Clinical Endoscopy

Volume 51(1); January 2018

Commentarys

Is Percutaneous Endoscopic Gastrostomy Acceptable in Centenarian Patients?: Cheol Min Shin, Dong Ho Lee; Clin Endosc 2018;51(1):1-2. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.018

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Balloon-Assisted Endoscopy: A Powerful Tool for Complete Colonoscopy: Kyung Hwan Song, Beom Jae Lee; Clin Endosc 2018;51(1):3-4. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.027

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Use of a novel endoscopic overtube with bilateral tool channels for endoscopic resection of experimental lesions and repair of intestinal defects in the right colon: preclinical trial
Shinya Urakawa, Teijiro Hirashita, Yuka Hirashita, Kentaro Matsuo, Lea Lowenfeld, Jeffrey W. Milsom
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Use of an endoscopic flexible grasper as a traction tool for excision of polyps: preclinical trial
Shinya Urakawa, Teijiro Hirashita, Yuka Hirashita, Lea Lowenfeld, Krishna C. Gurram, Makoto Nishimura, Jeffrey W. Milsom
Scientific Reports.2021;[Epub] CrossRef

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Can Contrast-Enhanced Harmonic Endoscopic Ultrasonography Differentiate Malignancy from Benign Disease?: Tae Hoon Lee; Clin Endosc 2018;51(1):5-7. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.016

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Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: a systematic review and meta-analysis
Yong-tao Yang, Neng Shen, Fei Ao, Wei-qing Chen
Surgical Endoscopy.2020; 34(9): 3754. CrossRef
Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplasms
Yousuke Nakai, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Kazuhiko Koike
Clinical Endoscopy.2019; 52(6): 527. CrossRef

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Focused Review Series: The New Eras of Therapeutic Endoscopy - Endoscopic Submucosal Surgery

Introduction to Endoscopic Submucosal Surgery: Weon Jin Ko, Joo Young Cho; Clin Endosc 2018;51(1):8-12. Published online January 23, 2018; DOI: https://doi.org/10.5946/ce.2017.154

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The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.

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Design and validation of performance-oriented injectable chitosan thermosensitive hydrogels for endoscopic submucosal dissection
Jia Liu, Panxianzhi Ni, Yi Wang, Zhengkui Zhou, Junlin Li, Tianxu Chen, Tun Yuan, Jie Liang, Yujiang Fan, Jing Shan, Xiaobin Sun, Xingdong Zhang
Biomaterials Advances.2023; 146: 213286. CrossRef
Comparison of peroral endoscopic myotomy between de-novo achalasia and achalasia with prior treatment
Abdullah Ozgur Yeniova, In kyung Yoo, Eunju Jeong, Joo Young Cho
Surgical Endoscopy.2021; 35(1): 200. CrossRef
Tunnel endoscopic interventions in esophageal diseases
E. A. Drobyazgin, Yu. V. Chikinev, D. A. Arkhipov, N. I. Mit’ko, M. N. Chekanov, E. I. Vereshchagin, I. V. Peshkova, A. S. Polyakevich
Experimental and Clinical Gastroenterology.2021; 1(6): 75. CrossRef

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Current Status of Peroral Endoscopic Myotomy: Young Kwan Cho, Seong Hwan Kim; Clin Endosc 2018;51(1):13-18. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2017.165

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Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

