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Volume 50(6); November 2017
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Commentarys
Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology
Jie-Hyun Kim
Clin Endosc 2017;50(6):511-513.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.168
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Clinical Significance of Risk Factors for Asymptomatic Peptic Ulcer Disease
Cheal Wung Huh, Byung-Wook Kim
Clin Endosc 2017;50(6):514-515.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.159
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  • 5,842 View
  • 160 Download
  • 2 Web of Science
  • 3 Crossref
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Proper Treatment Option for Small Rectal Neuroendocrine Tumors Using Precut Endoscopic Mucosal Resection
Seun Ja Park
Clin Endosc 2017;50(6):516-517.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.182
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Focused Review Series: Endoscopic approacheses to Neuroendocrine Tumors
Diagnosis and Management of Upper Gastrointestinal Neuroendocrine Tumors
Jun Liong Chin, Dermot O’Toole
Clin Endosc 2017;50(6):520-529.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.181
AbstractAbstract PDFPubReaderePub
Upper gastrointestinal neuroendocrine tumors (NETs) are rare tumors which are increasingly recognised by practising endoscopists. After confirmation by endoscopic biopsies of these focal lesions, many questions may arise. As NETs are less frequently encountered compared to other malignancies or gastrointestinal pathology, many endoscopists may not fully understand the natural history, diagnosis and management of these tumors. In this review, we aim to update the practising endoscopist on the key clinical features and management of patients with upper gastrointestinal NET.

