Clinical Endoscopy

Anesthesia for Advanced Endoscopic Procedures: Basavana Goudra, Monica Saumoy; Clin Endosc 2022;55(1):1-7. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.236

The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review.

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Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
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Optimizing perioperative anesthesia strategies for safety and high-quality during painless gastrointestinal endoscopy diagnosis and treatment
Le Xu, Yanhong Li, Hong Zheng, Rurong Wang
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Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Case of Concomitant Endoscopic Treatment of Achalasia with Superficial Esophageal Cancer
Myung-Hun Lee, Kyoungwon Jung, Jae Hyun Kim, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
The Korean Journal of Gastroenterology.2023; 82(5): 248. CrossRef

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When to Discharge a Patient After Endoscopy: A Narrative Review: Swapnil Sahebrao Walke, Shamshersingh Chauhan, Vikas Pandey, Rahul Jadhav, Vipul Chaudhari, Deepti Vishwanathan, Kailash Kolhe, Meghraj Ingle; Clin Endosc 2022;55(1):8-14. Published online January 27, 2022; DOI: https://doi.org/10.5946/ce.2021.110

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Video endoscopy is an important modality for the diagnosis and treatment of various gastrointestinal diseases. Most endoscopic procedures are performed as outpatient basis, sometimes requiring sedation and deeper levels of anesthesia. Moreover, advances in endoscopic techniques have allowed invasion into the third space and the performance of technically difficult procedures that require the utmost precision. Hence, formulating strategies for the discharge of patients requiring endoscopy is clinically and legally challenging. In this review, we have discussed the various criteria and scores for the discharge of patients who have undergone endoscopic procedures with and without anesthesia.

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Strukturelle, prozedurale und personelle Voraussetzungen für eine sektorenübergreifende Erbringung endoskopischer gastroenterologischer Leistungen
Ludger Leifeld, Ulrike Denzer, Thomas Frieling, Ralf Jakobs, Siegbert Faiss, Henrike Lenzen, Petra Lynen, Julia Mayerle, Johann Ockenga, Ulrich Tappe, Birgit Terjung, Heiner Wedemeyer, Jörg Albert
Zeitschrift für Gastroenterologie.2023; 61(07): 799. CrossRef
Promoting Research that Supports High-Quality Gastrointestinal Endoscopy in Children
Lisa B. Mahoney, Catharine M. Walsh, Jenifer R. Lightdale
Current Gastroenterology Reports.2023; 25(11): 333. CrossRef

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Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors: Tetsuya Suwa, Kohei Takizawa, Noboru Kawata, Masao Yoshida, Yohei Yabuuchi, Yoichi Yamamoto, Hiroyuki Ono; Clin Endosc 2022;55(1):15-21. Published online September 29, 2021; DOI: https://doi.org/10.5946/ce.2021.141

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Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.

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International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef
Underwater Endoscopic Mucosal Resection Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors ≤20 mm
Zhikun Yin, Ji Li, Weilin Yang, Weifeng Huang, Dong Xu, Xiaoyi Lei, Jinyan Zhang
Journal of Clinical Gastroenterology.2023; 57(9): 928. CrossRef
Long-term outcomes of endoscopic resection for duodenal neuroendocrine tumors
Kiyoun Yi, Gwang Ha Kim, Su Jin Kim, Cheol Woong Choi, Moon Won Lee, Bong Eun Lee, Geun Am Song
Scientific Reports.2023;[Epub] CrossRef
Endoscopic management of NADTs
Enrique Pérez-Cuadrado-Robles, Pierre H. Deprez
Endoscopy International Open.2022; 10(06): E733. CrossRef
Duodenaladenome und -karzinome: chirurgische Therapiekonzepte
Michael Ghadimi, Jochen Gaedcke
Allgemein- und Viszeralchirurgie up2date.2022; 16(03): 257. CrossRef
Issues and Prospects of Current Endoscopic Treatment Strategy for Superficial Non-Ampullary Duodenal Epithelial Tumors
Tetsuya Suwa, Masao Yoshida, Hiroyuki Ono
Current Oncology.2022; 29(10): 6816. CrossRef
Duodenaladenome und -karzinome: chirurgische Therapiekonzepte
Michael Ghadimi, Jochen Gaedcke
Onkologie up2date.2022; 4(04): 325. CrossRef

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Radiation Proctitis and Management Strategies: Dushyant Singh Dahiya, Asim Kichloo, Faiz Tuma, Michael Albosta, Farah Wani; Clin Endosc 2022;55(1):22-32. Published online November 18, 2021; DOI: https://doi.org/10.5946/ce.2020.288

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Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.