Citations

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Quality of Life of Patients with Achalasia After Minimally Invasive Interventions
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Colorectal Endoscopic Submucosal Dissection: Performance of a Novel Hybrid-Technology Knife in an Animal Trial
Jérémie Jacques, Horst Neuhaus, Markus D. Enderle, Ulrich Biber, Walter Linzenbold, Martin Schenk, Kareem Khalaf, Alessandro Repici
Diagnostics.2023; 13(21): 3347. CrossRef
Outcomes of Per-Oral Endoscopic Myotomy in the Treatment of Esophageal Achalasia: Over One Hundred Cases in a Single Tertiary Center
Kannikar Laohavichitra, Jerasak Wannaprasert, Thawee Raranachu-ek
Siriraj Medical Journal.2023; 75(9): 629. CrossRef
Geriatric patients with esophageal motility disorders benefit more from minimally invasive peroral endoscopic myotomy: a multicenter study in Japan
Naoto Ujiie, Hiroki Sato, Mary Raina Angeli Fujiyoshi, Shinwa Tanaka, Hironari Shiwaku, Junya Shiota, Ryo Ogawa, Hiroshi Yokomichi, Takashi Kamei, Haruhiro Inoue
Diseases of the Esophagus.2022;[Epub] CrossRef
Nonachalasic esophageal motor disorders, from diagnosis to therapy
Mentore Ribolsi, Matteo Ghisa, Edoardo Savarino
Expert Review of Gastroenterology & Hepatology.2022; 16(3): 205. CrossRef
Peroral endoscopic longer vs shorter esophageal myotomy for achalasia treatment: A systematic review and meta-analysis
Chun-Yan Weng, Cheng-Hai He, Ming-Yang Zhuang, Jing-Li Xu, Bin Lyu
World Journal of Gastrointestinal Surgery.2022; 14(3): 247. CrossRef
Features and results of minimally invasive treatment of recurrent achalasia
E.A. Gallyamov, S.A. Erin, G.Yu. Gololobov, A.I. Burmistrov, M.A. Chicherina, A.A. Rikunova
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Anesthesia for Per-oral endoscopic myotomy (POEM) – not so poetic!
Soumya Sarkar, Puneet Khanna, Deepak Gunjan
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A rare complication: Tension pneumothorax after peroral endoscopic myotomy
Seokin Kang, Yuri Kim, Do Hoon Kim
International Journal of Gastrointestinal Intervention.2022; 11(3): 139. CrossRef
Endoscopic management of mucosal incision site dehiscence following peroral endoscopic myotomy
Suryaprakash Bhandari, Darshan Parekh, Smita Bhandari
Endoscopy International Open.2022; 10(09): E1307. CrossRef
The POEM bottom-up technique for achalasia
Gad Marom, Harold Jacob, Ariel Benson, Tiberiu Hershcovici, Rachel Gefen, Jonathan B. Yuval, Ronit Brodie, Avraham I Rivkind, Yoav Mintz
Surgical Endoscopy.2021; 35(11): 6117. CrossRef
Per-oral endoscopic myotomy for esophageal diverticula with or without esophageal motility disorders
Beatrice Orlandini, Maximilien Barret, Marie-Anne Guillaumot, Chloé Léandri, Sarah Leblanc, Frédéric Prat, Stanislas Chaussade
Clinics and Research in Hepatology and Gastroenterology.2020; 44(1): 82. CrossRef
Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center
Maen Masadeh, Peter Nau, Subhash Chandra, Jagpal Klair, John Keech, Kalpaj Parekh, Rami El Abiad, Henning Gerke
Clinical Endoscopy.2020; 53(3): 321. CrossRef
Intraoperative use of a functional lumen imaging probe during peroral endoscopic myotomy in patients with achalasia: A single-institute experience and systematic review
Hyeon Jeong Goong, Su Jin Hong, Shin Hee Kim, Shawn Groth
PLOS ONE.2020; 15(6): e0234295. CrossRef
How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective
Michel Kahaleh, Amy Tyberg, Supriya Suresh, Arnon Lambroza, Monica Gaidhane, Felipe Zamarripa, Guadalupe Ma Martínez, Juan C. Carames, Eduardo T. Moura, Galileu F. Farias, Maria G. Porfilio, Jose Nieto, Mario Rey, Fernando Rodriguez Casas, Oscar V. Mondra
Endoscopy International Open.2020; 08(10): E1392. CrossRef
Endoscopic Equipment—From Simple to Advanced
Sarah Choi, Kevin El-Hayek
Surgical Clinics of North America.2020; 100(6): 993. CrossRef
Peroral Endoscopic Myotomy for Esophageal Motility Disorders
Jun Young Kim, Yang Won Min
Clinical Endoscopy.2020; 53(6): 638. CrossRef
Anesthesia for peroral endoscopic myotomy in Japan
Hiroaki Murata, Taiga Ichinomiya, Tetsuya Hara
Current Opinion in Anaesthesiology.2019; 32(4): 511. CrossRef
Anesthetic Consideration for Peroral Endoscopic Myotomy
Yun-Sic Bang, Chunghyun Park
Clinical Endoscopy.2019; 52(6): 549. CrossRef

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Endoscopic Treatment of Subepithelial Tumors: Su Young Kim, Kyoung-Oh Kim; Clin Endosc 2018;51(1):19-27. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.020

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Gastrointestinal subepithelial tumors (SETs) are generally found during endoscopy and their incidence has gradually increased. Although the indications for the endoscopic treatment of patients with SETs remain to be established, the feasibility and safety of endoscopic dissection, including the advantages of this method compared with surgical treatment, have been validated in many studies. The development of endoscopic techniques, such as endoscopic submucosal dissection, endoscopic enucleation, endoscopic excavation, endoscopic submucosal tunnel dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection has enabled the removal of SETs while reducing the occurrence of complications. Here, we discuss the endoscopic treatment of patients with SETs, outcomes for endoscopic treatment, and procedure-related complications. We also consider the advantages and disadvantages of the various endoscopic techniques.

