Based on the unexpected Middle East respiratory syndrome (MERS) outbreak in Korea, it was established that the virus can spread easily, MERS exposure in hospitals carries an extreme risk for infection as well as mortality, and the sharing of information was essential for infection control. Although the incidence of exogenous infections related to contaminated endoscopes is very low, the majority of published outbreaks have been caused by various shortcomings in reprocessing procedures, including insufficient training or awareness. Ever since the inauguration of "Clinical Endoscopy" as an English-language journal of the Korean Society of Gastrointestinal Endoscopy in 2011, it has published several articles on disinfection of the endoscope and its accessories. Many Science Citation Index journals have also emphasized high-level disinfection of the gastrointestinal endoscope. Many papers have been produced specifically, since the outbreak of carbapenem-resistant Enterobacteriaceae in 2013. The recent review papers concluded that quality control is the most important issue among all the aspects of procedural care, including the efficiency of the gastrointestinal endoscopy unit and reprocessing room. Thorough reprocessing of endoscopes using high-level disinfection and sterilization methods may be essential for reducing the risk of infection.

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Several issues concerning endoscope reprocessing remain unresolved based on currently available data. Thus, further studies are required to confirm standard practices including safe endoscope shelf life, proper frequency of replacement of some accessories including water bottles and connecting tubes, and microbiological surveillance testing of endoscopes after reprocessing. The efficacy and cost-effectiveness of newer technology that allows automated cleaning and disinfection is one such controversial issue. In addition, there are no guidelines on whether delayed reprocessing and extended soaking may harm endoscope integrity or increase the bioburden on the external or internal device surfaces. In this review, we discuss the unresolved and controversial issues regarding endoscope reprocessing.

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A duodenoscope has a very complex structure that contains many small parts which make reprocessing more challenging. The difficulty in cleaning duodenoscopes contributes to a higher risk of infection than that of conventional gastrointestinal endoscopes. However, a duodenoscope shares similar disinfection process with other gastrointestinal endoscopes. Recent outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography procedures have raised many concerns worldwide. Duodenoscope-associated infections involving CRE or other multidrug-resistant bacteria pose a great threat to patients undergoing procedures using duodenoscopes and should be dealt with a great concern. Updated guidelines regarding cleaning and disinfection of duodenoscope needs to be developed urgently to prevent transmission of infection and ensure patient safety. Meanwhile, healthcare staff should pay special attention to thorough cleaning and disinfection of duodenoscopes.

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Arising from human curiosity in terms of the desire to look within the human body, endoscopy has undergone significant advances in modern medicine. Direct visualization of the gastrointestinal (GI) tract by traditional endoscopy was first introduced over 50 years ago, after which fairly rapid advancement from rigid esophagogastric scopes to flexible scopes and high definition videoscopes has occurred. In an effort towards early detection of precancerous lesions in the GI tract, several high-technology imaging scopes have been developed, including narrow band imaging, autofocus imaging, magnified endoscopy, and confocal microendoscopy. However, these modern developments have resulted in fundamental imaging technology being skewed towards red-green-blue and this technology has obscured the advantages of other endoscope techniques. In this review article, we have described the importance of image quality analysis using a survey to consider the diversity of endoscope system selection in order to better achieve diagnostic and therapeutic goals. The ultimate aims can be achieved through the adoption of modern endoscopy systems that obtain high image quality.