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Daiana A. Balaeva, Denis S. Romanov, Oxana P. Trofimova, Zarina Z. Gadzhibabaeva, Yury Yu. Gorchak, Garia A. Gariaev
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Jinsheng Gao, Yousong Li, Jiaohua Chen, Wen Feng, Jianchen Bu, Zixuan Lu, Jiandong Wang
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Dandan Gao, Heng Zhang, Wanjun Sun, Huaqing Wang, Hui Wang
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António Moreira Monteiro, Diogo Alpuim Costa, Virgínia Mareco, Carla Espiney Amaro
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Qiulian Li, Guangjie Liao
Annals of Oncology Research and Therapy.2022; 2(1): 10. CrossRef

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Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis: Shivanand Bomman, Munish Ashat, Navroop Nagra, Mahendran Jayaraj, Shruti Chandra, Richard A Kozarek, Andrew Ross, Rajesh Krishnamoorthi; Clin Endosc 2022;55(1):33-40. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.212

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Background
/Aims: Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethylene oxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review and meta-analysis was performed to assess the impact of ESRT on the contamination rates.
Methods
A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model.
Results
A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%–10.8%, inconsistency index [I²]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%, I²=94.96).
Conclusions
While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.

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Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan
Wei-Kuo Chang, Chen-Ling Peng, Yen-Wei Chen, Cheuk-Kay Sun, Chieh-Chang Chen, Tao-Chieh Liu, Yin-Yi Chu, I-Fang Tsai, Chen-Shuan Chung, Hsiao-Fen Lin, Fang-Yu Hsu, Wei-Chen Tai, Hsi-Chang Lee, Hsu-Heng Yen, E-Ming Wang, Shu-Hui Chen, Cheng-Hsin Chu, Ming-
Journal of Microbiology, Immunology and Infection.2024; 57(2): 211. CrossRef
Duodenoscopes With Disposable Elevator Caps—An Incremental Reduction in Infection Risk for Patients
Melinda Wang, Graham M. Snyder
JAMA Internal Medicine.2023; 183(3): 200. CrossRef
Transmission of oral microbiota to the biliary tract during endoscopic retrograde cholangiography
Maria Effenberger, Ramona Al-Zoairy, Ronald Gstir, Ivo Graziadei, Hubert Schwaighofer, Herbert Tilg, Heinz Zoller
BMC Gastroenterology.2023;[Epub] CrossRef
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Harishankar Gopakumar, Neil R. Sharma
Frontiers in Gastroenterology.2023;[Epub] CrossRef
Performance of single-use duodenoscopes for ERCP: a systematic review and meta-analysis
Harishankar Gopakumar, Ishaan Vohra, Neil R. Sharma, Srinivas R. Puli
iGIE.2022; 1(1): 77. CrossRef

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Endoscopic Endoluminal Vacuum Therapy or Self-Expandable Metallic Stent: Treatment Option in Anastomotic Leakage after Esophageal Surgery: Chul-Hyun Lim; Clin Endosc 2022;55(1):41-42. Published online January 27, 2022; DOI: https://doi.org/10.5946/ce.2022.011

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Is General Anesthesia Needed in Endoscopic Submucosal Dissection for Lesions Located in the Mid to Upper Stomach?: Prasit Mahawongkajit, Jirawat Swangsri; Clin Endosc 2022;55(1):43-44. Published online November 18, 2021; DOI: https://doi.org/10.5946/ce.2021.247

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Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps: Naoki Muguruma, Tetsuji Takayama; Clin Endosc 2022;55(1):45-46. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.266

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Value of Endoscopic Ultrasonography in Evaluating Unexplained Isolated Common Bile Duct Dilation on Imaging: Seifeldin Hakim, Amrita Sethi; Clin Endosc 2022;55(1):47-48. Published online January 27, 2022; DOI: https://doi.org/10.5946/ce.2022.029

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Impact of the COVID-19 Outbreak on Anesthesiologist Assistance for Endoscopic Procedures: Calcedonio Calcara, Camilla Ciscato, Arnaldo Amato, Emanuele Sinagra, Costanza Alvisi, Sandro Ardizzone, Andrea Anderloni, Pietro Gambitta, on behalf of the FISMAD Lombardy COVID-19 Impact on Anesthesiologist-Assisted Endoscopy Study Group; Clin Endosc 2022;55(1):49-57. Published online January 27, 2022; DOI: https://doi.org/10.5946/ce.2021.191