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Chun-Yan Li, Yi-Feng Wang, Li-Kang Luo, Xiao-Jun Yang
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Paolo Cecinato, Emanuele Sinagra, Liboria Laterza, Federica Pianigiani, Giuseppe Grande, Romano Sassatelli, Giovanni Barbara
Best Practice & Research Clinical Gastroenterology.2024; 71: 101931. CrossRef
Endoscopic resection in subepithelial lesions of the upper gastrointestinal tract: Experience at a tertiary referral hospital in The Netherlands
Cynthia Verloop, Lieke Hol, Marco Bruno, Lydi Van Driel, Arjun Dave Koch
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Cold snare endoscopic resection for subepithelial tumors of the upper third of the esophagus
Xiaosan Hu, Lifeng Zhou, Jian Chen, Yunlin Yue
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An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look
Mafalda João, Inês Cunha, Elisa Gravito-Soares, Marta Gravito-Soares, Pedro Amaro, Pedro Figueiredo
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Mehmet Zeki Buldanlı, Oktay Yener
Prague Medical Report.2022; 123(1): 20. CrossRef
Natural History of Asymptomatic Esophageal Subepithelial Tumors of 30 mm or Less in Size
Seokin Kang, Do Hoon Kim, Yuri Kim, Dongsub Jeon, Hee Kyong Na, Jeong Hoon Lee, Ji Yong Ahn, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
Risk stratification in patients with upper gastrointestinal submucosal tumors undergoing submucosal tunnel endoscopic resection
Yong Lv, Shaohua Li, Xiuhe Lv, Qing Liu, Yu Zheng, Yang Su, Changbin Yang, Yanglin Pan, Liping Yao, Huahong Xie
Frontiers in Medicine.2022;[Epub] CrossRef
Endoscopic versus surgical resection in the management of gastric schwannomas
Ya-qi Zhai, Ning-li Chai, Wen-gang Zhang, Hui-kai Li, Zhong-sheng Lu, Xiu-xue Feng, Sheng-zhen Liu, En-qiang Linghu
Surgical Endoscopy.2021; 35(11): 6132. CrossRef
Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria
Ah Lon Jung, Sang Wook Park, Gun Young Hong, Hyeong Chul Moon, Seo Joon Eun
Clinical Endoscopy.2021; 54(1): 131. CrossRef
A Review of Endoscopic Full-thickness Resection, Submucosal Tunneling Endoscopic Resection, and Endoscopic Submucosal Dissection for Resection of Subepithelial Lesions
Vicky H. Bhagat, Marina Kim, Michel Kahaleh
Journal of Clinical Gastroenterology.2021; 55(4): 309. CrossRef
A modified endoscopic full thickness resection for gastric subepithelial tumors from muscularis propria layer: Novel method
Jung Min Lee, In Kyung Yoo, Sung Pyo Hong, Joo Young Cho, Young Kwan Cho
Journal of Gastroenterology and Hepatology.2021; 36(9): 2558. CrossRef
Endoscopic resection of esophageal and gastric submucosal tumors from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation: A systematic review and meta-analysis
Fernando Lopes Ponte Neto, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Fabio Catache Mancini, Mateus Bond Boghossian, Thomas R. McCarty, Nelson Tomio Miyajima, Edson Ide, Wanderley Marques Bernardo, Eduardo Guimarã
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The retrospective comparison between submucosal tunneling endoscopic resection and endoscopic submucosal excavation for managing esophageal submucosal tumors originating from the muscularis propria layer
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Shria Kumar, Vinay Chandrasekhara, Michael L Kochman, Nuzhat Ahmad, Sara Attalla, Immanuel K Ho, David L Jaffe, Peter J Lee, Kashyap V Panganamamula, Monica Saumoy, Danielle Fortuna, Gregory G Ginsberg
Diseases of the Esophagus.2020;[Epub] CrossRef
Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions
Hung Leng Kaan, Khek Yu Ho
Clinical Endoscopy.2020; 53(5): 541. CrossRef
Gestielter submuköser Tumor im Jejunum
Tanja Miltner
Der Gastroenterologe.2019; 14(6): 470. CrossRef
Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study
Sufang Tu, Silin Huang, Guohua Li, Xiaowei Tang, Haitao Qing, Qiaoping Gao, Jingwen Fu, Guoping Du, Wei Gong
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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Gastric Peroral Endoscopic Myotomy: Hyunsoo Chung, Mouen A Khashab; Clin Endosc 2018;51(1):28-32. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.001

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Gastroparesis (GP) is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach or proximal small bowel. Currently available dietary and medical therapies are limited and have suboptimal efficacy. Pylorus-directed therapies have showed promising results. Gastric peroral endoscopic myotomy (G-POEM) has been reported for the treatment of GP refractory to standard therapy with promising results. This article reviews the current applications and results of G-POEM for the treatment of refractory GP.