Citations

Citations to this article as recorded by  
  • Endoscopy in the Diagnosis and Management of Gastrointestinal Neuroendocrine Tumors
    Noble Varghese Mathews, Sudipta Dhar Chowdhury, Anoop John
    Gastroenterology, Hepatology and Endoscopy Practice.2024; 4(1): 1.     CrossRef
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    Journal of Surgical Oncology.2024; 129(6): 1121.     CrossRef
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    玉娇 吴
    Advances in Clinical Medicine.2024; 14(05): 1329.     CrossRef
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    Philipp E. Hartrampf, Sebastian E. Serfling, Takahiro Higuchi, Jörg Bojunga, Alexander Weich, Rudolf A. Werner
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    Cancer Medicine.2023; 12(10): 11344.     CrossRef
  • Endoscopic differential diagnosis of the gastritis-like form of primary non-Hodgkin’s lymphomas and neuroendocrine tumors of the stomach
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    Pelvic Surgery and Oncology.2023; 13(2): 27.     CrossRef
  • European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for gastroduodenal neuroendocrine tumours (NETs) G1–G3
    Francesco Panzuto, John Ramage, D. Mark Pritchard, Marie‐Louise F. van Velthuysen, Joerg Schrader, Nehara Begum, Anders Sundin, Massimo Falconi, Dermot O'Toole
    Journal of Neuroendocrinology.2023;[Epub]     CrossRef
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    Yuri Kim, Bokyung Ahn, Kee Don Choi, Beom-Su Kim, Jeong-Hwan Yook, Gin Hyug Lee, Seung-Mo Hong, Jeong Hoon Lee
    Gut and Liver.2023; 17(6): 863.     CrossRef
  • Therapeutic strategies for gastroenteropancreatic neuroendocrine neoplasms: State-of-the-art and future perspectives
    Elettra Merola, Andrea Michielan, Umberto Rozzanigo, Marco Erini, Sandro Sferrazza, Stefano Marcucci, Chiara Sartori, Chiara Trentin, Giovanni de Pretis, Franca Chierichetti
    World Journal of Gastrointestinal Surgery.2022; 14(2): 78.     CrossRef
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    World Journal of Gastroenterology.2022; 28(17): 1751.     CrossRef
  • Current updates and future directions in diagnosis and management of gastroenteropancreatic neuroendocrine neoplasms
    Andrew Canakis, Linda S Lee
    World Journal of Gastrointestinal Endoscopy.2022; 14(5): 267.     CrossRef
  • Gastroenteropancreatic Neuroendocrine Tumors
    Conrad J. Fernandes, Galen Leung, Jennifer R. Eads, Bryson W. Katona
    Gastroenterology Clinics of North America.2022; 51(3): 625.     CrossRef
  • Targeted therapy for upper gastrointestinal tract cancer: current and future prospects
    Matthew W Rosenbaum, Raul S Gonzalez
    Histopathology.2021; 78(1): 148.     CrossRef
  • Endoscopic Treatment of Gastric and Duodenal Neuroendocrine Tumors: Present and Future
    Sung Woo Jung
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(1): 29.     CrossRef
  • Impact of margin status on outcomes after endoscopic resection of well-differentiated duodenal neuroendocrine tumors
    Jonathan Ragheb, Shruti Mony, Jason Klapman, Tolga Erim, Angela Reagan, Robert Butler, Yanbin Dong, Michael Cruise, Barbara A. Centeno, Pablo Bejarano, Tyler Stevens, Umar Hayat, Amit Bhatt
    Gastrointestinal Endoscopy.2021; 94(3): 580.     CrossRef
  • Patterns of Lymph Node Metastasis in Patients With T1/T2 Gastroduodenal Neuroendocrine Neoplasms: Implications for Endoscopic Treatment
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    Frontiers in Endocrinology.2021;[Epub]     CrossRef
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    Profilakticheskaya meditsina.2021; 24(7): 50.     CrossRef
  • Successful endoscopic resection of an unusually enlarged and pedunculated type I gastric carcinoid tumour
    Tanya Odisho, Dongping Shi, Ahmad Aburashed
    BMJ Case Reports.2021; 14(8): e244292.     CrossRef
  • Comparison of the Clinical Features and Outcomes of Gallbladder Neuroendocrine Carcinoma with Those of Adenocarcinoma: A Propensity Score-Matched Analysis
    Min-Young Do, Sung-Ill Jang, Hua-Pyong Kang, Eui-Joo Kim, Kyong-Joo Lee, Go-Eun Park, Su-Jee Lee, Dong-Ki Lee, Sang-Myung Woo, Jae-Hee Cho
    Cancers.2021; 13(18): 4713.     CrossRef
  • Selective Resection of Type 1 Gastric Neuroendocrine Neoplasms and the Risk of Progression in an Endoscopic Surveillance Programme
    Jun Liong Chin, Jim O’Connell, Cian Muldoon, Niall Swan, John Vincent Reynolds, Narayanasamy Ravi, Justin Geoghegan, Kevin C. Conlon, Donal O’Shea, Dermot O’Toole
    Digestive Surgery.2021; 38(1): 38.     CrossRef
  • Neuroendocrine Tumors of the Gastrointestinal Tract: A Focused Review and Practical Approach for Gastroenterologists
    Joana  Carvão, Mário Dinis-Ribeiro, Pedro Pimentel-Nunes, Diogo Libânio
    GE - Portuguese Journal of Gastroenterology.2021; 28(5): 336.     CrossRef
  • Is There a Role for Surgery in Patients with Neuroendocrine Tumors of the Esophagus? A Contemporary View from the NCDB
    Suna Erdem, Esther Troxler, René Warschkow, Catherine Tsai, Babatunde Yerokun, Bruno Schmied, Christoph Stettler, Dan G. Blazer, Matthew Hartwig, Mathias Worni, Beat Gloor
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    Monjur Ahmed
    World Journal of Gastrointestinal Oncology.2020; 12(8): 791.     CrossRef
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    Kojiro Eto, Naoya Yoshida, Shiro Iwagami, Masaaki Iwatsuki, Hideo Baba
    Annals of Gastroenterological Surgery.2020; 4(6): 652.     CrossRef
  • Neuroendocrine Carcinoma of Duodenum—an Uncommon Tumour at an Unusual Site
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    Indian Journal of Surgical Oncology.2019; 10(1): 199.     CrossRef
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    A. V. Alekberzade, N. N. Krylov, T. N. Garmanova, R. Shahbazov, F. Azari, K. S. Zuykova, E. D. Litovchenko
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    Rongzhi Wang, Rui Zheng-Pywell, H Alexander Chen, James A Bibb, Herbert Chen, J Bart Rose
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  • 431 Download
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Diagnosis and Management of Rectal Neuroendocrine Tumors
Shreya Chablaney, Zachary A. Zator, Nikhil A. Kumta
Clin Endosc 2017;50(6):530-536.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.134
AbstractAbstract PDFPubReaderePub
The incidence of rectal neuroendocrine tumors (NETs) has increased by almost ten-fold over the past 30 years. There has been a heightened awareness of the malignant potential of rectal NETs. Fortunately, many rectal NETs are discovered at earlier stages due to colon cancer screening programs. Endoscopic ultrasound is useful in assessing both residual tumor burden after retrospective diagnosis and tumor characteristics to help guide subsequent management. Current guidelines suggest endoscopic resection of rectal NETs ≤10 mm as a safe therapeutic option given their low risk of metastasis. Although a number of endoscopic interventions exist, the best technique for resection has not been identified. Endoscopic submucosal dissection (ESD) has high complete and en-bloc resection rates, but also an increased risk of complications including perforation. In addition, ESD is only performed at tertiary centers by experienced advanced endoscopists. Endoscopic mucosal resection has been shown to have variable complete resection rates, but modifications to the technique such as the addition of band ligation have improved outcomes. Prospective studies are needed to further compare the available endoscopic interventions, and to elucidate the most appropriate course of management of rectal NETs.

