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Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea
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Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee
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Clin Endosc 2024;57(4):476-485. Published online April 12, 2024
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DOI: https://doi.org/10.5946/ce.2023.198
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Graphical Abstract
Abstract
PDFPubReaderePub
- Background
/Aims: Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation.
Methods This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm.
Results Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79–0.86) and displayed a moderate discriminatory power.
Conclusions High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.
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Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy
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Hee Seok Moon, Eun Kwang Choi, Ji Hyun Seo, Jeong Seop Moon, Ho June Song, Kyoung Oh Kim, Jong Jin Hyun, Sung Kwan Shin, Beom Jae Lee, Sang Heon Lee
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Clin Endosc 2017;50(4):345-356. Published online July 31, 2017
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DOI: https://doi.org/10.5946/ce.2017.106
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Abstract
PDFPubReaderePub
- The Korean Society of Gastrointestinal Endoscopy (KSGE) developed a gastrointestinal (GI) endoscopy board in 1995 and related regulations. Although the KSGE has acquired many specialists since then, the education and training aims and guidelines were insufficient. During GI fellowship training, obtaining sufficient exposure to some types of endoscopic procedures is difficult. Fellows should acquire endoscopic skills through supervised endoscopic procedures during GI fellowship training. Thus, the KSGE requires training guidelines for fellowships that allow fellows to perform independent endoscopic procedures without supervision. This document is intended to provide principles that the Committee of Education and Training of the KSGE can use to develop practical guidelines for granting privileges to perform accurate GI endoscopy safely. The KSGE will improve the quality of GI endoscopy by providing guidelines for fellowships and supervisors.
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Giulio Antonelli, Andrei M. Voiosu, Katarzyna M. Pawlak, Tiago Cúrdia Gonçalves, Nha Le, Michiel Bronswijk, Marcus Hollenbach, Omar Elshaarawy, Ulrike Beilenhoff, Pietro Mascagni, Theodor Voiosu, Maria Pellisé, Mário Dinis-Ribeiro, Konstantinos Triantafyl Endoscopy.2024; 56(02): 131. CrossRef - Training in Advanced Endoscopy: Current Status and Future Directions
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Tae Jun Kim, Jeung Hui Pyo, Young Hye Byun, Sung Chul Choi, Jin Pyo Hong, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Poong-Lyul Rhee, Jae J. Kim, Jun Haeng Lee Clinical Gastroenterology and Hepatology.2023; 21(5): 1205. CrossRef - Global trends in training and credentialing guidelines for gastrointestinal endoscopy: a systematic review
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Ho Seok Seo, So Jung Kim, Chul Hyo Jeon, Kyo Young Song, Han Hong Lee Journal of Korean Medical Science.2022;[Epub] CrossRef - Implementation effect of institutional policy of EGD observation time on neoplasm detection
Jae Myung Park, Sang Yoon Kim, Ga-Yeong Shin, Younghee Choe, Hyun Sun Cho, Chul-Hyun Lim, Yu Kyung Cho, Myung-Gyu Choi Gastrointestinal Endoscopy.2021; 93(5): 1152. CrossRef - Training in endoscopic retrograde cholangio-pancreatography: a critical assessment of the broad scenario of training programs and models
Camilla Gallo, Ivo Boškoski, Maria Valeria Matteo, Beatrice Orlandini, Guido Costamagna Expert Review of Gastroenterology & Hepatology.2021; 15(6): 675. CrossRef - Colonoscopy quality in community hospitals and nonhospital facilities in Korea
Jae Gon Lee, Dong Soo Han, Young-Eun Joo, Dae-Seong Myung, Dong Il Park, Seul Ki Kim, Yunho Jung, Won Hyun Lee, Eun Soo Kim, Joon Seok Yoon, Chang Soo Eun The Korean Journal of Internal Medicine.2021; 36(Suppl 1): S35. CrossRef - Guidelines for accreditation of endoscopy units: quality measures from the Korean Society of Coloproctology
Rumi Shin, Seongdae Lee, Kyung-Su Han, Dae Kyung Sohn, Sang Hui Moon, Dong Hyun Choi, Bong-Hyeon Kye, Hae-Jung Son, Sun Il Lee, Sumin Si, Won-Kyung Kang Annals of Surgical Treatment and Research.2021; 100(3): 154. CrossRef - Why Should We Implement a System of Endoscopic Retrograde Cholangiopancreatography Certification?
