Clinical Endoscopy

2021 Korean Society of Gastrointestinal Endoscopy Clinical Practice Guidelines for Endoscopic Sedation: Hong Jun Park, Byung-Wook Kim, Jun Kyu Lee, Yehyun Park, Jin Myung Park, Jun Yong Bae, Seung Young Seo, Jae Min Lee, Jee Hyun Lee, Hyung Ku Chon, Jun-Won Chung, Hyun Ho Choi, Myung Ha Kim, Dong Ah Park, Jae Hung Jung, Joo Young Cho, Endoscopic Sedation Committee of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2022;55(2):167-182. Published online February 22, 2022; DOI: https://doi.org/10.5946/ce.2021.282

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Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonary complications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.

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Using Clinical-based Discharge Criteria to Discharge Patients After Endoscopy Procedures Under Drug-induced Intravenous Sedation in the Outpatient Care Unit: An Observational Study
Liangyu Fang, Lina Chen, Bingbing Wu, Yinchuan Xu, Laijuan Chen
Journal of PeriAnesthesia Nursing.2024;[Epub] CrossRef
Development and Effectiveness Evaluation of 360-Degree Virtual Reality-Based Educational Intervention for Adult Patients Undergoing Colonoscopy
Minju Gwag, Jaeyong Yoo
Healthcare.2024; 12(14): 1448. CrossRef
Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea
Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee
Clinical Endoscopy.2024; 57(4): 476. CrossRef
Experience of organizing outpatient anesthetic care at Endoscopy centre of Multidisciplinary city clinic
O. V. Makarov, S. A. Osipov, E. P. Rodionov, A. A. Malyshev, I. Yu. Korzheva, L. M. Avramenko, Z. Z. Loseva, I. V. Balykov, L. A. Baichorova, E. I. Alikhanova, A. V. Vlasenko, E. A. Evdokimov, V. I. Makovey, V. V. Erofeev
Medical alphabet.2023; (6): 50. CrossRef
Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study
Sneha Shaha, Yinglin Gao, Jiahao Peng, Kendrick Che, John J. Kim, Wasseem Skef
Clinical Endoscopy.2023; 56(5): 658. CrossRef
Current status of the gastric cancer screening program in Korea
Young-Il Kim, Il Ju Choi
Journal of the Korean Medical Association.2022; 65(5): 250. CrossRef
In pursuit of the right plan for airway management in gastrointestinal endoscopic procedures…the battle half won?
Upender Gowd, Sukhminder Jit Singh Bajwa, Madhuri Kurdi, Gaurav Sindwani
Indian Journal of Anaesthesia.2022; 66(10): 683. CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef

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Can Computed Tomography Colonography Replace Optical Colonoscopy in Detecting Colorectal Lesions?: State of the Art: Alessia Chini, Michele Manigrasso, Grazia Cantore, Rosa Maione, Marco Milone, Francesco Maione, Giovanni Domenico De Palma; Clin Endosc 2022;55(2):183-190. Published online February 24, 2022; DOI: https://doi.org/10.5946/ce.2021.254

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Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions <5 mm or flat lesions, which, although rarely, can have a malignant potential.

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Multi-view orientational attention network combining point-based affinity for polyp segmentation
Yan Liu, Yan Yang, Yongquan Jiang, Zhuyang Xie
Expert Systems with Applications.2024; 249: 123663. CrossRef
The Influence of Mechanical Bowel Preparation on Volatile Organic Compounds for the Detection of Gastrointestinal Disease—A Systematic Review
Ashwin Krishnamoorthy, Subashini Chandrapalan, Sofie Bosch, Ayman Bannaga, Nanne K.H. De Boer, Tim G.J. De Meij, Marcis Leja, George B. Hanna, Nicoletta De Vietro, Donato Altomare, Ramesh P. Arasaradnam
Sensors.2023; 23(3): 1377. CrossRef
The Detection of Colorectal Cancer through Machine Learning-Based Breath Sensor Analysis
Inese Poļaka, Linda Mežmale, Linda Anarkulova, Elīna Kononova, Ilona Vilkoite, Viktors Veliks, Anna Marija Ļeščinska, Ilmārs Stonāns, Andrejs Pčolkins, Ivars Tolmanis, Gidi Shani, Hossam Haick, Jan Mitrovics, Johannes Glöckler, Boris Mizaikoff, Mārcis Lej
Diagnostics.2023; 13(21): 3355. CrossRef