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Complications related to third space endoscopic procedures
Rami El Abiad, Munish Ashat, Mouen Khashab
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Prospective study on the efficacy of endoscopic through-the-scope tack and suture system for gastric peroral endoscopic myotomy mucosal incision site closure
Hafiz M. Khan, Tony S. Brar, Muhammad K. Hasan, Kambiz Kadkhodayan, Mustafa A. Arain, Maham Hayat, Aimen Farooq, Gurdeep Singh, Dennis Yang
Endoscopy International Open.2023; 11(02): E187. CrossRef
Systematic review with meta‐analysis: one‐year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis
Faisal Kamal, Muhammad Ali Khan, Wade Lee‐Smith, Sachit Sharma, Ashu Acharya, Dawit Jowhar, Umer Farooq, Muhammad Aziz, Abdul Kouanda, Sun‐Chuan Dai, Colin W. Howden, Craig A. Munroe
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Gastric Peroral Endoscopic Myotomy
Mishal Reja, Avantika Mishra, Amy Tyberg, Iman Andalib, Guadalupe M. Martínez, Felipe Zamarripa, Monica Gaidhane, Jose Nieto, Michel Kahaleh
Journal of Clinical Gastroenterology.2022; 56(4): 339. CrossRef
New Applications for Submucosal Tunneling in Third Space Endoscopy
Briette Karanfilian, Michel Kahaleh
Journal of Clinical Gastroenterology.2022; 56(6): 465. CrossRef
Safety and efficacy of prophylactic gastric open peroral endoscopic myotomy for prevention of post‐ESD stenosis: A case series (with video)
Won Dong Lee, Jae Sun Song, Byung Sun Kim, Min A. Yang, Young Jae Lee, Gum Mo Jung, Ji Woong Kim, Yong Keun Cho, Jin Woong Cho
Journal of Digestive Diseases.2022; 23(4): 220. CrossRef
A New Paradigm Shift in Gastroparesis Management
Parit Mekaroonkamol, Kasenee Tiankanon, Rungsun Rerknimitr
Gut and Liver.2022; 16(6): 825. CrossRef
Endoscopic and Surgical Treatments for Gastroparesis
Roman V. Petrov, Charles T. Bakhos, Abbas E. Abbas, Zubair Malik, Henry P. Parkman
Gastroenterology Clinics of North America.2020; 49(3): 539. CrossRef
Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide
Parit Mekaroonkamol, Rushikesh Shah, Qiang Cai
World Journal of Gastroenterology.2019; 25(8): 909. CrossRef
Endoscopic techniques for myotomy of the lower esophageal sphincter and pylorus
Nasim Parsa, Mouen A. Khashab
Current Opinion in Gastroenterology.2019; 35(5): 416. CrossRef

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Endoscopic Full-Thickness Resection Combined with Laparoscopic Surgery: Chan Gyoo Kim; Clin Endosc 2018;51(1):33-36. Published online January 12, 2018; DOI: https://doi.org/10.5946/ce.2017.153

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Endoscopic full-thickness resection combined with laparoscopic surgery was recently developed. These procedures could be categorized as “Cut first and then suture” and “Suture first and then cut”. “Cut first and then suture” includes laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR). Recent studies have demonstrated the safety and efficacy of LECS and LAEFR. However, these techniques are limited by the related exposure of the tumor and gastric mucosa to the peritoneal cavity and manipulation of these organs, which could lead to viable cancer cell seeding and the spillage of gastric juice into the peritoneal cavity. In the “Suture first and then cut” technique, the serosal side of the stomach is sutured to invert the stomach and subsequently endoscopic resection is performed. In this article, details of these techniques, including their advantages and limitations, are described.

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Reviews

Colorectal Cancer Screening—Who, How, and When?: Roisin Bevan, Matthew D Rutter; Clin Endosc 2018;51(1):37-49. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2017.141

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Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant, latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screening guidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50–75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%–33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.

