. Pembrolizumab, another antibody against PD1, showed a similar response rate as nivolumab in phase 2(Keynote 224) and phase 3 (Keynote 240) trials of HCC patients for second line treatment. The real-world experienceof immunotherapy for unresectable HCC from Taiwan (Cancers (Basel). 2020;12(1):182) showed an ORR of 24.4%. A
10-10 rule of early AFP response can predict objective response and survival to immune checkpoint inhibitor (ICI)
treatment in unresectable HCC. ALBI grade and Child-Pugh class determines survival by ICI treatment. Lenvatinib is en-rolled in Taiwan NHI since Jan 2020 with rapidly growing recently. Recently, combination treatment of atezolizumab
plus bevacizumab in a phase 3 IMbrave 150 trial has showed an ORR of 27%, and overall survival of not yet reached infirst line setting. Pembrolizumab plus lenvatinib; Nivolumab plus ipilimumab also showed encouraging results in the firstline and the second line settings. Combination treatment will be a promising strategy in the treatment of advanced HCC
and is ongoing in Taiwan.

Curriculum Vitae
Yi-Hsiang Huang

Taipei Veterans General Hospital, National Yang-Ming University

Professor Huang is currently the Chief for Division of Gastroenterology and Hepatology at the Veterans General Hospital in Taipei. He is also the Director for the Department of Internal Medicine, aProfessor for the Institute of Clinical Medicine at the National Yang-Ming University, School of Medicine in Taipei. Completing his medical and PhD training at National Yang-Ming University, he furthered his training as a research fellow at the Vaccine Branch of National Cancer Institute, National Institute of Health, USA from 2006 to 2007. Prof. Huang became a full professor at the Institute of Clinical Medicine,
NYMU, in 2011. Prof. Huang has received numerous awards including academic awards of Prof. JL Sung’s Research
Foundation, physician research scholarships, and merit scholarship awards in recognition of his outstanding work. Prof.
Huang is the Chairman of 2019 Taiwan Association for the Study of the Liver (TASL) annual meeting, Chairman of 2020
Taiwan Liver Cancer Association (TLCA) annual meeting, and currently the secretary general of the TASL from 20202022, and the secretary general of the Chinese Medical Association of Taiwan from 2020-2022, and a board member of
the Taiwan Liver Cancer Association and the Taiwan Academy of Tumor Ablation. As a well-recognised expert in hepatology, Dr. Huang is on the editorial board for renowned journals such as Liver International, PLoS One, Liver Cancer International, Journal of Chinese Medical Association, and Advances in Digestive Medicine. He has been invited as keynote and guest speaker at international conferences such as the Asian Oncology Summit, Asia Pacific Association for
the Study of the Liver,.APASL Single Topic Conference, and Asia-Pacific Primary Liver Cancer Expert Meeting. Prof.
Huang’s study interest is in the virology and immunology of viral hepatitis and HCC, including the issue of HBV reactivation related to immunosuppressive treatment, HCC immunopathogenesis and systemic therapy. He has published over
200 articles in international peer-reviewed journals, including Journal of Clinical Oncology, Journal of Hepatology, Hepatology, Clinical Gastroenterology and Hepatology, and Journal for ImmunoTherapy of Cancer.

34

November 5, 2020 Portopia Hotel

JKT4-RS1

 reatment strategy for unresectable hepatocellular carcinoma with aTfocus on maintaining hepatic reserve

Yuji Eso
Department of Gastroenterology and Hepatology, Kyoto University Hospital