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Background
/Aims: The coronavirus disease 2019 (COVID-19) outbreak has modified the activities of endoscopy units worldwide. Herein, we investigated the impact of the COVID-19 outbreak on anesthesiologist assistance for endoscopic procedures in Lombardy, Italy.
Methods
A questionnaire concerning anesthesiologist assistance provided from October 26 to December 6, 2020, in comparison with the same period in 2019, was sent to endoscopic units in Lombardy.
Results
Approximately 54% (34/63) of the units responded. A reduction in the number of all endoscopies (-33.5%; 18792 in 2020 vs. 28264 in 2019) and anesthesiologist-assisted endoscopies (-15.3%; 2652 in 2020 vs. 3132 in 2019) was reported. A greater reduction in anesthesiologist assistance was observed in government community units (-29.5%) than in academic (-14%) and private community units (-4.6%). Among all units, 85% reported a reduction in anesthesiologist assistance; 65% observed a delay/cancellation of procedures; 59%, a restricted patient selection; 17%, the need to transfer some patients to other hospitals; and 32%, a related worsening of procedure quality.
Conclusion
The COVID-19 pandemic compromised the anesthesiologist assistance for endoscopic procedures in Lombardy, which worsened the procedure quality mainly in government community units. The COVID-19 “stress test” suggests a more balanced allocation of anesthesiologic resources in the future.

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COVID-19 and the Pancreas: A Narrative Review
Emanuele Sinagra, Endrit Shahini, Federica Crispino, Ina Macaione, Valentina Guarnotta, Marta Marasà, Sergio Testai, Socrate Pallio, Domenico Albano, Antonio Facciorusso, Marcello Maida
Life.2022; 12(9): 1292. CrossRef

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Endoscopic Management of Anastomotic Leakage after Esophageal Surgery: Ten Year Analysis in a Tertiary University Center: Nader El-Sourani, Sorin Miftode, Maximilian Bockhorn, Alexander Arlt, Christian Meinhardt; Clin Endosc 2022;55(1):58-66. Published online October 14, 2021; DOI: https://doi.org/10.5946/ce.2021.099

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Background
/Aims: Anastomotic leakage after esophageal surgery remains a feared complication. During the last decade, management of this complication changed from surgical revision to a more conservative and endoscopic approach. However, the treatment remains controversial as the indications for conservative, endoscopic, and surgical approaches remain non-standardized.
Methods
Between 2010 and 2020, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. The data of 28 patients diagnosed with anastomotic leak were further analyzed.
Results
Among 141 patients who underwent resection, 28 (19.9%) developed an anastomotic leak, eight (28.6%) of whom died. Thirteen patients were treated with endoluminal vacuum therapy (EVT), seven patients with self-expanding metal stents (SEMS) four patients with primary surgery, one patient with a hemoclip, and three patients were treated conservatively. EVT achieved closure in 92.3% of the patients with a large defect and no EVT-related complications. SEMS therapy was successful in clinically stable patients with small defect sizes.
Conclusions
EVT can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should be limited to clinically stable patients with a small defect size. Surgery is only warranted in patients with sepsis with graft necrosis.

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RETRACTED ARTICLE: Changes in diagnosis and management of anastomotic leakage after esophagectomy for underlying malignancy reduce postoperative mortality and improve patient outcome
Nader El-Sourani, Sorin Miftode, Achim Troja, Fadl Alfarawan, Maximilian Bockhorn
European Surgery.2023; 55(2): 77. CrossRef
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Endoscopic vacuum therapy significantly improves clinical outcomes of anastomotic leakages after 2-stage, 3-stage, and transhiatal esophagectomies
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Sang-Ho Jeong, Jin-Kwon Lee, Kyung Won Seo, Jae-Seok Min
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Endoscopic vacuum therapy versus self-expandable metal stent for treatment of anastomotic leaks < 30 mm following oncologic Ivor-Lewis esophagectomy: a matched case–control study
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Endoscopic Endoluminal Vacuum Therapy or Self-Expandable Metallic Stent: Treatment Option in Anastomotic Leakage after Esophageal Surgery
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Treating an Intractable Jejunocutaneous Fistula by Endoscopic Metallic Stent Placement: A Case Report of Successful Palliative Endoscopic Treatment in a Case Demonstrating Peritoneal Dissemination with Terminal Stage Gastric Cancer
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Internal Medicine.2022; 61(22): 3343. CrossRef
Management of intra-thoracic anastomotic leakages after esophagectomy: updated systematic review and meta-analysis of endoscopic vacuum therapy versus stenting
Pasquale Scognamiglio, Matthias Reeh, Nathaniel Melling, Marcus Kantowski, Ann-Kathrin Eichelmann, Seung-Hun Chon, Nader El-Sourani, Gerhard Schön, Alexandra Höller, Jakob R. Izbicki, Michael Tachezy
BMC Surgery.2022;[Epub] CrossRef
Risk Factors and Effect of Intrathoracic Anastomotic Leakage after Esophagectomy for Underlying Malignancy—A Ten-Year Analysis at a Tertiary University Centre
Nader El-Sourani, Sorin Miftode, Fadl Alfarawan, Achim Troja, Maximilian Bockhorn
Clinics and Practice.2022; 12(5): 782. CrossRef