Kwang Bum Cho The Korean Journal of Pancreas and Biliary Tract.2021; 26(4): 211. CrossRef - Process and Renewal of Pancreatobiliary Cerification System
Dong Wook Lee, Byoung Kwan Son The Korean Journal of Pancreas and Biliary Tract.2020; 25(1): 1. CrossRef - Impact of Hospital Volume and the Experience of Endoscopist on Adverse Events Related to Endoscopic Retrograde Cholangiopancreatography: A Prospective Observational Study
Hyun Jik Lee, Chang Min Cho, Jun Heo, Min Kyu Jung, Tae Nyeun Kim, Kook Hyun Kim, Hyunsoo Kim, Kwang Bum Cho, Ho Gak Kim, Jimin Han, Dong Wook Lee, Yoon Suk Lee Gut and Liver.2020; 14(2): 257. CrossRef - Quality indicators in diagnostic upper gastrointestinal endoscopy
Wladyslaw Januszewicz, Michal F. Kaminski Therapeutic Advances in Gastroenterology.2020;[Epub] CrossRef - Optimized diagnosis ofHelicobacter pyloriand tailored eradication therapy for preventing gastric cancer: a proposal for SHAKE strategy
Jun-Hyung Cho, So-Young Jin Expert Review of Gastroenterology & Hepatology.2020; 14(7): 553. CrossRef - Endoscopy training in Korea
Joon Sung Kim, Byung-Wook Kim The Korean Journal of Internal Medicine.2019; 34(2): 237. CrossRef - Current Korean Medical Specialty and Subspecialty System for Preparation of Privileging and Credentialing of ERCP Subspecialty
Eun Kwang Choi The Korean Journal of Pancreas and Biliary Tract.2019; 24(2): 47. CrossRef - Accredited Endoscopy Unit Program of Korea: Overview and Qualification
Jung-Wook Kim, Yu Kyung Cho, Jin-Oh Kim, Jae-Young Jang Clinical Endoscopy.2019; 52(5): 426. CrossRef - ERCP practice beyond the training period – bridging the gap between guidelines and real-life practice: a single operator experience of 679 procedures
Theodor Voiosu, Andrei Voiosu, Andreea Benguş, Bogdan Mateescu Romanian Journal of Internal Medicine.2019; 57(2): 151. CrossRef - Basic training in digestive endoscopy for resident physicians in gastroenterology. Recommendations by the Sociedad Española de Endoscopia Digestiva (SEED)
Álvaro Brotons, Angels Vilella, Cristina Sánchez-Montes, Catalina Garau, Albert Vila, Vicente Pons Beltrán, Carlos Dolz Abadía Revista Española de Enfermedades Digestivas.2018;[Epub] CrossRef
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Experimental Models of Pancreatitis
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Jong Jin Hyun, Hong Sik Lee
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Clin Endosc 2014;47(3):212-216. Published online May 31, 2014
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DOI: https://doi.org/10.5946/ce.2014.47.3.212
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Abstract
PDFPubReaderePub
Acute pancreatitis is an inflammatory disease characterized by interstitial edema, inflammatory cell infiltration, and acinar cell necrosis, depending on its severity. Regardless of the extent of tissue injury, acute pancreatitis is a completely reversible process with evident normal tissue architecture after recovery. Its pathogenic mechanism has been known to be closely related to intracellular digestive enzyme activation. In contrast to acute pancreatitis, chronic pancreatitis is characterized by irreversible tissue damage such as acinar cell atrophy and pancreatic fibrosis that results in exocrine and endocrine insufficiency. Recently, many studies of chronic pancreatitis have been prompted by the discovery of the pancreatic stellate cell, which has been identified and distinguished as the key effector cell of pancreatic fibrosis. However, investigations into the pathogenesis and treatment of pancreatitis face many obstacles because of its anatomical location and disparate clinical course. Due to these difficulties, most of our knowledge on pancreatitis is based on research conducted using experimental models of pancreatitis. In this review, several experimental models of pancreatitis will be discussed in terms of technique, advantages, and limitations.