Transcatheter therapy (transarterial chemoembolization: TACE) and systemic therapy (molecular-targeted therapy:
MTA) are the medical treatment options for patients with intermediate/advanced-stage hepatocellular carcinoma (HCC)
who are unable to undergo liver resection or radiofreqnency ablation (RFA). About half of all deaths in HCC patients are
due to cancer; on the other hand, a high percentage of patients die from liver failure due to worsening liver reserve orcomplications of cirrhosis. Therefore, it is very important to prevent deterioration of hepatic reserve in the treatmentof HCC to improve patient prognosis.
In addition, regorafenib, ramucirumab, and cabozantinib as second-line therapies, and novel first-line regimens, including lenvatinib and the combination of Atezolizumab and bevacizumab, were recently introduced. Systemic therapies
such as lenvatinib and atezolizumab plus bevacizumab, which have a high response rate, may offer the possibility of
selecting radical therapies such as liver resection or RFA, but this may not be possible if the hepatic reserve is compromised.
In this presentation, we will present the data on HCC patients treated with TACE or Lenvatinib at our institution (Eso et
al. Cancers 2019. “Combination of Mac-2 Binding Protein Glycosylation Isomer and Up-To-Seven Criteria as a UsefulPredictor for Child-Pugh Grade Deterioration after Transarterial Chemoembolization for Hepatocellular Carcinoma.”/
Eso et al. J Hepatobiliary Pancreat Sci 2020. “Branched-chain amino acid to tyrosine ratio is an essential pre-treatment factor for maintaining sufficient treatment intensity of lenvatinib in patients with hepatocellular carcinoma.”) anddiscuss strategies for optimizing the treatment of unresectable HCC in anticipation of the advent of combination thera-py with MTAs and immune checkpoint inhibitors.

Curriculum Vitae
Yuji Eso

Department of Gastroenterology and Hepatology, Kyoto University Hospital
Yuji Eso, M.D., Ph.D.
Assistant Professor
Department of Gastroenterology and Hepatology
Graduate School of Medicine, Kyoto University
Areas of Interest
Treatment and diagnosis for hepatocellular carcinoma
Ultrasound-guided biopsy and local ablation therapy for liver tumor
Education2017 Ph.D., Graduate School of Medicine, Kyoto University
2004 M.D., Kyoto University School of Medicine
1998 Graduated from Nada High School (Hyogo, Japan)
Professional Training and Employment
2019.11- Assistant Professor in Department of Gastroenterology and Hepatology, Kyoto University Hospital
2015-2019 Medical Staff in Department of Gastroenterology and Hepatology,
Kyoto University Hospital
2011-2015 Research Fellow in Graduate School of Medicine, Kyoto University
2006-2011 Medical Staff in Department of Gastroenterology and Hepatology,
Osaka Red Cross Hospital
2004-2006 Junior Resident, Osaka Red Cross Hospital
Honors and Awards
2020 Research Encouragement Award of Japan Society of Hepatology
2020 Best Poster Award of the 21st Meeting of Japan Association of Molecular Targeted Therapy for HCC
2020 Best Presentation Award of the 19th Meeting of Kansai Study Group on
Hepatic Blood Flow and Dynamic Imaging
2020 Best Poster Award of the 20th Meeting of Japan Association of Molecu-

lar Targeted Therapy for HCC
2019 Best Poster Award of the 19th Meeting of Japan Association of Molecular Targeted Therapy for HCC
2019 Young Investigator Award of the 22nd Meeting of Japan Society of Metabolism and Clinical Nutrition2018 International Grant Award of the 13rd Congress of the Asian Federationof Societies for Ultrasound in Medicine and Biology (AFSUMB 2018 Seoul)2017 Best Poster Award of the 16th World Congress of the World Federation
for Ultrasound in Medicine and Biology (WFUMB 2017 TAIPEI)2017 AbbVie Award (Japan Society of Hepatology)
2017 Best Presentation Award at Kansai Liver Club 20172012 Best Poster Award of the 15th Meeting of Japan Society of Metabolism
and Clinical Nutrition
2011 Best Poster Award of the 13rd World Congress of the World Federation
for Ultrasound in Medicine and Biology (WFUMB 2011 Vienna)
Professional membership / activities
Fellow of the Japanese Society of Internal Medicine (#029872)
Senior Fellow of the Japanese Society of Internal Medicine
Board Certified Fellow of the Japanese Society of Gastroenterology (#32603)
Senior Fellow of the Japanese Society of Gastroenterology (#06423)
Board Certified Hepatologist of the Japan Society of Hepatology (#6037)
Board Certified Fellow of the Japan Gastroenterological Endoscopy Society(#20120084)
Board Certified Fellow of the Japan Society of Ultrasonics and Medicine (FJSUM-2143)
Senior Fellow of the Japan Society of Ultrasonics and Medicine (SJSUM-1435)
Board Certified Fellow of the Japan Society of Metabolism and Clinical Nutrition (#12-022(01))
Senior Fellow of the Japan Society of Metabolism and Clinical Nutrition (#16028)