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Incidence of Infection among Subjects with Helicobacter pylori Seroconversion: Young Jung Kim, Sun-Young Lee, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park; Clin Endosc 2022;55(1):67-76. Published online April 1, 2021; DOI: https://doi.org/10.5946/ce.2020.299

Abstract PDF PubReader ePub

Background
/Aims: Helicobacter pylori (H. pylori) seroconversion may occur during screening for gastric cancer. Our study aimed to assess the number of seroconverted subjects with H. pylori and their results in follow-up tests.
Methods
Data were consecutively collected on subjects who were H. pylori-seronegative and presented for gastric cancer screening. Subjects who were followed up using the same serology test and pepsinogen (PG) assays on the day of endoscopy were included in the study.
Results
During the follow-up of 57.7±21.4 months, 61 (15.0%) of 407 seronegative subjects showed seroconversion. H. pylori infection was detected in six (9.8%) of 61 seroconverted subjects. A diffuse red fundal appearance, with a significant increase in the Kyoto classification scores for gastritis, was observed in the infected subjects (p<0.001). Compared to the false-seropositive subjects, infected subjects showed higher serology titers (p<0.001) and PG II levels (p<0.001) and lower PG I/II ratios (p=0.002), in the follow-up tests.
Conclusions
Seroconversion occurred in 3.3% of seronegative subjects per year; however, only 9.8% had H. pylori infection. The majority (90.2%) of the seroconverted subjects showed false seropositivity without significant changes in the follow-up test results. The diffuse red fundal appearance could be an indicator of H. pylori infection.

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Type A, Type B, and Non-atrophic Gastritis
Sun-Young Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(2): 108. CrossRef
Endoscopic Resection for Gastric Adenocarcinoma of the Fundic Gland Type: A Case Series
Hwa Jin Lee, Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Korean Journal of Gastroenterology.2023; 81(6): 259. CrossRef
Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis
Hee Seok Moon
Journal of the Korean Medical Association.2022; 65(5): 259. CrossRef
Serum Assay Findings after Successful Helicobacter pylori Eradication
Sun-Young Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(4): 287. CrossRef
Prognosis of Seronegative Subjects with a Helicobacter pylori-infected Spouse
Jae Min Park, Sun-Young Lee, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(4): 311. CrossRef

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Clinical Outcomes and Adverse Events of Gastric Endoscopic Submucosal Dissection of the Mid to Upper Stomach under General Anesthesia and Monitored Anesthetic Care: Jong-In Chang, Tae Jun Kim, Na Young Hwang, Insuk Sohn, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim; Clin Endosc 2022;55(1):77-85. Published online July 5, 2021; DOI: https://doi.org/10.5946/ce.2021.002

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technically challenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upper stomach performed under general anesthesia (GA) or monitored anesthesia care (MAC).
Methods
Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100 patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA or MAC were analyzed.
Results
The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed high rates of en bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There were no significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logistic regression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events.
Conclusions
ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the method of anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.

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Efficacy, safety, and impact on procedural outcomes of local anesthesia in endoscopic submucosal dissection: a systematic review and meta-analysis
Hazem Abosheaishaa, Abdelmalek Abdelghany, Abdallfatah Abdallfatah, Doha Mohamed, Ammar Ayman Bahbah, Islam Mohamed, Khaled Elfert, Ahmed E. Salem, Azizullah Beran, Ahmad Madkour, Mohammad Al-Haddad
Baylor University Medical Center Proceedings.2024; : 1. CrossRef
General Anesthesia and Endoscopic Upper Gastrointestinal Tumor Resection
Seung Hyun Kim
Journal of Digestive Cancer Research.2023; 11(3): 125. CrossRef
Is General Anesthesia Needed in Endoscopic Submucosal Dissection for Lesions Located in the Mid to Upper Stomach?
Prasit Mahawongkajit, Jirawat Swangsri
Clinical Endoscopy.2022; 55(1): 43. CrossRef
Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
Eun Jeong Gong, Chang Seok Bang
Journal of the Korean Medical Association.2022; 65(5): 284. CrossRef
Paneth Cell Carcinoma of the Stomach
Jun Wan Kim, Gwang Ha Kim, Kyung Bin Kim
The Korean Journal of Gastroenterology.2022; 80(1): 34. CrossRef
Comparing Different Anesthesia Methods on Anesthetic Effect and Postoperative Pain in Patients with Early Gastric Cancer during Endoscopic Submucosal Dissection
Jie Zhang, Yanlei Chen, Zhiwu Liu, Zhihao Pan, Jinghua Pan
Journal of Oncology.2022; 2022: 1. CrossRef

3,962 View
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Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy: Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama; Clin Endosc 2022;55(1):86-94. Published online August 13, 2021; DOI: https://doi.org/10.5946/ce.2021.084

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site.
Methods
We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups.
Results
The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group.
Conclusions
Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