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Association of HLA-G 3′ Untranslated Region Indel Polymorphism and Its Serum Expression with Susceptibility to Colorectal Cancer
Garrach Behaeddin, Ben Othmen Abdelwaheb, Khamlaoui Wided, Yatouji Sonia, Toumi Iheb, Zaied Sonia, Zouari Khadija, Hammami Mohamed, Hammami Sonia
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Quality is the Key for Emerging Issues of Population-Based Colonoscopy Screening: Jin Young Yoon, Jae Myung Cha, Yoon Tae Jeen, on behalf of Medical Policy Committee of Korean Association for the Study of Intestinal Diseases (KASID), Quality Improvement Committee of Korean Society of Gastrointestinal Endoscopy (KSGE); Clin Endosc 2018;51(1):50-55. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.010

Abstract PDF PubReader ePub

Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

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Original Articles

Safety of Percutaneous Endoscopic Gastrostomy Tubes in Centenarian Patients: Zain A Sobani, Kevin Tin, Steven Guttmann, Anna A Abbasi, Ira Mayer, Yuriy Tsirlin; Clin Endosc 2018;51(1):56-60. Published online July 21, 2017; DOI: https://doi.org/10.5946/ce.2017.059

Abstract PDF PubReader ePub

Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure; however, no study has evaluated the safety of PEG tube placement in patients over the age of 100 years.
Methods
We conducted a retrospective review of patient records for patients who underwent PEG tube placement. Thirty patients aged 100 years and older were identified and a random sample of 275 patients was selected for comparison.
Results
The mean age of the patients was 80.6±16.2 years. No procedure-related deaths or major complications were identified; the overall inpatient mortality rate was 7.6%. Minor complications were noted in 4% (n=12) of the patients. Centenarian patients were predominantly female (80% [n=24] vs. 54% [n=147], p=0.006), with a mean age of 100.5±0.9 years. There was no significant difference in procedural success rates (93.3% vs. 97.4%, p=0.222) or inpatient mortality (6.7% [n=2] vs. 7.7% [n=21], p=1.000) between the two groups. However, a higher minor complication rate was noted in the older patients (13.3% [n=4] vs. 2.9% [n=8], p=0.022).
Conclusions
Success rates, major complications and inpatient mortality associated with PEG tubes in patients aged over 100 years are comparable to those observed in relatively younger patients at our center; however minor complication rates are relatively higher. These findings lead us to believe that PEG tubes may be safely attempted in carefully selected patients in this subset of the population.

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Cem Azılı, Harun Karabacak, Şener Balas, Muhammed Apaydın, Selim Tamam, Serdar Çulcu, Ahmet Oğuz Hasdemir
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Luiz Eduardo MIRANDA, Marcel Rolland Ciro da PENHA, Ana Clara Galindo MIRANDA, Diego Laurentino LIMA, Matheus Wanderly Fernandes COSTA, Alexandre de Oliveira AMORIM
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Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study: Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han; Clin Endosc 2018;51(1):61-65. Published online August 29, 2017; DOI: https://doi.org/10.5946/ce.2017.027

Abstract PDF PubReader ePub

Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.
Methods
This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.
Results
A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.
Conclusions
The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

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Double-Balloon Endoscopy after Incomplete Colonoscopy and Its Comparison with Computed Tomography Colonography: Carlijn Hermans, Dennis van der Zee, Lennard Gilissen; Clin Endosc 2018;51(1):66-71. Published online January 10, 2018; DOI: https://doi.org/10.5946/ce.2017.011

Abstract PDF PubReader ePub

Background
/Aims: Because of the national screening program for colorectal carcinoma in The Netherlands, the number of colonoscopies has increased. In case of incomplete colonoscopy, computed tomography colonography (CTC) and double-balloon colonoscopy (DBc) are alternative options. This study evaluated cecal intubation rate and pathology detection rate in the previously unexplored part of the colon, complication rate of DBc, and CTC results after incomplete colonoscopy.
Methods
Retrospective observational study in a tertiary referral hospital regarding DBc and CTC reports from cases with incomplete colonoscopy.
Results
Sixty-three DBcs were performed after incomplete colonoscopy. Cecal intubation rate was 95%. Detection rate was 58% (5% carcinoma and 3% high-grade dysplastic adenoma). CTC preceded 54% of DBcs and 62% of CTC findings were confirmed. In 16%, a biopsy was taken, and in 60%, an intervention (mostly polypectomy) was performed. One major complication (1.5%) occurred, i.e., arterial bleeding due to polypectomy necessitating right hemicolectomy. CTC (n=213) showed a possible lesion in 35%, and could be confirmed by follow-up endoscopy or surgery in 65%.
Conclusions
DBc is effective and safe for completion of colon inspection in incomplete colonoscopy. In patients with a high likelihood of pathology, DBc is preferred over CTC.