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• Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review
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  Clinical Endoscopy.2020; 53(2): 176.     CrossRef
• Endoscopic transpapillary stenting for the management of acute cholecystitis
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  Langenbeck's Archives of Surgery.2020; 405(2): 191.     CrossRef
• Cerrahi için yüksek riskli bir hastada akut kolesistitin endoskopik transpapiller drenajı
  Sinem İPOR, Mehmet ÇETİN, Atilla ÖNMEZ, Alper İPOR, Serkan TORUN
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• An unusual complication of pyloric ring obstruction caused by flange of lumen apposing metal stent in endoscopic ultrasound-guided gallbladder drainage
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• Endoscopic transpapillary gallbladder drainage for acute cholecystitis is feasible for patients receiving antithrombotic therapy
  Ryota Sagami, Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Satoshi Suehiro, Yasushi Katsuyama, Hideaki Harada, Hidefumi Nishikiori, Kazunari Murakami, Yuji Amano
  Digestive Endoscopy.2020; 32(7): 1092.     CrossRef
• Successful Cholecystectomy After Endoscopic Ultrasound Gallbladder Drainage Compared With Percutaneous Cholecystostomy, Can it Be Done?
  Monica Saumoy, Amy Tyberg, Elizabeth Brown, Soumitra R. Eachempati, Michael Lieberman, Cheguevara Afaneh, Rastislav Kunda, Natalie Cosgrove, Ali Siddiqui, Monica Gaidhane, Michel Kahaleh
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• Classification of the cystic duct patterns and endoscopic transpapillary cannulation of the gallbladder to prevent post-ERCP cholecystitis
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• EUS-guided Versus Percutaneous Gallbladder Drainage
  Amy Tyberg, Monica Saumoy, Enrique V. Sequeiros, Marc Giovannini, Everson Artifon, Anthony Teoh, Jose Nieto, Amit P. Desai, Nikhil A. Kumta, Monica Gaidhane, Reem Z. Sharaiha, Michel Kahaleh
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• Risk factors for post-ERCP cholecystitis: a single-center retrospective study
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• Endoscopic Ultrasound-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: A Systematic Review
  Deepanshu Jain, Bharat Singh Bhandari, Nikhil Agrawal, Shashideep Singhal
  Clinical Endoscopy.2018; 51(5): 450.     CrossRef
• Endoskopik transpapiller safra kesesi drenajı: Tek merkez deneyimi
  Mustafa KAPLAN, Bülent ÖDEMİŞ, Selçuk DİŞİBEYAZ, Erkan PARLAK, Erkin ÖZTAŞ, Volkan GÖKBULUT, Orhan COŞKUN
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• Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: Is it better than percutaneous gallbladder drainage?
  Muhammad Ali Khan, Omair Atiq, Nisa Kubiliun, Bilal Ali, Faisal Kamal, Richard Nollan, Mohammad Kashif Ismail, Claudio Tombazzi, Michel Kahaleh, Todd H. Baron
  Gastrointestinal Endoscopy.2017; 85(1): 76.     CrossRef
• Endoscopic ultrasound gallbladder drainage: Patient selection, preparation, and performance
  A.J. Small, S. Irani
  Techniques in Gastrointestinal Endoscopy.2017; 19(4): 230.     CrossRef
• Management of acute cholecystitis
  Prabhava Bagla, Juan C. Sarria, Taylor S. Riall
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• Can percutaneous cholecystostomy be a definitive treatment in the elderly?
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• A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
  Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
  Clinical Endoscopy.2021; 54(1): 139.     CrossRef
• Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?
  Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Takuto Hikichi, Hiromasa Ohira
  World Journal of Gastrointestinal Endoscopy.2020; 12(8): 220.     CrossRef
• Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
  Tae Young Park, Tae Jun Song
  World Journal of Gastroenterology.2019; 25(24): 3091.     CrossRef
• Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article
  Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
  Journal of Digestive Diseases.2019; 20(12): 631.     CrossRef
• Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
  Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
  Saudi Journal of Gastroenterology.2019; 25(6): 355.     CrossRef
• Endoscopic Management of Difficult Bile Duct Stones
  Murad Aburajab, Kulwinder Dua
  Current Gastroenterology Reports.2018;[Epub]     CrossRef
• Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis
  Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, Jai Hoon Yoon
  Surgical Endoscopy.2018; 32(11): 4598.     CrossRef
• Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients
  Min-Gui Han, Eunae Cho, Chang-Hwan Park, Chung-Hwan Jun, Seon-Young Park
  Hepatobiliary & Pancreatic Diseases International.2018; 17(6): 546.     CrossRef
• Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations
  Seon Mee Park
  Clinical Endoscopy.2016; 49(4): 376.     CrossRef

Previous studies reported that ultrathin endoscope (UE) provides endoscopic guidance during insertion of a self-expanding metal stent (SEMS) without fluoroscopic monitoring in patients with upper gastrointestinal stenosis (benign or malignant) or postoperative esophageal leakage. According to the type of SEMS and level of the stenosis, the technique of the procedure is variable. Herein, we report a patient who underwent placement of a distal release esophageal SEMS to treat an esophagogastric anastomotic stricture via retroflexed UE.

A 50-year-old woman with incidentally detected multiple gastric polyps and biopsy-proven neuroendocrine tumor (NET) was referred to our hospital. More than 10 polypoid lesions (less than 15 mm) with normal gastric mucosa were detected from the gastric body to the fundus. The serum level of gastrin was within the normal limits. There was no evidence of atrophic changes on endoscopy and serologic marker as pepsinogen I/II ratio. Computed tomography of the abdomen and pelvis revealed no evidence of metastatic lesions. She refused surgery, and we performed endoscopic polypectomy for almost all the gastric polyps that were greater than 5 mm. Although the histological examination revealed that all the removed polys were diagnosed as NET G1, three of them extended to the lateral or vertical resection margins, while two exhibited lymphovascular invasion. A follow-up upper endoscopy that was performed 6 months after the diagnosis showed multiple remnant gastric polyps that were suggestive of remnant gastric NET.