35

The 4th Joint Session between

JDDW - KDDW - TDDW
JKT4-RS2

 aradigm change in intermediate and advanced HCC: Role of locoreP
gional therapy in the rise of systemic therapy

Sun Young Yim
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Hospital

Transarterial chemoembolization (TACE) has been established as the most widely used therapeutic intervention for patients with intermediate-stage hepatocellular carcinoma (HCC) (BCLC stage B). Systemic therapy is the recommended
treatment for advanced stage HCC (BCLC stage C) but different treatment strategies such as hepatic arterial chemo-infusion and radiotherapy are applied in Asian countries. TACE is commonly used beyond the guideline and outcomesmay be compromised.
There are now multiple systemic agents that have been approved in the first- and second-line setting for hepatocellular
carcinoma (HCC), increasing the therapeutic options for patient and clinicians. Therefore, with a greater number of systemic agents available, the role of locoregional therapy (LRT) has become a topic of debate, especially regarding sequencing therapy from LRT to systemic therapy as well as combination treatment. There are several trials such as OPTIMIS, TACTICS, BRISKS-TA trial, showing the potential opportunities for sequencing and combining LRTs with systemic
therapies. Recently, immunotherapies such as nivolumab, pembrolizumab and atezolizumab have been introduced. However, immunotherapy alone may not be enough to deplete Tregs or to stimulate antitumor response and therefore theireffect may be boosted by LRT. We will discuss the guide to select patients for combination of LRT and systemic treatment/immunotherapy based on scientific rational.

Curriculum Vitae
Sun Young Yim

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University
Hospital

Education:
2001-2007 Korea University College of Medicine (Bachelor’s degree)
2007-2011 Korea University College of Medicine Department of Internal Medicine (Master’s degree)
2012-2015 Korea University College of Medicine Department of Internal Medicine (PhD)
Training:
2008-2012 Residency: Department of Internal Medicine, Korea University Hospital
2012-2016 Clinical instructor: Division of Gastroenterology and Hepatology, Korea University Hospital
2016-2018 Research Fellow, MD Anderson Cancer Center, Houston
2017-2020 Clinical assistant professor: Division of Gastroenterology and Hepatology, Korea University Hospital
2020- Assistant professor: Division of Gastroenterology and Hepatology, Korea University Hospital36

November 5, 2020 Portopia Hotel

JKT4-RS3Immune contexture of HCC: from Sorafenib to immune checkpoint
inhibitors

Li-Chun Lu
National Taiwan University Hospital

Antiangiogenic agents and/or immune checkpoint inhibitors (ICIs) have been standard-of-care for advanced hepatocellular carcinoma (HCC). Recently, the interaction between the tumor microenvironment (TME) and systemic therapy response has been a major focus of research.
Sorafenib, a multikinase inhibitor with antiangiogenic properties and the first systemic therapy approved for HCC, hasbeen demonstrated to exhibit various immunomodulatory effects. The impact of sorafenib on PD-L1 expression in the
TME of advanced HCC was unclear. We analyzed the tissue slides using immunohistochemistry to semiquantitatively
score the membrane PD-L1 staining in tumor cells (TCs) or tumor-infiltrating immune cells (ICs). In 23 paired HCC tissues, PD-L1 expression in ICs was increased in HCC tissues after sorafenib treatment. However, PD-L1 expression inTCs did not increase significantly after sorafenib treatment. We also demonstrated that PD-L1-expressing ICs werehighly co-localized with CD68-positive tumor-infiltrating macrophages, suggesting that PD-L1-expressing macrophages
play roles in HCC progression after treatment with sorafenib.
In addition, the antitumor effects of ICIs are influenced by the immune contexture of the TME. However, whether distinct immune contextures in different organ systems contribute to the variable tumor response to ICIs in HCC was unknown. We reviewed data from patients with advanced HCC who had received ICIs and had measurable diseases. The
objective response to ICIs in tumors located in different organ systems was evaluated independently. Among the 75 enrolled patients, 58, 34, 19, and 18 patients had measurable hepatic tumors and lung, lymph node, and other intra-abdominal metastases, respectively, with the corresponding organ-specific objective response rates being 22.4%, 41.2%,
26.3%, and 38.9%. Among the patients who had both hepatic and extrahepatic tumors such as lung metastases, morepatients had disease control in the extrahepatic tumors but progressive disease in the hepatic tumors. We demonstrated that hepatic tumors of HCC are less responsive to ICIs than extrahepatic lesions, and lung metastases respond mostfavorably to ICIs, suggesting that the TME influences the efficacy of ICIs. Mechanistically, we utilized orthotopic liver
tumor models and found that higher percentages of macrophages, more exhausted CD8+ T cells, and higher VEGF levels in liver tumors, which could render the TME in liver more immunosuppressive and lead to a poorer ICI response thanin other organ systems. Our findings provide insights that could facilitate the development of systemic therapy for advanced HCC in the future.