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Endoscopic Suturing for the Prevention and Treatment of Complications Associated with Endoscopic Mucosal Resection of Large Duodenal Adenomas: Jaeil Chung, Kelly Wang, Alexander Podboy, Srinivas Gaddam, Simon K. Lo; Clin Endosc 2022;55(1):95-100. Published online March 3, 2021; DOI: https://doi.org/10.5946/ce.2020.281

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic mucosal resection (EMR) is the primary treatment for duodenal adenomas; however, it is associated with a high risk of perforation and bleeding, especially with larger lesions. The goal of this study was to demonstrate the feasibility and safety of endoscopic suturing (ES) for the closure of mucosal defects after duodenal EMR.
Methods
Consecutive adult patients who underwent ES of large mucosal defects after EMR of large (>2 cm) duodenal adenomas were retrospectively enrolled. The OverStitch ES system was employed for closing mucosal defects after EMR. Clinical outcomes and complications, including delayed bleeding and perforation, were documented.
Results
During the study period, ES of mucosal defects was performed in seven patients in eight sessions (six for prophylaxis and two for the treatment of perforation). All ES sessions were technically successful. No early or delayed post-EMR bleeding was recorded. In addition, no clinically obvious duodenal stricture or recurrence was encountered on endoscopic follow-up evaluation, and no patients required subsequent surgical intervention.
Conclusions
ES for the prevention and treatment of duodenal perforation after EMR is technically feasible, safe, and effective. ES should be considered an option for preventing or treating perforations associated with EMR of large duodenal adenomas.

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Adaption of novel clip-closure technique for large mucosal defects after EMR of a colon laterally spreading tumor using standard hemostatic clips
Hannah Saven, Andrew Canakis, Raymond E. Kim
VideoGIE.2024; 9(1): 42. CrossRef
Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study
Jose Antonio Almario, Linda Y. Zhang, Jonathan Cohen, Gregory B. Haber, Hemchand Ramberan, Andrew C. Storm, Stuart Gordon, Jeffrey M. Adler, Heiko Pohl, Alexander Schlachterman, Anand Kumar, Shailendra Singh, Bashar Qumseya, Peter V. Draganov, Nikhil A. K
Endoscopy.2023; 55(09): 865. CrossRef
Double-scope technique to recover from hand-suturing trouble in the duodenum
Leonardo Yoshio Sato, Yoshitaka Hata, Mitsuru Esaki, Eikichi Ihara, Shiho Tajiri, Tomohiko Moriyama, Yosuke Minoda
Endoscopy.2023; 55(S 01): E1193. CrossRef
Initial multicenter experience using a novel endoscopic tack and suture system for challenging GI defect closure and stent fixation (with video)
Tala Mahmoud, Louis M. Wong Kee Song, Stavros N. Stavropoulos, Tarek H. Alansari, Hemchand Ramberan, Norio Fukami, Neil B. Marya, Prashanth Rau, Christopher Marshall, Bachir Ghandour, Michael Bejjani, Mouen A. Khashab, Gregory B. Haber, Hiroyuki Aihara, M
Gastrointestinal Endoscopy.2022; 95(2): 373. CrossRef
Endoscopic management of non-ampullary duodenal adenomas
Maxime Amoyel, Arthur Belle, Marion Dhooge, Einas Abou Ali, Rachel Hallit, Frederic Prat, Anthony Dohan, Benoit Terris, Stanislas Chaussade, Romain Coriat, Maximilien Barret
Endoscopy International Open.2022; 10(01): E96. CrossRef
Outcomes of endoscopic mucosal resection for large superficial non-ampullary duodenal adenomas
Maxime Amoyel, Arthur Belle, Marion Dhooge, Einas Abou Ali, Anna Pellat, Rachel Hallit, Benoit Terris, Frédéric Prat, Stanislas Chaussade, Romain Coriat, Maximilien Barret
Scientific Reports.2022;[Epub] CrossRef
Effectiveness and safety of endoscopic resection for duodenal gastrointestinal stromal tumors: A single center analysis
Zhen-Zhen Wang, Xiao-Dan Yan, Hai-Deng Yang, Xin-Li Mao, Yue Cai, Xin-Yu Fu, Shao-Wei Li
World Journal of Gastrointestinal Endoscopy.2022; 14(11): 684. CrossRef

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Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan: Jandos Amankulov, Dilyara Kaidarova, Zhamilya Zholdybay, Marianna Zagurovskaya, Nurlan Baltabekov, Madina Gabdullina, Akmaral Ainakulova, Dias Toleshbayev, Alexandra Panina, Elvira Satbayeva, Zhansaya Kalieva; Clin Endosc 2022;55(1):101-112. Published online July 15, 2021; DOI: https://doi.org/10.5946/ce.2021.066

Abstract PDF PubReader ePub: Background
/Aims: The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods
A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results
Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions
Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.