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• Endoscopic Management of Gastro-Entero-Pancreatic Neuroendocrine Tumours: An Overview of Proposed Resection and Ablation Techniques
  Rocio Chacchi-Cahuin, Edward J. Despott, Nikolaos Lazaridis, Alessandro Rimondi, Giuseppe Kito Fusai, Dalvinder Mandair, Andrea Anderloni, Valentina Sciola, Martyn Caplin, Christos Toumpanakis, Alberto Murino
  Cancers.2024; 16(2): 352.     CrossRef
• Multimodal management of foregut neuroendocrine neoplasms
  Yichan Zhou, James Weiquan Li, Noriya Uedo
  Best Practice & Research Clinical Gastroenterology.2024; 68: 101889.     CrossRef
• Clinicopathological features of primary gastric neuroendocrine neoplasms: A single‐center analysis
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  Journal of Digestive Diseases.2016; 17(3): 162.     CrossRef
• A 15-year experience with gastric neuroendocrine tumors: Does type make a difference?
  Lauren M. Postlewait, Gillian G. Baptiste, Cecilia G. Ethun, Nina Le, Kenneth Cardona, Maria C. Russell, Field F. Willingham, David A. Kooby, Charles A. Staley, Shishir K. Maithel
  Journal of Surgical Oncology.2016; 114(5): 576.     CrossRef

Bezoars are retained masses of ingested materials accumulating within the gastrointestinal track. While gastric bezoars are often observed, duodenal bezoars are rarely reported. A 77-year-old man who had frequently consumed persimmons and had never undergone gastric surgery had symptoms of epigastric pain and early satiety for 10 days. Esophagogastroduodenoscopy showed many diospyrobezoars in a severely distended duodenal bulb, otherwise known as megaduodenum. The patient's treatment consisted of repeated endoscopic removal of the bezoars by using a retrieval net.

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• Case Report: A Child With Functional Chronic Duodenal Obstruction Caused by Megaduodenum
  Zhibo Qu, Biao Zheng, Chuncheng Ju, Jiaxu Liu, Bingyang Liu, Haoran Zhang
  Frontiers in Pediatrics.2021;[Epub]     CrossRef
• A rare case of idiopathic congenital megaduodenum in adult misinterpreted during childhood: case report and literature review
  Natally Horvat, Vicente Bohrer Brentano, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Publio Cesar Cavalcante Viana, Marcel Cerqueira Cesar Machado
  Radiology Case Reports.2019; 14(7): 858.     CrossRef

Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.

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• A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks
  Mihajlo Gjeorgjievski, Zaid Imam, Mitchell S. Cappell, Laith H. Jamil, Michel Kahaleh
  Journal of Clinical Gastroenterology.2021; 55(7): 551.     CrossRef
• Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer
  Ting Wang, Asmitananda Thakur, Baoqing Chen
  BMC Pulmonary Medicine.2021;[Epub]     CrossRef
• Over-the-Scope Clip Closure of an Esophageal-Pleural Fistula Secondary to Esophageal Stent Placement: A Case Report
  Justin Chuang, Naveena Luke, Khushbu Patel, Jordan Burlen, Ali Nawras
  Cureus.2021;[Epub]     CrossRef
• Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis
  Carlos Tuñon, Juan De Lucas, Jan Cubilla, Rafael Andrade, Miguel Aguirre, Julio Zúñiga Cisneros
  BMC Gastroenterology.2021;[Epub]     CrossRef
• Komplikationsbeherrschung bei Körperhöhlentrauma
  H. Vogelsang
  Trauma und Berufskrankheit.2017; 19(S1): 88.     CrossRef
• Endoscopic Approach for Major Complications of Bariatric Surgery
  Moon Kyung Joo
  Clinical Endoscopy.2017; 50(1): 31.     CrossRef
• Endoscopic clipping of spontaneous esophageal rupture: Case reports of three patients
  Koji Otsuka, Masahiko Murakami, Tomotake Ariyoshi, Takeshi Yamashita, Satoru Goto, Makoto Watanabe, Takeshi Aoki
  International Journal of Surgery Case Reports.2017;[Epub]     CrossRef

The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion

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• Balloon-Assisted Enteroscopy for Retrieval of Small Intestinal Foreign Bodies: A KASID Multicenter Study
  Jeongseok Kim, Beom Jae Lee, Nam Seok Ham, Eun Hye Oh, Kee Don Choi, Byong Duk Ye, Jeong-Sik Byeon, Chang Soo Eun, Jin Su Kim, Dong-Hoon Yang
  Gastroenterology Research and Practice.2020; 2020: 1.     CrossRef
• Foreign Body Penetration through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct
  Najib Nassani, Elie El-Charabaty, Patricia Nasr, Iskandar Barakat, Sherif Andrawes
  ACG Case Reports Journal.2017; 4(1): e12.     CrossRef

