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Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection
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Duk Su Kim, Yunho Jung, Ho Sung Rhee, Su Jin Lee, Yeong Geol Jo, Jong Hwa Kim, Jae Man Park, Il-Kwun Chung, Young Sin Cho, Tae Hoon Lee, Sang-Heum Park, Sun-Joo Kim
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Clin Endosc 2016;49(3):273-281. Published online March 4, 2016
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DOI: https://doi.org/10.5946/ce.2015.086
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Abstract
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- Background
/Aims: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy.
Methods Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients.
Results DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size ≥40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and non-hemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438; IIb, p=0.397; IIc, p=0.773) during second-look endoscopy.
Conclusions The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.
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Citations
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Murat Ferhat Ferhatoglu, Abdulcabbar Kartal, Ali Ilker Filiz, Abut Kebudi Bariatric Surgical Practice and Patient Care.2022; 17(3): 148. CrossRef - Forrest Classification for Bleeding Peptic Ulcer: A New Look at the Old Endoscopic Classification
Hsu-Heng Yen, Ping-Yu Wu, Tung-Lung Wu, Siou-Ping Huang, Yang-Yuan Chen, Mei-Fen Chen, Wen-Chen Lin, Cheng-Lun Tsai, Kang-Ping Lin Diagnostics.2022; 12(5): 1066. CrossRef - Performance Comparison of the Deep Learning and the Human Endoscopist for Bleeding Peptic Ulcer Disease
Hsu-Heng Yen, Ping-Yu Wu, Pei-Yuan Su, Chia-Wei Yang, Yang-Yuan Chen, Mei-Fen Chen, Wen-Chen Lin, Cheng-Lun Tsai, Kang-Ping Lin Journal of Medical and Biological Engineering.2021; 41(4): 504. CrossRef - Prevention of bleeding in the early postoperative period after intraluminal stomach resection: results of a prospective randomized study
S.G. Shapovalyants, R.V. Plakhov, M.V. Bordikov, E.V. Gorbachev, I.V. Zhitareva, E.D. Fedorov Endoskopicheskaya khirurgiya.2020; 26(5): 5. CrossRef - Risk factors for delayed bleeding by onset time after endoscopic submucosal dissection for gastric neoplasm
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Koichi Izumikawa, Masaya Iwamuro, Tomoki Inaba, Shigenao Ishikawa, Kenji Kuwaki, Ichiro Sakakihara, Kumiko Yamamoto, Sakuma Takahashi, Shigetomi Tanaka, Masaki Wato, Hiroyuki Okada BMC Gastroenterology.2018;[Epub] CrossRef - Continuous esomeprazole infusion versus bolus administration and second look endoscopy for the prevention of rebleeding in children with a peptic ulcer
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Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome
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Young Sin Cho, Tae Hoon Lee, Soon Oh Hwang, Sunhyo Lee, Yunho Jung, Il-Kwun Chung, Sang-Heum Park, Sun-Joo Kim
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Clin Endosc 2014;47(4):367-370. Published online July 28, 2014
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DOI: https://doi.org/10.5946/ce.2014.47.4.367
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Abstract
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Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.
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Yuga Komaki, Shuji Kanmura, Akihito Tanaka, Mari Nakashima, Fukiko Komaki, Hiromichi Iwaya, Shiho Arima, Fumisato Sasaki, Yuichiro Nasu, Shiroh Tanoue, Shinichi Hashimoto, Akio Ido Internal Medicine.2019; 58(17): 2473. CrossRef - Intestinal stones: A rare cause of bowel obstruction
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Current status and trends of green endoscopy
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Kihyun Ryu, Won Jae Yoon, Sang Hoon Kim, Da Hee Park, Jin Hwa Park, Ki Bae Bang, Tae Joo Jeon, Da Hyun Jung, Young Sin Cho
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Received December 16, 2024 Accepted January 21, 2025 Published online May 21, 2025
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DOI: https://doi.org/10.5946/ce.2024.332
[Epub ahead of print]
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Abstract
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- The increasing global emphasis on sustainability has extended its influence to the field of medicine, including endoscopy. Green endoscopy aims to minimize the environmental footprint of endoscopic practices while maintaining high standards of patient care. This review examines the current status of green endoscopy, focusing on its environmental impact, strategies for waste reduction, and adoption of sustainable practices. The key topics include the environmental challenges posed by single-use devices, the role of sterilization and recycling, and innovations in energy-efficient endoscopic equipment. Furthermore, we highlight policy recommendations and actionable strategies for healthcare systems to transition toward green practices. By integrating these approaches, the field of endoscopy can meaningfully contribute to global sustainability efforts without compromising clinical outcomes.
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