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Artificial Intelligence-Based Colorectal Polyp Histology Prediction by Using Narrow-Band Image-Magnifying Colonoscopy: Istvan Racz, Andras Horvath, Noemi Kranitz, Gyongyi Kiss, Henriett Regoczi, Zoltan Horvath; Clin Endosc 2022;55(1):113-121. Published online September 23, 2021; DOI: https://doi.org/10.5946/ce.2021.149

Abstract PDF PubReader ePub

Background
/Aims: We have been developing artificial intelligence based polyp histology prediction (AIPHP) method to classify Narrow Band Imaging (NBI) magnifying colonoscopy images to predict the hyperplastic or neoplastic histology of polyps. Our aim was to analyze the accuracy of AIPHP and narrow-band imaging international colorectal endoscopic (NICE) classification based histology predictions and also to compare the results of the two methods.
Methods
We studied 373 colorectal polyp samples taken by polypectomy from 279 patients. The documented NBI still images were analyzed by the AIPHP method and by the NICE classification parallel. The AIPHP software was created by machine learning method. The software measures five geometrical and color features on the endoscopic image.
Results
The accuracy of AIPHP was 86.6% (323/373) in total of polyps. We compared the AIPHP accuracy results for diminutive and non-diminutive polyps (82.1% vs. 92.2%; p=0.0032). The accuracy of the hyperplastic histology prediction was significantly better by NICE compared to AIPHP method both in the diminutive polyps (n=207) (95.2% vs. 82.1%) (p<0.001) and also in all evaluated polyps (n=373) (97.1% vs. 86.6%) (p<0.001)
Conclusions
Our artificial intelligence based polyp histology prediction software could predict histology with high accuracy only in the large size polyp subgroup.

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Colon polyps: updates in classification and management
David Dornblaser, Sigird Young, Aasma Shaukat
Current Opinion in Gastroenterology.2024; 40(1): 14. CrossRef
Employing deep learning for predicting the thermal properties of water and nano-encapsulated phase change material
Saihua Xu, Ali Basem, Hasan A Al-Asadi, Rishabh Chaturvedi, Gulrux Daminova, Yasser Fouad, Dheyaa J Jasim, Javid Alhoee
International Journal of Low-Carbon Technologies.2024; 19: 1453. CrossRef
Endoscopic Artificial Intelligence for Image Analysis in Gastrointestinal Neoplasms
Ryosuke Kikuchi, Kazuaki Okamoto, Tsuyoshi Ozawa, Junichi Shibata, Soichiro Ishihara, Tomohiro Tada
Digestion.2024; : 1. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef
Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps
Naoki Muguruma, Tetsuji Takayama
Clinical Endoscopy.2022; 55(1): 45. CrossRef
Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Ji Young Chang
Clinical Endoscopy.2022; 55(5): 699. CrossRef
Response to Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Istvan Racz, Andras Horvath, Zoltán Horvath
Clinical Endoscopy.2022; 55(5): 701. CrossRef

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Diagnostic Value of Endoscopic Ultrasonography for Common Bile Duct Dilatation without Identifiable Etiology Detected from Cross-Sectional Imaging: Nonthalee Pausawasdi, Penprapai Hongsrisuwan, Lubna Kamani, Kotchakon Maipang, Phunchai Charatcharoenwitthaya; Clin Endosc 2022;55(1):122-127. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.122

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct (CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation of unknown etiology.
Methods
Retrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017.
Results
A total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormal liver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve (AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture (BBS), was 0.98 (95% confidence interval [CI], 0.95-1.00). The AUROC of EUS for detecting malignancy, choledocholithiasis, and BBS was 0.91 (95% CI, 0.85-0.97), 1.00 (95% CI, 1.00-1.00), and 0.93 (95% CI, 0.87-0.99), respectively. Male sex, alanine aminotransferase ≥3× the upper limit of normal (ULN), alkaline phosphatase ≥3× the ULN, and intrahepatic duct dilatation were predictors for pathological obstruction, with odds ratios of 5.46 (95%CI, 1.74-17.1), 5.02 (95% CI, 1.48-17.0), 4.63 (95% CI, 1.1-19.6), and 4.03 (95% CI, 1.37-11.8), respectively.
Conclusions
EUS provides excellent diagnostic value in identifying the etiology of CBD dilatation detected by cross-sectional imaging.