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Acute Duodenal Ischemia and Periampullary Intramural Hematoma after an Uneventful Endoscopic Retrograde Cholangiopancreatography in a Patient with Primary Myelofibrosis
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Chang Ho Jung, Jong Jin Hyun, Dae Hoe Gu, Eul Sun Moon, Jae Seon Kim, Hong Sik Lee, Chang Duck Kim
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Clin Endosc 2014;47(3):270-274. Published online May 31, 2014
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DOI: https://doi.org/10.5946/ce.2014.47.3.270
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Abstract
PDFPubReaderePub
Acute duodenal ischemia and periampullary intramural hematoma are rare complications after endoscopic retrograde cholangiopancreatography (ERCP). A 77-year-old man with splenomegaly complained of abdominal pain caused by common bile duct (CBD) stone. After successful removal of the CBD stone without immediate complications, the patient developed intramural hematoma around the ampulla of Vater along with diffuse duodenal edema. The findings were compatible with acute intestinal ischemia, and further evaluation revealed that he had underlying primary myelofibrosis. Myeloproliferative diseases are known to be significantly associated with an increased risk of thrombohemorrhagic complications. Therefore, particular attention should be given to this group of patients when a high-risk procedure such as ERCP is performed.
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- Ischemic duodenitis after endoscopic retrograde cholangiopancreatography‐related procedure
Yuki Tanisaka, Akashi Fujita, Shomei Ryozawa Digestive Endoscopy.2022; 34(6): 1264. CrossRef - Ruptured Dissecting Intramural Duodenal Hematoma Following Endoscopic Retrograde Cholangiopancreatography
Eric Weiss, Madeline Tadley, Pak S. Leung, Mark Kaplan ACG Case Reports Journal.2017; 4(1): e70. CrossRef
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Preparation and Patient Evaluation for Safe Gastrointestinal Endoscopy
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Seong Hee Kang, Jong Jin Hyun
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Clin Endosc 2013;46(3):212-218. Published online May 31, 2013
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DOI: https://doi.org/10.5946/ce.2013.46.3.212
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Abstract
PDFPubReaderePub
Patient evaluation and preparation is the first and mandatory step to ensure safety and quality of endoscopic procedures. This begins and ends with identifying the patient, procedure type, and indication. Every patient has the right to be fully informed about risks and benefits of what is to be performed on them, and the medical personnel should respect the decision made by the patients. Thoroughly performed history taking and physical examination will guide the endoscopists to better stratify risk and plan sedation. Special attention should be given to higher-risk patients with higher-risk condition undergoing higher-risk procedures. Making preparations to monitor the patients and being ready to handle emergency situations throughout the endoscopic procedure are sine qua non to warrant safe endoscopy.
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- Challenges in procedural sedation and analgesia
Šćepan Sinanović, Tanja Prodović, Olivera Milovanović, Saša Bubanj, Miljan Krstović, Srećko Potić, Jelena Sekulić, Danilo Jeremić Acta Facultatis Medicae Naissensis.2023; 40(2): 149. CrossRef - Gastrointestinal Endoscopy Performed by Gastroenterologists: Opportunistic Screening Strategy for Newly Diagnosed Head and Neck Cancers
Chih-Wei Yang, Yueng-Hsiang Chu, Hsin-Chien Chen, Wei-Chen Huang, Peng-Jen Chen, Wei-Kuo Chang Frontiers in Oncology.2022;[Epub] CrossRef - SAFETY IN THE GASTROENTEROLOGY SETTING
Gastroenterology Nursing.2021; 44(6): 467. CrossRef - Spontaneous superior mesenteric artery dissection following upper gastrointestinal panendoscopy: A case report and literature review
Chih-Ming Ou Yang, Yu-Tong Yen, Chai-Hock Chua, Chin-Chu Wu, Kuan-En Chu, Tsung-I Hung World Journal of Clinical Cases.2019; 7(20): 3276. CrossRef - Using Etomidate and Midazolam for Screening Colonoscopies Results in More Stable Hemodynamic Responses in Patients of All Ages
Jung Min Lee, Geeho Min, Bora Keum, Jae Min Lee, Seung Han Kim, Hyuk Soon Choi, Eun Sun Kim, Yeon Seok Seo, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Soon Ho Um, Chang Duck Kim Gut and Liver.2019; 13(6): 649. CrossRef - Reversal of Warfarin-Associated Life-Threatening Bleed With an Attenuated Dose of 4-Factor Prothrombin Complex Concentrate
Allyson H. Wexler, Megan A. Rech Annals of Pharmacotherapy.2018; 52(2): 212. CrossRef - Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly
Jung Min Lee, Geeho Min, Jae Min Lee, Seung Han Kim, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Chang Duck Kim, Jong-Jae Park, Beom Jae Lee, Seong Ji Choi, Woojung Kim Medicine.2018; 97(20): e10635. CrossRef - Characteristics and Outcomes of Fasting Orders Among Medical Inpatients
Atsushi Sorita, Charat Thongprayoon, John T. Ratelle, Ruth E. Bates, Katie M. Rieck, Aditya P. Devalapalli, Adil Ahmed, Deanne T. Kashiwagi Journal of Hospital Medicine.2017; 12(1): 36. CrossRef - Training and Competency in Sedation Practice in Gastrointestinal Endoscopy