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    Shun Ito, Satoshi Ono, Akihiro Kobayashi, Kyohei Maejima, Shosuke Hosaka, Kiyotaka Umeki, Shin-ichiro Sato, Satoshi Wakasugi, Kenji Ogata
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  • Incidental diagnosis of very small rectal neuroendocrine neoplasms: when should endoscopic submucosal dissection be performed? A single ENETS centre experience
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    Zhi-Jie Wang, Ke An, Rui Li, Wei Shen, Man-Dula Bao, Jin-Hua Tao, Jia-Nan Chen, Shi-Wen Mei, Hai-Yu Shen, Yun-Bin Ma, Fu-Qiang Zhao, Fang-Ze Wei, Qian Liu
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  • Management of Gastrointestinal Neuroendocrine Tumors
    Rongzhi Wang, Rui Zheng-Pywell, H Alexander Chen, James A Bibb, Herbert Chen, J Bart Rose
    Clinical Medicine Insights: Endocrinology and Diabetes.2019; 12: 117955141988405.     CrossRef
  • Proper Treatment Option for Small Rectal Neuroendocrine Tumors Using Precut Endoscopic Mucosal Resection
    Seun Ja Park
    Clinical Endoscopy.2017; 50(6): 516.     CrossRef
  • 10,315 View
  • 385 Download
  • 36 Web of Science
  • 34 Crossref
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Diagnosis of Pancreatic Neuroendocrine Tumors
Dong Wook Lee, Michelle Kang Kim, Ho Gak Kim
Clin Endosc 2017;50(6):537-545.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.131
AbstractAbstract PDFPubReaderePub
Pancreatic neuroendocrine tumors (PNETs) are relatively rare; however, the incidence has increased over the last few decades. They are classified as functional or non-functional tumors according to the presence of associated clinical symptoms. The majority are non-functional tumors. For classification and staging, the World Health Organization 2010 classification system is the most commonly accepted. Chromogranin A is the most sensitive marker but has insufficient specificity. In general, PNETs are hypervascular tumors, and multiphasic contrast-enhanced computed tomography is considered the first choice for imaging study. Multiphasic magnetic resonance imaging can detect PNETs smaller than 2 cm and small liver metastasis compared with other modalities. Somatostatin receptor scintigraphy is often used in cases where functional PNETs are suspected. Positron emission tomography (PET) scan with 18F-fluorodeoxyglucose cannot visualize PNETs, but PET with 68-Ga DOTATATE can. Endoscopic ultrasonography can characterize smaller PNETs using contrast and confirm histology through fine needle aspiration or biopsy. In this article, we review the characteristics of grading systems and diagnostic modalities commonly used for PNETs.

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Therapy of Pancreatic Neuroendocrine Tumors: Fine Needle Intervention including Ethanol and Radiofrequency Ablation
Sundeep Lakhtakia
Clin Endosc 2017;50(6):546-551.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.167
AbstractAbstract PDFPubReaderePub
Pancreatic neuroendocrine tumors (PNETs) are increasingly being detected, though usually as incidental findings. Majority of the PNETs are non-functional and surgical resection is the standard of care for most of them. However, in patients with small PNETs localized within the pancreas, who are unfit or unwilling for surgery, alternate methods of treatment are needed. Direct methods of ablation of PNETs, using either ethanol injection or radiofrequency ablation (RFA), are emerging as effective methods. The limited literature available as case reports or case series on endoscopic ultrasound (EUS)-guided local ablation using either ethanol or RFA has demonstrated safety and efficacy along with short- to medium-term sustained relief. Long-term benefits with these local ablative therapies are awaited. Comparative studies are needed to show which of these two competing technologies is superior. Finally, comparative trials of EUS-guided ablation with surgical resection in terms of efficacy and safety will ensure their place in the management algorithm.