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Incidental findings of gallbladder and bile ducts – Management strategies: Normal findings, anomalies, “silent gallstones” and bile duct dilatation - A World Federation of Ultrasound in Medicine and Biology (WFUMB) position paper
Christian Jenssen, Christian P. Nolsøe, Torben Lorentzen, Jae Young Lee, Nitin Chaubal, Kathleen Möller, Caroline Ewertsen, Xin Wu Cui, Edda Leonor Chaves, Alina Popescu, Yi Dong, Christoph F. Dietrich
WFUMB Ultrasound Open.2024; 2(1): 100034. CrossRef
Role of endoscopic ultrasound in the evaluation of unexplained extrahepatic bile duct dilatation
Long-Jiang Chen, Xiao-Yi Wang, Jian-Hua Dai, Zhi-Gang Tang
European Journal of Gastroenterology & Hepatology.2023; 35(1): 73. CrossRef
The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept
Claudio Giovanni De Angelis, Eleonora Dall’Amico, Maria Teresa Staiano, Marcantonio Gesualdo, Mauro Bruno, Silvia Gaia, Marco Sacco, Federica Fimiano, Anna Mauriello, Simone Dibitetto, Chiara Canalis, Rosa Claudia Stasio, Alessandro Caneglias, Federica Me
Diagnostics.2023; 13(20): 3265. CrossRef
Value of Endoscopic Ultrasonography in Evaluating Unexplained Isolated Common Bile Duct Dilation on Imaging
Seifeldin Hakim, Amrita Sethi
Clinical Endoscopy.2022; 55(1): 47. CrossRef

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Biliary Self-Expandable Metal Stent Could Be Recommended as a First Treatment Modality for Immediate Refractory Post-Endoscopic Retrograde Cholangiopancreatography Bleeding: Sun Young Moon, Jun Heo, Min Kyu Jung, Chang Min Cho; Clin Endosc 2022;55(1):128-135. Published online May 25, 2021; DOI: https://doi.org/10.5946/ce.2021.057

Abstract PDF PubReader ePub: Background
/Aims: Recent reports suggest that the biliary self-expandable metallic stent (SEMS) is highly effective for maintaining hemostasis when endoscopic hemostasis fails in endoscopic retrograde cholangiopancreatography (ERCP)-related bleeding. We compared whether temporary SEMS offers better efficacy than angioembolization for refractory immediate ERCP-related bleeding.
Methods
Patients who underwent SEMS placement or underwent angioembolization for bleeding control in refractory immediate ERCP-related bleeding were included in the retrospective analysis. We evaluated the hemostasis success rate, severity of bleeding, change in hemoglobin levels, amount of transfusion, and delay to the start of hemostasis.
Results
A total of 27 patients with SEMS and 13 patients who underwent angioembolization were enrolled. More transfusions were needed in the angioembolization group (1.0±1.4 units vs. 2.5±2.0 units; p=0.034). SEMS failure was successfully rescued by angioembolization. The partially covered SEMS (n=23, 85.1%) was generally used, and the median stent-indwelling time was 4 days. The mean delay to the start of angioembolization was 95.2±142.9 (range, 9–491) min.
Conclusions
Temporary SEMS had similar results to those of angioembolization (96.3% vs. 92.3%; p=0.588). Immediate SEMS insertion is considered a bridge treatment modality for immediate refractory ERCP-related bleeding. Angioembolization still has a role as rescue therapy when SEMS does not work effectively.

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Successful Endoscopic Resection of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Unresponsive to Helicobacter pylori Eradication Therapy: Jeongmin Choi; Clin Endosc 2022;55(1):136-140. Published online November 16, 2020; DOI: https://doi.org/10.5946/ce.2020.232

Abstract PDF PubReader ePub

Eradication of Helicobacter pylori is the first-line treatment for gastric mucosa-associated lymphoid tissue (MALT) lymphomas; however, lesions may persist in 20% of patients after initial treatment, thereby necessitating the use of an additional therapeutic approach. Other treatment options include radiation therapy, chemotherapy, endoscopic resection, rituximab therapy, or watchful waiting. We present a case of localized gastric MALT lymphoma that did not respond to H. pylori eradication therapy. The patient waited for 12 months but the tumor showed no signs of regression endoscopically. Histologic examination revealed residual MALT lymphoma. The tumor was then successfully treated using endoscopic submucosal dissection and the patient remained disease-free for 4 years. To our knowledge, this is the first case in which a gastric MALT lymphoma was treated with endoscopic submucosal dissection. In conclusion, endoscopic resection may be recommended as second-line therapy for properly selected patients with gastric MALT lymphoma as it is effective and minimally invasive.