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When Experts Fail: Use of a Short Turning Radius Colonoscope Facilitates Successful Completion of Colonoscopy in Patients with Bowel Fixity
Mohit Girotra, Saurabh Sethi, Monique T. Barakat, Robert J. Huang, Shai Friedland, Uri Ladabaum, Subhas Banerjee
Digestive Diseases and Sciences.2020; 65(5): 1429. CrossRef
How I Approach Colonoscopy in Anatomically Difficult Colons
Douglas K. Rex
American Journal of Gastroenterology.2020; 115(2): 151. CrossRef
Diagnostic evaluation of a deep learning model for optical diagnosis of colorectal cancer
Dejun Zhou, Fei Tian, Xiangdong Tian, Lin Sun, Xianghui Huang, Feng Zhao, Nan Zhou, Zuoyu Chen, Qiang Zhang, Meng Yang, Yichen Yang, Xuexi Guo, Zhibin Li, Jia Liu, Jiefu Wang, Junfeng Wang, Bangmao Wang, Guoliang Zhang, Baocun Sun, Wei Zhang, Dalu Kong, K
Nature Communications.2020;[Epub] CrossRef
Performance of radiographic imaging after incomplete colonoscopy for nonmalignant causes in clinical practice
Nasim Parsa, Krishna C. Vemulapalli, Douglas K. Rex
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Computed Tomography Colonography Versus Standard Optical Colonoscopy for the Detection of Colorectal Polyp in Patients Who Faced Curative Surgery for Colorectal Cancer: A Diagnostic Performance Study
Lu He, Liang Guo, Chunhong Hu
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Balloon-Assisted Colonoscopy after Incomplete Conventional Colonoscopy—Experience from Two European Centres with A Comprehensive Review of the Literature
Robertson Alexander R, Koulaouzidis Anastasios, Yung Diana E, Fraser Christopher, Nemeth Artur, Trimble Kenneth, Toth Ervin, Plevris John N, Wurm Johansson Gabriele
Journal of Clinical Medicine.2020; 9(9): 2981. CrossRef
Balloon-Assisted Endoscopy: A Powerful Tool for Complete Colonoscopy
Kyung Hwan Song, Beom Jae Lee
Clinical Endoscopy.2018; 51(1): 3. CrossRef

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Is There a Change in Patient Preference for a Female Colonoscopist during the Last Decade in Korea?: Jung Min Lee, Eun Sun Kim, Hoon Jai Chun, In Kyung Yoo, Jae Min Lee, Seung Han Kim, Hyuk Soon Choi, Bora Keum, Yeon Seok Seo, Hong Sik Lee, Yoon Tae Jeen, Jong-Jae Park, Sang Woo Lee, Soon Ho Um, Chang Duck Kim; Clin Endosc 2018;51(1):72-79. Published online October 10, 2017; DOI: https://doi.org/10.5946/ce.2017.057

Abstract PDF PubReader ePub

Background
/Aims: Patients may feel embarrassed during colonoscopy. Our study aimed to assess changes in patient preference, over the past decade, for the sex of their colonoscopist.
Methods
Prospective studies were performed at a single health center from July to September 2008, and from July to September 2016. Subjects included colonoscopy patients (2008: 354, 2016: 304) who were asked to complete a questionnaire before colonoscopy.
Results
In 2016, 69 patients (24.9%) expressed a sex preference, compared with 46 patients (14.6%) in 2008. By 2016, female patient preference for a female colonoscopist had significantly increased to 95% (odds ratio [OR], 2.678; 95% confidence interval [CI], 1.418– 5.057; P=0.002). In multivariate analysis, patient sex (OR, 4.404; P=0.000), patient age (OR, 0.977; 95% CI, 0.961–0.992; P=0.004), and year of procedure (OR, 1.674; 95% CI, 1.028–2.752) were statistically significant factors in sex preference. Between 2008 and 2016, female patients preferred a female colonoscopist because of embarrassment. Male patients also preferred a male colonoscopist, and the primary reason shifted from expertise to patient embarrassment (2008: 29%, 2016: 63%).
Conclusions
Patients have an increased gender preference for the colonoscopist because of embarrassment. Taking this into account can increase patient satisfaction during colonoscopy.

