(Interview) Yoo Young Dong, Professor of Pancreatic Hepatobiliary Surgery, Korea University Anam Hospital “The main causes of gallstone disease and gallbladder polyps are excessive cholesterol… 3-7% of normal people” “Pancreatic cancer in men is twice as common as than women… Quitting smoking is the surest way to prevent
Yoo Young-don, professor of hepatobiliary and pancreatic surgery, Korea University Anam Hospital. Photographer Park Hae Yoon
What to do if the upper right part of the abdomen or the epigastric region hurts from a certain day? There are so many causes of abdominal pain that you need to get a detailed examination, but if it is accompanied by symptoms of indigestion or jaundice, it is very likely that you have problems with the gallbladder or biliary tract. The symptoms are similar, but if you have severe pain in your upper abdomen and pain that radiates to your back, it’s likely that your pancreas has failed. In particular, by the time you start to feel pain, pancreatic cancer often has metastasized to other organs.
The gallbladder and pancreas equally secrete digestive juices, especially the pancreas is a key metabolic organ that secretes hormones that control blood sugar levels. Recently, when the number of diseases related to the gallbladder (biliary tract) and pancreas has increased significantly, each university hospital has a department of hepatobiliary and pancreas surgery specialized in their treatment. What typical diseases occur in the gallbladder, biliary tract and pancreas and what are the methods of their treatment? To find the answer, we met with Yoo Young-dong, professor of hepatobiliary and pancreatic surgery at Anam Hospital of Korea University, who is known for liver transplantation and pancreatobiliary surgery using robots and laparoscopy.
Treatment of gallbladder stones increased by 50% in 4 years
What is the location and function of the gallbladder and bile ducts?
“The gallbladder and bile ducts are located inside the liver in the upper right part of the abdomen and have a volume of approximately 40 to 70 ml. The biliary tract descends from the liver to the gallbladder on the left side and down through the pancreas (head) and connects to the duodenum. Bile, a digestive juice produced in the liver, travels through the bile ducts and is stored in the gallbladder. When needed, the gallbladder contracts and releases it into the intestines to aid digestion.”
What are the most common diseases associated with the gallbladder and biliary tract?
“Representative diseases are gallstones (cholelithiasis) and gallbladder polyps. When stones and polyps form in the bile ducts, they lead to gallstones and biliary polyps. Gallstones are stones that form as a result of bile clotting. Cholesterol gallstones are mostly due to excess cholesterol, a component of bile, but there are also pigmented gallstones in which bilirubin coagulates due to excessive carbohydrate intake and parasite infestation.”
What are the main symptoms of gallstone disease?
“Depending on where it occurs, it may or may not be painful. Sometimes there are no symptoms at all and the gallstones disappear. The main symptom is severe abdominal pain. In particular, there are many cases of pain in the right upper abdomen or in the pit of the stomach, and in severe cases, the pain may radiate to the back. If there is pain or complications, they must be treated.”
What are gallbladder polyps or bile duct polyps?
“This refers to any form of bile that grows in the gallbladder or biliary tract and is often asymptomatic. Usually in many cases there are several small (less than 1 cm) polyps (multiple), but most of them are benign. Although rare, polyps larger than 1 cm can be malignant and immediate removal is recommended.”
Why do gallbladder polyps occur?
“Polyps of the gallbladder are divided into non-tumor and neoplastic. Noncancerous polyps are caused by an excessive accumulation of cholesterol, such as obesity or fatty foods. Neoplastic polyps can be caused by genetic or environmental factors such as long-term cholecystitis.”
In fact, in Korea, gallstones and gallbladder polyps are found in 3-7% of normal people who have undergone ultrasound, according to the westernization of dietary lifestyle. According to statistics from the Health Insurance Review and Evaluation Service, the number of patients treated for gallstones has increased by about 50% in four years, from 112,761 in 2017 to 168,692 in 2021. The gender ratio of patients with cholecystitis was about 55%, which is slightly higher than in men.
How to treat and prevent cholecystitis and gallbladder polyps?
“Cholecystitis should only be removed endoscopically if symptoms are present. If left untreated, it can cause complications such as cholangitis. Gallbladder polyps should be removed if they are larger than 1 cm, because there is a possibility of their malignancy, and if they are less than this size, only progress is observed. Prevention of gallstones and polyps is important for a healthy diet and lifestyle, such as treating obesity so that cholesterol does not build up, and preventing excessive drinking and smoking.”