Citations

Citations to this article as recorded by  
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    Xavier M. Keutgen, Kimberly J. Ornell, Alyx Vogle, Olga Lakiza, Jelani Williams, Paul Miller, Katelyn S. Mistretta, Namrata Setia, Ralph R. Weichselbaum, Jeannine M. Coburn
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    Kazuyuki Matsumoto, Hironari Kato, Masayuki Kitano, Kazuo Hara, Masaki Kuwatani, Reiko Ashida, Mamoru Takenaka, Tatsuhiro Yamazaki, Jun Sakurai, Michihiro Yoshida, Hiroyuki Okada
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    Marc Barthet, Marc Giovannini, Mohamed Gasmi, Nathalie Lesavre, Christian Boustière, Bertrand Napoleon, Arthur LaQuiere, Stephane Koch, Geoffroy Vanbiervliet, Jean-Michel Gonzalez
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    Ghassan El Sayed, Levente Frim, Jamie Franklin, Raymond McCrudden, Charles Gordon, Safa Al-Shamma, Szabolcs Kiss, Péter Hegyi, Bálint Erőss, Péter Jenő Hegyi
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    Hsiang‐Hung Lin, Chen‐Wang Chang, Ming‐Jen Chen
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    Mihai Rimbaş, Mihaela Horumbă, Gianenrico Rizzatti, Stefano Francesco Crinò, Antonio Gasbarrini, Guido Costamagna, Alberto Larghi
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Reviews
Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity
Deepanshu Jain, Bharat Singh Bhandari, Ankit Arora, Shashideep Singhal
Clin Endosc 2017;50(6):552-561.   Published online June 13, 2017
DOI: https://doi.org/10.5946/ce.2017.032
AbstractAbstract PDFPubReaderePub
Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant (p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.

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    Bharti Shetye, Franchell Richard Hamilton, Harold Edward Bays
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    João de Siqueira Neto, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sérgio Alexandre Barrichello, Kelly E Harthorn, Christopher C Thompson
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    Steven A. Edmundowicz, Christopher C. Thompson
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    Sérgio Barrichello, Diogo Turiani Hourneaux de Moura, Eduardo Guimaraes Hourneaux de Moura, Pichamol Jirapinyo, Anna Carolina Hoff, Ricardo José Fittipaldi-Fernandez, Giorgio Baretta, João Henrique Felício Lima, Eduardo N. Usuy, Leonardo Salles de Almeida
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    Sam Alhayo, Michael Devadas
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    Antonio Coutinho Madruga-Neto, Wanderley Marques Bernardo, Diogo Turiani Hourneaux de Moura, Vitor Ottoboni Brunaldi, Rafael Krieger Martins, Iatagan Rocha Josino, Eduardo Turiani Hourneaux de Moura, Thiago Ferreira de Souza, Marco Aurélio Santo, Eduardo
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    Brian Johnson, Marc D. Basson
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  • 368 Download
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Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection
Hiroya Mizutani, Satoshi Ono, Daisuke Ohki, Chihiro Takeuchi, Seiichi Yakabi, Yosuke Kataoka, Itaru Saito, Yoshiki Sakaguchi, Chihiro Minatsuki, Yosuke Tsuji, Keiko Niimi, Shinya Kodashima, Nobutake Yamamichi, Mitsuhiro Fujishiro, Kazuhiko Koike
Clin Endosc 2017;50(6):562-568.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.108
AbstractAbstract PDFPubReaderePub
Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world.

Citations

Citations to this article as recorded by  
  • Conventional Versus Traction Endoscopic Submucosal Dissection for Colorectal Tumors
    Sahib Singh, Babu P. Mohan, Saurabh Chandan, Neil Sharma, Rakesh Vinayek, Sudhir Dutta, Sergey V. Kantsevoy, Michelle Le, Douglas G. Adler
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Original Articles
Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis
Chang Seok Bang, Jae Myung Park, Gwang Ho Baik, Jong Jae Park, Moon Kyung Joo, Jae Young Jang, Seong Woo Jeon, Suck Chei Choi, Jae Kyu Sung, Kwang Bum Cho
Clin Endosc 2017;50(6):569-577.   Published online July 25, 2017
DOI: https://doi.org/10.5946/ce.2017.017
AbstractAbstract PDFPubReaderePub
Background
/Aims: To assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology.
Methods
Cases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed.
Results
From 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years).
Conclusions
ER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.