Ben Da, James Buxbaum Gastrointestinal Endoscopy Clinics of North America.2016; 26(3): 443. CrossRef - Technical skills and training of upper gastrointestinal endoscopy for new beginners
Seung-Hwa Lee, Young-Kyu Park, Sung-Min Cho, Joon-Koo Kang, Duck-Joo Lee World Journal of Gastroenterology.2015; 21(3): 759. CrossRef - Endoscopic Sedation: From Training to Performance
Tae Hoon Lee, Chang Kyun Lee Clinical Endoscopy.2014; 47(2): 141. CrossRef - Sedation-related complications in gastrointestinal endoscopy
Somchai Amornyotin World Journal of Gastrointestinal Endoscopy.2013; 5(11): 527. CrossRef
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Feasibility of Obtaining Quantitative 3-Dimensional Information Using Conventional Endoscope: A Pilot Study
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Jong Jin Hyun, Hoon Jai Chun, Bora Keum, Yeon Seok Seo, Yong Sik Kim, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Jong-Wook Lim, Dong-Gi Woo, Young-Joong Kim, Myo-Taeg Lim
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Clin Endosc 2012;45(3):182-188. Published online August 22, 2012
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DOI: https://doi.org/10.5946/ce.2012.45.3.182
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Abstract
PDFPubReaderePub
- Background/Aims
Three-dimensional (3D) imaging is gaining popularity and has been partly adopted in laparoscopic surgery or robotic surgery but has not been applied to gastrointestinal endoscopy. As a first step, we conducted an experiment to evaluate whether images obtained by conventional gastrointestinal endoscopy could be used to acquire quantitative 3D information. MethodsTwo endoscopes (GIF-H260) were used in a Borrmann type I tumor model made of clay. The endoscopes were calibrated by correcting the barrel distortion and perspective distortion. Obtained images were converted to gray-level image, and the characteristics of the images were obtained by edge detection. Finally, data on 3D parameters were measured by using epipolar geometry, two view geometry, and pinhole camera model. ResultsThe focal length (f) of endoscope at 30 mm was 258.49 pixels. Two endoscopes were fixed at predetermined distance, 12 mm (d12). After matching and calculating disparity (v2-v1), which was 106 pixels, the calculated length between the camera and object (L) was 29.26 mm. The height of the object projected onto the image (h) was then applied to the pinhole camera model, and the result of H (height and width) was 38.21 mm and 41.72 mm, respectively. Measurements were conducted from 2 different locations. The measurement errors ranged from 2.98% to 7.00% with the current Borrmann type I tumor model. ConclusionsIt was feasible to obtain parameters necessary for 3D analysis and to apply the data to epipolar geometry with conventional gastrointestinal endoscope to calculate the size of an object.
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Tara M. Urner, Andrew Inman, Benjamin Lapid, Shu Jia Biomedical Optics Express.2022; 13(2): 590. CrossRef - 3D light-field endoscopic imaging using a GRIN lens array
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Siyang Zuo, Shuxin Wang Expert Review of Medical Devices.2016; 13(12): 1095. CrossRef - Application of robotics in gastrointestinal endoscopy: A review
Baldwin Po Man Yeung World Journal of Gastroenterology.2016; 22(5): 1811. CrossRef - Quantitative analysis of velopharyngeal movement using a stereoendoscope: accuracy and reliability of range images
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Geun Am Song Clinical Endoscopy.2012; 45(3): 181. CrossRef
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Management of Non-Variceal Upper Gastrointestinal Bleeding
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Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Sang Woo Lee
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Clin Endosc 2012;45(3):220-223. Published online August 22, 2012
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DOI: https://doi.org/10.5946/ce.2012.45.3.220
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Abstract
PDFPubReaderePub
Upper gastrointestinal bleeding (UGIB) is a critical condition that demands a quick and effective medical management. Non-variceal UGIB, especially peptic ulcer bleeding is the most significant cause. Appropriate assessment and treatment have a major influence on the prognosis of patients with UGIB. Initial fluids resuscitation and/or transfusion of red blood cells are necessary in patients with clinical evidence of intravascular volume depletion. Endoscopy is essential for diagnosis and treatment of UGIB, and should be provided within 24 hours after presentation of UGIB. Pre-endoscopic use of intravenous proton pump inhibitor (PPI) can downstage endoscopic signs of hemorrhage. Post-endoscopic use of high-dose intravenous PPI can reduce the risk of rebleeding and further interventions such as repeated endoscopy and surgery. Eradication of Helicobacter pylori and withdrawal of non-steroidal anti-inflammatory drugs are recommended to prevent recurrent bleeding.