Phlebosclerotic colitis is a rare disease of intestinal ischemia and differentiating it from the typical ischemic colitis. It is caused by venous obstruction due to colonic and mesenteric venous calcification. We report a 36-year-old woman presenting with intermittent abdominal pain. Initial radiologic findings showed multiple tortuous thread-like calcifications in the region of the right side of the colon and transverse colon on plain abdominal radiographs and computed tomography images. In the colonoscopy, edematous dark-bluish colonic mucosa, sclerotic colon wall, and multiple ulcers without clear boundaries were observed from the ascending colon to the transverse colon. In the sigmoid colon only showed the edematous dark-bluish colonic mucosa, sclerotic colon wall. On the basis of these findings, we diagnosed the patient as having phlebosclerotic colitis. We report a rare case of phlebosclerotic colitis in healthy young woman.

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• Phlebosclerotic Colitis in a Healthy Young Female with Long-term Herbal Medicine Use
  Taehong Kim, Jin Lee, Ji Eun Na, Yong Eun Park, Jongha Park, Tae Oh Kim
  The Korean Journal of Gastroenterology.2023; 82(1): 30.     CrossRef
• A rare cause of ischemic colitis: A case series of idiopathic mesenteric phlebosclerotic colitis from two medical centers in Taiwan
  Chien‐Neng Kao, Pao‐Ying Lin, Li‐Chun Chang, Wen‐Feng Hsu, Chia‐Hung Tu, Han‐Mo Chiu, Chun‐Chao Chang
  Advances in Digestive Medicine.2020; 7(4): 201.     CrossRef
• Phlebosclerotic Colitis – An Enigma Among Ischemic Colitis
  Rishi Philip Mathew, Safwat Girgis, Malcolm Wells, Gavin Low
  Journal of Clinical Imaging Science.2019; 9: 18.     CrossRef
• Idiopathic mesenteric phlebosclerosis caused by traditional medicine in a married couple and review of literature
  Chi‐Su Sun, Jyh‐Jou Chen, Pei‐Lun Lee, Ming‐Jenn Chen, Khin‐Than Win
  Advances in Digestive Medicine.2018; 5(1-2): 63.     CrossRef
• Phlebosclerotic colitis
  Wenguo Chen, Huatuo Zhu, Hongtan Chen, Guodong Shan, Guoqiang Xu, Lihua Chen, Fei Dong
  Medicine.2018; 97(43): e12824.     CrossRef
• Exclusive Phlebosclerosis of Submucosal Veins Leading to Ischemic Necrosis and Perforation of the Large Bowel: First European Case
  Sebastian Klein, Denise Buchner, De-hua Chang, Reinhard Büttner, Uta Drebber, Jochen W.U. Fries
  Case Reports in Gastroenterology.2018; 12(1): 137.     CrossRef

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.

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• Single Balloon Enteroscopy-Guided Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy: Long vs. Short Type
  Chang-Hwan Park
  The Korean Journal of Pancreas and Biliary Tract.2021; 26(3): 181.     CrossRef
• Direct Insertion of a Short-Type Single-Balloon Enteroscope and Using a Stent Retriever to Treat Difficult Bile Duct Stones in Surgically Altered Anatomy
  Takashi Sasaki, Naoki Sasahira
  Clinical Endoscopy.2021; 54(6): 937.     CrossRef
• Single-balloon enteroscopy-assisted ERCP in patients with Roux-en-Y anatomy and choledocholithiasis: do technical improvements mean better outcomes?
  Jesús Espinel Díez, María Eugenia Pinedo Ramos
  Revista Española de Enfermedades Digestivas.2020;[Epub]     CrossRef
• Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration
  Wen-Guang Wu, Lu-Cui Qin, Xiao-Ling Song, Ming-Ning Zhao, Wen-Jie Zhang, Jun Gu, Hao Weng, Ying-Bin Liu, Yi Zhang, Chun-Ying Qu, Lei-Ming Xu, Xue-Feng Wang
  World Journal of Gastroenterology.2019; 25(36): 5505.     CrossRef
• Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis
  Alberto Machado da Ponte-Neto, Wanderley M. Bernardo, Lara M. de A. Coutinho, Iatagan Rocha Josino, Vitor Ottoboni Brunaldi, Diogo T. H. Moura, Paulo Sakai, Rogério Kuga, Eduardo G. H. de Moura
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  Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada
  Gut and Liver.2017; 11(2): 306.     CrossRef