Curriculum Vitae
Li-Chun Lu

National Taiwan University Hospital
Education:
1996-2003 M.D. School of Medicine, Taipei
Medical University, Taipei, Taiwan
2013-2020 Ph.D. Graduate Institute of Oncology, National Taiwan University Collegeof Medicine, Taipei, Taiwan
Training and Working Experience:
2005-2008 Resident, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
2008-2011 Fellow, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
2011-2013 Attending Physician, Department of Oncology, National
Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
2013Attending Physician, Department of Oncology, National
Taiwan University Hospital, Taipei, Taiwan
Board Certification:
2003- Medical Doctor
2008- Internal Medicine
2010- Medical Oncology
Selected Publications in recent 5 years:
1. Li-Chun Lu, Chih-Hung Hsu, Chiun Hsu, et al. Tumor heterogeneity
in hepatocellular carcinoma: facing the challenges. Liver Cancer
2016;5:128-138.
2. Hsiao-Hui Lin, Wen-Chi Feng, Li-Chun Lu, et al. Inhibition of the
Wnt/β-catenin signaling pathway improves the anti-tumor effects ofsorafenib against hepatocellular carcinoma. Cancer Letters
2016;381:58-66.

3. Li-Chun Lu, Chih-Hung Hsu. Tumor-associated neutrophils: an
emerging player in the immune microenvironment of hepatocellular
carcinoma. Translational Cancer Research 2016;5:S296-S299.
4. Li-Chun Lu, Pei-Jer Chen, Yi-Chun Yeh, et al. Prescription patternsof sorafenib and outcomes of patients with advanced hepatocellular
carcinoma: a national population study. Anticancer Research
2017;37:2593-2599.
5. Chun-Jung Chang, Yao-Hsu Yang, Chiao-Juno Chiu, Li-Chun Lu, etal. Targeting tumor-infiltrating Ly6G+ myeloid cells improves
sorafenib efficacy in mouse orthotopic hepatocellular carcinoma. International Journal of Cancer 2018; 142:1878-1889.
6. Li-Chun Lu, Yi-Hsuan Lee, Chun-Jung Chang, et al. Increased expression of programmed death-ligand 1 in infiltrating immune cells inhepatocellular carcinoma tissues after sorafenib treatment. Liver
Cancer 2019;8:110-120.
7. Li-Chun Lu, Chun-Jung Chang, Chih-Hung Hsu. Targeting myeloid-derived suppressor cells in the treatment of hepatocellular carcinoma: current state and future perspectives. Journal of Hepatocellular Carcinoma 2019;6:71-84.
8. Tsung-Hao Liu, Yu-Yun Shao, Li-Chun Lu, et al. Considerations ofheterogeneity in clinical trials for hepatocellular carcinoma. Expert
Review of Gastroenterology & Hepatology 2019;13:615-621.
9. Li-Chun Lu, Chiun Hsu, Yu-Yun Shao, et al. Differential organ-specific tumor response to immune checkpoint inhibitors in hepatocellular carcinoma. Liver Cancer 2019;8:480-490.
10. Yu-Yun Shao, Tsung-Hao Liu, Chiun Hsu, Li-Chun Lu, et al. Early
alpha-fetoprotein response associated with treatment efficacy of immune checkpoint inhibitors for advanced hepatocellular carcinoma.
Liver International 2019;39:2184-2189.

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