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Screening Perspectives: The Role of Colorectal Cancer Awareness in Shaping Attitudes Toward Colonoscopy in Palestine
Mohamedraed Elshami, Maram Albandak, Mohammed Alser, Ibrahim Al-Slaibi, Mohammed Ayyad, Mohammad F. Dwikat, Shoruq A. Naji, Balqees M. Mohamad, Wejdan S. Isleem, Adela Shurrab, Bashar Yaghi, Yahya Ayyash Qabaja, Fatma K. Hamdan, Raneen R. Sweity, Remah T.
JCO Global Oncology.2024;[Epub] CrossRef
Gender of endoscopist and endoscopy staff: Patient preference
Mayank Jain
Indian Journal of Gastroenterology.2023; 42(1): 143. CrossRef
Sex/gender differences in gastrointestinal endoscopy from the perspective of patients and gastroenterologists
Nayoung Kim
Clinical Endoscopy.2023; 56(3): 268. CrossRef
Canadian Gastroenterology Career Pathway Experiences: Exploring the Gender Divide
Noor Jawaid, Monica Boctor, Jordan LoMonaco, Natasha Bollegala
Journal of the Canadian Association of Gastroenterology.2022; 5(4): 177. CrossRef
Intentions to undergo primary screening with colonoscopy under the National Cancer Screening Program in Korea
Kyeongmin Lee, Haejoo Seo, Sunho Choe, Seung-Yong Jeong, Ji Won Park, Mina Suh, Aesun Shin, Kui Son Choi, Filipe Prazeres
PLOS ONE.2021; 16(2): e0247252. CrossRef
Does provider gender matter in endoscopy? An international perspective
Pascale Anglade, Halah Ibrahim, Sawsan Abdel-Razig
Gastrointestinal Endoscopy.2021; 93(5): 1160. CrossRef
Identifying Gender Barriers for Colorectal Cancer Screening and Assessing the Need for a Multigender Endoscopy Team: A Prospective Multicenter Study
Harshit S. Khara, Darshan Suthar, Marika Bergenstock, Andrea Berger, Jessica L. McKee, Dana Stewart, Samuel R. Theis, Michael Komar, Amitpal S. Johal, Diego R. Valencia Chavez, William B. Hale, Rakhee Mangla
American Journal of Gastroenterology.2021; 116(8): 1646. CrossRef
Unique perspective of Muslim patients on gender preference for GI endoscopists: a multicenter survey
Lubna Kamani, Nazish Butt, Farheen Taufiq, Ana Garcia de Paredes, Elizabeth Rajan
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Gut and Liver.2019; 13(6): 649. CrossRef

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Clinical Value of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Pancreatic and Gallbladder Masses: Galam Leem, Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Si Young Song, Jae Bock Chung, Seung Woo Park; Clin Endosc 2018;51(1):80-88. Published online September 20, 2017; DOI: https://doi.org/10.5946/ce.2017.044

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Recent studies have revealed that contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) is beneficial in the differential diagnosis of malignant neoplasms of the pancreas and gallbladder from benign masses, in terms of the evaluation of microvasculature and real-time perfusion. In this study, we aimed to prove the clinical value of CEH-EUS in the differential diagnosis of pancreatic and gallbladder masses by direct comparison with that of conventional EUS.
Methods
We reviewed the sonographic images and medical information of 471 patients who underwent conventional EUS and CEH-EUS for the diagnosis of pancreatic and gallbladder masses at a single medical center (Severance Hospital, Seoul, Korea) between March 2010 and March 2016.
Results
The enhancement pattern of CEH-EUS of the pancreatic solid masses showed higher sensitivity and specificity in differentiating pancreatic adenocarcinoma and neuroendocrine tumors (82.0% and 87.9% for pancreatic adenocarcinoma and 81.1% and 90.9% for neuroendocrine tumors, respectively), and the area under the receiver operating characteristic curves was higher than that of conventional EUS. The enhancement texture of CEH-EUS of the gallbladder masses showed a higher sensitivity in differentiating malignant masses than that of conventional EUS; however, the difference between the areas under the receiver operating characteristic curves was not statistically significant.
Conclusions
CEH-EUS can complement conventional EUS in the diagnosis of pancreatic and gallbladder masses, in terms of the limitations of the latter.

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Case Reports

Ménétrier’s Disease as a Gastrointestinal Manifestation of Active Cytomegalovirus Infection in a 22-Month-Old Boy: A Case Report with a Review of the Literature of Korean Pediatric Cases: Jeana Hong, Seungkoo Lee, Yoonjung Shon; Clin Endosc 2018;51(1):89-94. Published online June 13, 2017; DOI: https://doi.org/10.5946/ce.2017.038

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Ménétrier’s disease (MD), which is characterized by hypertrophic gastric folds and foveolar cell hyperplasia, is the most common gastrointestinal (GI) cause of protein-losing enteropathy (PLE). The clinical course of MD in childhood differs from that in adults and has often been reported to be associated with cytomegalovirus (CMV) infection. We present a case of a previously healthy 22-month-old boy presenting with PLE, who was initially suspected to have an eosinophilic GI disorder (EGID). However, he was eventually confirmed, by detection of CMV DNA using polymerase chain reaction (PCR) with gastric tissue, to have MD associated with an active CMV infection. We suggest that endoscopic and pathological evaluation is necessary for the differential diagnosis of MD. In addition, CMV DNA detection using PCR analysis of biopsy tissue is recommended to confirm the etiologic agent of MD regardless of the patient’s age or immune status.