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Abed H AlLehibi, Faisal F Alsubaie, Rayan H Alzahrani, Hussain A Ekhuraidah, Mohammed A Koshan, Nasser F Alotaibi, Fahad M Alotaibi, Hamdan S Alghamdi, Abdulrahman A Aljumah Cureus.2024;[Epub] CrossRef - Peptic ulcer in nephrotic syndrome patients due to steroid therapy
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MINORU TOMIZAWA, FUMINOBU SHINOZAKI, RUMIKO HASEGAWA, YOSHINORI SHIRAI, YASUFUMI MOTOYOSHI, TAKAO SUGIYAMA, SHIGENORI YAMAMOTO, NAOKI ISHIGE Biomedical Reports.2016; 4(6): 711. CrossRef - Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate
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Ki Bae Kim, Soon Man Yoon, Sei Jin Youn Clinical Endoscopy.2014; 47(4): 315. CrossRef - Upper Endoscopy in International Digestive Endoscopy Network 2012: Towards Upper End of Quality
Il Ju Choi Clinical Endoscopy.2012; 45(3): 217. CrossRef
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Comparison on the Efficacy of Disinfectants Used in Automated Endoscope Reprocessors: PHMB-DBAC versus Orthophthalaldehyde
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Sun Young Kim, Hong Sik Lee, Jong Jin Hyun, Min Ho Seo, Sun Young Yim, Ha Young Oh, Hye Sook Kim, Bora Keum, Yeon Seok Seo, Yong Sik Kim, Yoon Tae Jeen, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu
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Clin Endosc 2011;44(2):109-115. Published online December 31, 2011
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DOI: https://doi.org/10.5946/ce.2011.44.2.109
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Abstract
PDFPubReaderePub
- Background/Aims
Since endoscopes are reusable apparatus classified as semicritical item, thorough reprocessing to achieve high-level disinfection is of utmost importance to prevent spread of infection. To improve disinfection efficacy and safety, disinfectants and endoscope reprocessors are continuously evolving. This study aimed to compare the efficacy of the combination of polyhexamethylenebiguanide hydrochloride-alkyldimethylbenzylammonium chloride (PHMB-DBAC) and orthophthalaldehyde (OPA) used respectively in ultrasonographic cleaning incorporated automated endoscope reprocessors: COOLENDO (APEX Korea) or OER-A (Olympus Optical). MethodsA total of 86 flexible upper endoscopes were randomly reprocessed with either COOLENDO/PHMB-DBAC or OER-A/OPA. Culture samplings were done at two sites (endoscope tip and working channel) which were later incubated on blood agar plate. Bacterial colonies were counted and identified. ResultsThe culture-positive rate at the endoscope tip and working channel was 0% and 2.33% for COOLENDO/PHMB-DBAC and 4.65% and 0% for OER-A/OPA. Staphylococcus hominis was cultured from one endoscope reprocessed with COOLENDO/PHMB-DBAC and Pseudomonas putida was isolated from two endoscopes reprocessed with OER-A/OPA. ConclusionsThe reprocessing efficacy of COOLENDO/PHMB-DBAC was non-inferior to that of OER-A/OPA (p=0.032; confidence interval, -0.042 to 0.042). During the study period, significant side effect of PHMB-DBAC was not observed.
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Hyun Il Seo, Dae Sung Lee, Eun Mi Yoon, Min-Jung Kwon, Hyosoon Park, Yoon Suk Jung, Jung Ho Park, Chong Il Sohn, Dong Il Park Intestinal Research.2016; 14(2): 178. CrossRef - Role of Clinical Endoscopy in Emphasizing Endoscope Disinfection
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