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A Common Symptom With an Uncommon Diagnosis: A Case of Primary Esophageal Diffuse Large B-cell Lymphoma
Shruthi Narasimha, Rasiq Zackria, Jonathan Hughes, Vijay Jayaraman
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A Case of Esophageal MALT Lymphoma Mimicking a Subepithelial Tumor
Ha Eun Lee, Gwang Ha Kim, Min Ji Kim, Kyung Bin Kim, Dong Chan Joo, Hye Kyung Jeon, Moon Won Lee, Bong Eun Lee
The Korean Journal of Gastroenterology.2024; 83(4): 157. CrossRef
Clinical Management of Patients with Gastric MALT Lymphoma: A Gastroenterologist’s Point of View
Tamara Matysiak-Budnik, Kateryna Priadko, Céline Bossard, Nicolas Chapelle, Agnès Ruskoné-Fourmestraux
Cancers.2023; 15(15): 3811. CrossRef
Endoscopic Submucosal Dissection for Treatment of Localized Gastric Mucosa-associated Lymphoid Tissue Lymphoma: A Case Series
Jun-young Seo, Kee Don Choi, In Hye Song, Young Soo Park, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(3): 188. CrossRef
Bacteria-Mediated Oncogenesis and the Underlying Molecular Intricacies: What We Know So Far
Shashanka K. Prasad, Smitha Bhat, Dharini Shashank, Akshatha C. R., Sindhu R., Pornchai Rachtanapun, Devananda Devegowda, Prasanna K. Santhekadur, Sarana Rose Sommano
Frontiers in Oncology.2022;[Epub] CrossRef
Primary Esophageal Lymphoma: Clinical Experience in Diagnosis and Treatment
Junchi Qu, Yanyan Zhuang, Dandan Zheng, Fengting Huang, Shineng Zhang
Cureus.2021;[Epub] CrossRef

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A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection: Paraskevas Gkolfakis, Marc-André Bureau, Marianna Arvanitakis, Jacques Devière, Daniel Blero; Clin Endosc 2022;55(1):141-145. Published online April 16, 2021; DOI: https://doi.org/10.5946/ce.2021.033

Abstract PDF PubReader ePub

A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient’s symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

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Management of leakage and fistulas after bariatric surgery
Stephen A. Firkins, Roberto Simons-Linares
Best Practice & Research Clinical Gastroenterology.2024; 70: 101926. CrossRef
Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
Obesity Surgery.2022; 32(2): 342. CrossRef

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Intestinal Perforation Caused by Lumboperitoneal Shunt Insertion Repaired with an Over-the-Scope Clip: Naoki Ishizuka, Eiji Komatsu; Clin Endosc 2022;55(1):146-149. Published online March 3, 2021; DOI: https://doi.org/10.5946/ce.2020.293

Abstract PDF PubReader ePub

Lumboperitoneal or ventriculoperitoneal shunt insertion is a standard therapy for hydrocephalus that diverts cerebrospinal fluid from the subarachnoid space into the peritoneal cavity. Gastrointestinal perforations due to this procedure occur rarely; however, accepted treatment strategies have not yet been established. Hence, the most common treatment approaches are open surgery or spontaneous closure without endoscopy. We report the case of a small intestinal perforation in a 73-year-old-woman that occurred after the insertion of a lumboperitoneal shunt. A positive cerebrospinal fluid culture and high cerebrospinal fluid white blood cell count indicated a retrograde bacterial infection, and computed tomography revealed that the peritoneal tip of the shunt catheter was located in the lumen of the gastrointestinal tract. We repaired the perforation endoscopically using an over-the-scope clip, and the patient’s recovery was uneventful. Use of an over-the-scope clip could be an effective and minimally invasive treatment for intestinal perforations caused by lumboperitoneal or ventriculoperitoneal shunt insertion.

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Progress in Surgical Treatment of Traffic Hydrocephalus
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Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding: Michihiro Yoshida, Tadahisa Inoue, Itaru Naitoh, Kazuki Hayashi, Yasuki Hori, Makoto Natsume, Naoki Atsuta, Hiromi Kataoka; Clin Endosc 2022;55(1):150-155. Published online November 19, 2020; DOI: https://doi.org/10.5946/ce.2020.217

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We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placement for post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1 patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement 1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-side incision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additional endoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellent hemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimate treatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should be carefully examined for bleeding points, even after the CSEMS placement.

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Application of a New Hemostatic Clip to Prevent Delayed Bleeding After Endoscopic Sphincterotomy
Jinpei Dong, Qiushi Feng, Guigen Teng, Haixia Niu, Dapeng Bian
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Clinical Practice of Gastrointestinal Endoscopy in COVID-19 Patients: An Experience from Indonesia: Rabbinu Rangga Pribadi, Amanda Pitarini Utari, Virly Nanda Muzellina, Saskia Aziza Nursyirwan, Hasan Maulahela, Kaka Renaldi, Ari Fahrial Syam; Clin Endosc 2022;55(1):156-159. Published online July 20, 2021; DOI: https://doi.org/10.5946/ce.2021.088

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Gastrointestinal Endoscopy and Coronavirus Disease-2019 Pandemic
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Open Access Macedonian Journal of Medical Sciences.2022; 10(F): 81. CrossRef
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A Rare Case of Massive Hematochezia: Sang Hoon Lee, Sung Chul Park, Seung Koo Lee; Clin Endosc 2022;55(1):163-165. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.260

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