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Risk Factors for the Presence of Symptoms in Peptic Ulcer Disease
Sang Pyo Lee, In-Kyung Sung, Jeong Hwan Kim, Sun-Young Lee, Hyung Seok Park, Chan Sup Shim
Clin Endosc 2017;50(6):578-584.   Published online December 23, 2016
DOI: https://doi.org/10.5946/ce.2016.129
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Peptic ulcer disease (PUD) is a common condition, but is difficult to detect in asymptomatic individuals. We aimed to investigate the prevalence of symptomatic and asymptomatic PUD during screening endoscopy and to identify risk factors for the presence of symptoms in patients with PUD.
Methods
We investigated subjects who underwent a health inspection, including endoscopy of the upper gastrointestinal (GI) tract and a serum anti-Helicobacter pylori IgG assay, and who completed a self-report questionnaire about their symptoms.
Results
Of the 12,852 subjects included in the study, 124 (1.0%) had symptomatic PUD and 309 (2.4%) had asymptomatic PUD. Old age, current smoking, and H. pylori infection were independent risk factors for symptomatic and asymptomatic PUD. Use of non-steroidal anti-inflammatory drugs (NSAIDs) was an independent risk factor only for symptomatic PUD (p=0.040). Compared to subjects with asymptomatic PUD, subjects with symptomatic PUD were more likely to have active-stage ulcers (p=0.002) and to drink more heavily (p=0.005).
Conclusions
Use of NSAIDs is a risk factor for symptomatic PUD, but not for asymptomatic PUD. Excessive alcohol consumption and active-stage ulcers in patients with PUD are related to the presence of gastroduodenal symptoms.

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Efficacy of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors
Hoonsub So, Su Hyun Yoo, Seungbong Han, Gwang-un Kim, Myeongsook Seo, Sung Wook Hwang, Dong-Hoon Yang, Jeong-Sik Byeon
Clin Endosc 2017;50(6):585-591.   Published online October 12, 2017
DOI: https://doi.org/10.5946/ce.2017.039
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic resection is the first-line treatment for rectal neuroendocrine tumors (NETs) measuring <1 cm and those between 1 and 2 cm in size. However, conventional endoscopic resection cannot achieve complete resection in all cases. We aimed to analyze clinical outcomes of precut endoscopic mucosal resection (EMR-P) used for the management of rectal NET.
Methods
EMR-P was used to treat rectal NET in 72 patients at a single tertiary center between 2011 and 2015. Both, circumferential precutting and EMR were performed with the same snare device in all patients. Demographics, procedural details, and histopathological features were reviewed for all cases.
Results
Mean size of the tumor measured endoscopically was 6.8±2.8 mm. En bloc and complete resection was achieved in 71 (98.6%) and 67 patients (93.1%), respectively. The mean time required for resection was 9.0±5.6 min. Immediate and delayed bleeding developed in six (8.3%) and 4 patients (5.6%), respectively. Immediate bleeding observed during EMR-P was associated with the risk of delayed bleeding.
Conclusions
Both, the en bloc and complete resection rates of EMR-P in the treatment of rectal NETs using the same snare for precutting and EMR were noted to be high. The procedure was short and safe. EMR-P may be a good treatment choice for the management of rectal NETs.

Citations

Citations to this article as recorded by  
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    Giuseppe Iabichino, Milena Di Leo, Monica Arena, Giovanni Giuseppe Rubis Passoni, Elisabetta Morandi, Francesca Turpini, Paolo Viaggi, Carmelo Luigiano, Luca De Luca
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Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study
Ruchir Patel, Meghraj Ingle, Dhaval Choksi, Prateik Poddar, Vikas Pandey, Prabha Sawant
Clin Endosc 2017;50(6):592-597.   Published online August 9, 2017
DOI: https://doi.org/10.5946/ce.2017.010
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US).
Methods
All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP.
Results
We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach.
Conclusions
EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.