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Clinical Manifestation of Cytomegalovirus-Associated Protein-Losing Enteropathy in Children
Claire Ferrua, Anais Lemoine, Alexis Mosca, Anne-Aurélie Lopes
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Sofia Rao, Anna Viola, Omar Ksissa, Walter Fries
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Gastric Adenocarcinoma with Systemic Metastasis Involving the Intraocular Choroid and Duodenum: Soon Young Kim, Kee-Taek Jang, Jun Haeng Lee; Clin Endosc 2018;51(1):95-98. Published online May 22, 2017; DOI: https://doi.org/10.5946/ce.2017.049

Abstract PDF PubReader ePub

Gastric cancer with double metastasis to the orbit and duodenum is extremely rare. We report the case of a patient with gastric adenocarcinoma who presented with synchronous orbital and duodenal metastases at the time of initial diagnosis. A 60-year-old man presented with a 1-month history of visual disorder and pain in his right eye. He underwent ophthalmological examinations. The biopsy results suggested intraocular metastatic carcinoma. We conducted a systemic evaluation to identify primary malignancy. Finally, a diagnosis of advanced gastric adenocarcinoma with multi-organ metastasis was made. He planned to be treated with systemic chemotherapy.

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Management of Percutaneous Endoscopic Gastrostomy Site Gastric Ulcer in a Patient with an Esophageal Stricture and Hiatus Hernia: Clement C H Wu, James W Li, Keng Sin Ng, Daphne S Ang; Clin Endosc 2018;51(1):99-102. Published online May 22, 2017; DOI: https://doi.org/10.5946/ce.2017.035

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Percutaneous endoscopic gastrostomy (PEG) is commonly performed for feeding difficulties, in patients suffering from complications of nasopharyngeal carcinoma (NPC) and its treatment, namely radiotherapy and surgery. This case report describes the challenges in hemostasis and subsequent re-establishment of enteral access for feeding, in an elderly patient with a history of NPC, treated surgically, followed by radiotherapy, who presented with massive hematemesis following reinsertion of her PEG shortly after an accidental dislodgement. Her previous nasopharyngectomy, wide field radiation therapy, and radical neck dissection precluded nasogastric tube (NGT) feeding, and the presence of a large hiatus hernia made reinsertion of a new PEG technically challenging. This case highlights the methods used to overcome the above challenges.

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Epicardial access complications during electrophysiology procedures
Jorge Romero, Kavisha Patel, Dhanunjaya Lakkireddy, Isabella Alviz, Alejandro Velasco, Daniel Rodriguez, Joseph Karpenos, Xiao‐Dong Zhang, Andrea Natale, Luigi Di Biase
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Full-Thickness Resection Device for Complex Colorectal Lesions in High-Risk Patients as a Last-Resort Endoscopic Treatment: Initial Clinical Experience and Review of the Current Literature: Edris Wedi, Beatrice Orlandini, Mark Gromski, Carlo Felix Maria Jung, Irina Tchoumak, Stephanie Boucher, Volker Ellenrieder, Jürgen Hochberger; Clin Endosc 2018;51(1):103-108. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2017.093

Abstract PDF PubReader ePub

The full-thickness resection device (FTRD) is a novel endoscopic device approved for the resection of colorectal lesions. This case-series describes the device and its use in high-risk patients with colorectal lesions and provides an overview of the potential indications in recently published data.
Between December 2014 and September 2015, 3 patients underwent endoscopic full thickness resection using the FTRD for colorectal lesions: 1 case for a T1 adenocarcinoma in the region of a surgical anastomosis after recto-sigmoidectomy, 1 case for a non-lifting colonic adenoma with low-grade dysplasia in an 89-year old patient and 1 for a recurrent adenoma with high-grade dysplasia in a young patient with ulcerative rectocolitis who was under immunosuppression after renal transplantation. Both technical and clinical success rates were achieved in all cases. The size of removed lesions ranged from 9 to 30 mm.
Overall, the most frequent indication in the literature has been for lifting or non-lifting adenoma, submucosal tumors, neuroendocrin tumors, incomplete endoscopic resection (R1) or T1 carcinoma.
Colorectal FTRD is a feasible technique for the treatment of colorectal lesions and represents a minimally invasive alternative for either surgical or conventional endoscopic resection strategies.

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Ensayo clínico multicéntrico para la resección de pólipos rectales mediante un nuevo dispositivo de acceso transanal híbrido laparoendoscópico
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Brief Report

White Bile in Malignant Biliary Obstruction: A Poor Prognostic Marker: Anas Gremida, Tarun Rustagi; Clin Endosc 2018;51(1):109-110. Published online October 16, 2017; DOI: https://doi.org/10.5946/ce.2017.111

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