Is there any harm to the body if there is no gallbladder (biliary tract)?
“Even if the gallbladder (biliary tract) is removed, this is not a serious obstacle to life. Temporary indigestion or diarrhea may occur, but most recover. Since bile is made in the liver, the liver helps to fulfill this role even if you don’t have a gallbladder.”
Will pancreatic cancer be the number one cause of cancer deaths in the US in a few years?
What is the location and function of the pancreas?
“The pancreas is located behind the stomach and the transverse colon, and the small intestine is just below it. This is a thin and long organ 15 cm long and weighing about 100 g. It is divided into a head, body and tail. It secretes digestive enzymes to digest food and secretes blood sugar regulating hormones, insulin and glucagon.”
What are the most common diseases associated with the pancreas?
Pancreatitis and pancreatic cancer. First of all, pancreatitis occurs when gallstones block the flow of pancreatic juice, and excessive alcohol consumption (chronic drunkenness, binge drinking) is 70% of the causes. In addition, it can also be caused by infection with viruses or drugs, such as anti-cancer drugs. Most patients with acute pancreatitis complain of severe pain in the upper abdomen. Approximately 50% of patients simultaneously complain of back pain.
What is the treatment for pancreatitis?
“The first step is to eliminate factors that cause inflammation of the pancreas, such as biliary stones and excessive alcohol consumption. In the case of chronic pancreatitis, if the pain persists, surgery can be performed.”
What are the causes and symptoms of pancreatic cancer?
“Smoking, chronic pancreatitis, family history, chronic diabetes, and obesity may be major risk factors for pancreatic cancer. It is 2 to 3 times more common in smokers than non-smokers and almost twice as common in men than women. However, alcohol and caffeine use is not a risk factor. When cancer develops in the body or tail of the pancreas, symptoms do not appear at all until it has grown significantly. By the time symptoms appear and a diagnosis is made, 90% of cancers have spread to other organs. In the advanced stages, most people experience severe pain in the upper abdomen and weight loss. In cancer of the head of the pancreas, the tumor can block the flow of bile into the small intestine, causing symptoms of jaundice.”
Pancreatic cancer is expected to be the number one cause of cancer deaths in the United States.
“Pancreatic cancer is on the rise all over the world. It was originally expected to become the second leading cause of cancer death in the United States by 2030, but recent studies have shown that if population aging and incidence continue to increase at current rates, it will overtake colorectal cancer as the most common cause of cancer death. in the United States. leading cause of death in the mid-2020s.”
What is the treatment for pancreatic cancer?
“The most effective treatment for pancreatic cancer is surgery. However, a radical operation (an operation for a complete cure) is possible only in 20-25% of patients with pancreatic cancer. In most cases, surgery is limited to patients with tumors in the head of the pancreas and symptoms such as jaundice in the early stages of the cancer. Even if the cancer is surgically removed, the chance of recurrence within 2 years is very high at 60-80%, so adjuvant chemotherapy or simultaneous chemoradiotherapy is needed. The median survival time for patients with pancreatic cancer that cannot be surgically resected is about 6 months, and the main goal of treating these patients is symptomatic relief and improved quality of life during the survival period.”
Robotic surgery is a direction in cholecystectomy and pancreatectomy.
“Recent technologies have evolved a lot, so robotic surgery is active. In the case of cholecystectomy using the latest da Vinci SP robot, it is more effective than the current model and can be performed safely with minimal scarring. In pancreatectomy, the use of the da Vinci SP robot can minimize surgical scars and postoperative pain.”
Are there ways to prevent pancreatic cancer?
“Because pancreatic cancer often has a poor prognosis, prevention is paramount. △ Quit smoking △ Eat fruits, vegetables, dietary fiber, etc. △ Get rid of obesity through regular exercise △ High in calories, high in fat and carbohydrates
These include no carbohydrate intake, △ excessive alcohol consumption, reduced sugar intake, △ periodic check-ups. Smokers are twice as likely to get this disease than non-smokers. In addition, it is known that the risk of pancreatic cancer is high even 10 to 20 years after quitting smoking, so quitting smoking as soon as possible is the surest way to reduce the risk of pancreatic cancer.”
Reporter Yeoncheol Choi ftdog@donga.com