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    Lázaro Antonio Arango Molano, Andrés Sánchez Gil, Claudia Patricia Diaz Tovar, Andrés Valencia Uribe, Christian Germán Ospina Pérez, Pedro Eduardo Cuervo Pico, Rodrigo Alberto Jiménez Gómez
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Case Reports
Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation
Edris Wedi, Mohamed Bounnah, Riccardo Memeo, Carlo Jung
Clin Endosc 2017;50(6):598-601.   Published online June 1, 2017
DOI: https://doi.org/10.5946/ce.2017.024
AbstractAbstract PDFPubReaderePub
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.
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Gastric Perforation Caused by an Intragastric Balloon: Endoscopic Findings
In Kyung Yoo, Hoon Jai Chun, Yoon Tae Jeen
Clin Endosc 2017;50(6):602-604.   Published online May 18, 2017
DOI: https://doi.org/10.5946/ce.2017.015
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Intragastric balloon (IGB) insertion has been most frequently used in the West as an effective endoscopic treatment for morbid obesity, in practice. Recently, there is a growing number of cases requiring IGB deployment for obesity treatment in Korea. One of the reported complications of IGB use is gastric perforation. A 47-year-old woman was admitted to the hospital with mild symptoms, 7 weeks after having an IGB placed. Esophagogastroduodenoscopy was performed and gastric ulcer perforation was observed in the ulcer base, where food particles were impacted. Laparoscopic primary repair was done successfully. This was a case of gastric perforation, secondary to poor compliance with a proton-pump inhibitor (PPI). PPI and Helicobacter pylori eradication are important for ulcer prevention following IGB deployment.

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    Francesca Iacobellis, Giuseppina Dell’Aversano Orabona, Antonio Brillantino, Marco Di Serafino, Alessandro Rengo, Paola Crivelli, Luigia Romano, Mariano Scaglione
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  • 6,576 View
  • 173 Download
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Endoscopic Treatment of Jejunal Heterotopic Gastric Mucosa that Caused Recurrent Intussusception
Ke Ryun Ahn, Ja Seol Koo, Hwan Il Kim, Ji Hye Kim, Jee Hyun Lee, Seung Young Kim, Sung Woo Jung, Sang Woo Lee
Clin Endosc 2017;50(6):605-608.   Published online October 18, 2017
DOI: https://doi.org/10.5946/ce.2017.026
AbstractAbstract PDFPubReaderePub
Heterotopic gastric mucosa (HGM) is a rare anomaly in the small bowel and may be the cause of intussusception when it gets a lead point in the jejunum. All cases of intussusception due to intestinal HGM have been treated with surgical resection. A 5-year-old girl presented with chief complaints of vomiting and abdominal pain for 2 weeks. A computed tomography scan of the abdomen showed intussusception at the proximal jejunal loops. Three air reductions and one saline reduction were attempted without success. She continued to be symptomatic, and endoscopic evaluation was performed. Enteroscopy revealed some variable-sized polypoid mucosal lesions with erosions on the proximal jejunum. Endoscopic mucosal resection was performed using a snare. The resected tissues histologically showed a hyperplastic polyp arising from the HGM. Her symptoms did not recur within 1 year after the treatment. Our case showed that enteroscopy could be useful for the diagnosis and management of jejunal intussusception caused by HGM.

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    Siri A. Urquhart, Nayantara Coelho-Prabhu
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  • Heterotopic Gastric Mucosa Presenting as Lower Gastrointestinal Bleeding: An Unusual Case Report
    Syed Muhammad Ali, Ayman Abdelhafiz Ahmed, Leena Amin Hussain Saaid, Gihan Mustafa Kamal Mohamed, Amjad Ali Shah, Mohannad Al-Tarakji, Zia Aftab, Inamulla, Sameera Rashid
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Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding
Doo Hyun Ko, Tae Hyung Kim, Jong Wook Kim, Ja Joong Gu, Baek Hyun Yoon, Ji Hong Oh, Seung Goun Hong
Clin Endosc 2017;50(6):609-613.   Published online August 9, 2017
DOI: https://doi.org/10.5946/ce.2017.021
AbstractAbstract PDFPubReaderePub
Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.

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Brief Report
Including the Sheath Rinse to Improve Cellular Yield in Biliary Brushing Cytology
Glenda F. Amog-Jones, Subhash Chandra, Chris Jensen, Frederick C. Johlin
Clin Endosc 2017;50(6):614-616.   Published online November 30, 2017
DOI: https://doi.org/10.5946/ce.2017.113
PDFPubReaderePub

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Letter to the editor
False Reassurance Based on Non-Significant Results
Douglas G. Altman
Clin Endosc 2017;50(6):617-617.   Published online August 18, 2017
DOI: https://doi.org/10.5946/ce.2017.091
PDFPubReaderePub
  • 4,049 View
  • 133 Download
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