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Single Use (Disposable) Duodenoscope: Recent Development and Future: Kihyun Ryu, Sunguk Jang; Clin Endosc 2022;55(2):191-196. Published online June 22, 2021; DOI: https://doi.org/10.5946/ce.2021.075

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Unlike simple forward-viewing endoscopes such as gastroscope or colonoscope, duodenoscope houses much more complex design to fulfil its function. This design differences leave duodenoscopes more prone to contamination from inadequate disinfection process and potential dissemination of pathogens. Recent reports on dissemination of infection through the duodenoscope mandated an overhaul of duodenoscope utilization including development of a disposable duodenoscope. This article reviews the current state of disposable duodenoscope development, including reported early efficacy as well as its future direction and utilization.

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Materials Science Toolkit for Carbon Footprint Assessment: A Case Study for Endoscopic Accessories of Common Use
Rubén Martín-Cabezuelo, Guillermo Vilariño-Feltrer, Alberto J. Campillo-Fernández, Vicente Lorenzo-Zúñiga, Vicente Pons, Pedro López-Muñoz, Isabel Tort-Ausina
ACS Environmental Au.2024; 4(1): 42. CrossRef
The Evolution of Spinal Endoscopy: Design and Image Analysis of a Single-Use Digital Endoscope Versus Traditional Optic Endoscope
Shih-Hao Cheng, Yen-Tsung Lin, Hsin-Tzu Lu, Yu-Chuan Tsuei, William Chu, Woei-Chyn Chu
Bioengineering.2024; 11(1): 99. CrossRef
Cost-effectiveness Analysis of Single-Use Duodenoscope Applied to Endoscopic Retrograde Cholangiopancreatography
David Nicolás-Pérez, Antonio Zebenzuy Gimeno-García, Rafael Joaquín Romero-García, Iván Castilla-Rodríguez, Manuel Hernandez-Guerra
Pancreas.2024; 53(4): e357. CrossRef
ERCP with single-use disposable duodenoscopes in four different set-ups
Ronja Lagström, Svend Knuhtsen, Trine Stigaard, Mustafa Bulut
BMJ Case Reports.2023; 16(2): e251514. CrossRef
Good Practices on Endoscope Reprocessing in Italy: Findings of a Nationwide Survey
Michela Scarpaci, Tommaso Cosci, Benedetta Tuvo, Alessandra Guarini, Teresa Iannone, Angelo Zullo, Beatrice Casini
International Journal of Environmental Research and Public Health.2022; 19(19): 12082. CrossRef

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Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis: Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral; Clin Endosc 2022;55(2):197-207. Published online November 29, 2021; DOI: https://doi.org/10.5946/ce.2021.079

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Background
/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE).
Methods
We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations.
Results
Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needlebased CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization.
Conclusions
CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.

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Updates in Diagnosis and Endoscopic Management of Cholangiocarcinoma
Roxana-Luiza Caragut, Madalina Ilie, Teodor Cabel, Deniz Günșahin, Afrodita Panaitescu, Christopher Pavel, Oana Mihaela Plotogea, Ecaterina Mihaela Rînja, Gabriel Constantinescu, Vasile Sandru
Diagnostics.2024; 14(5): 490. CrossRef
Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms
Shreyas Krishna, Ahmed Abdelbaki, Phil A. Hart, Jorge D. Machicado
Cancers.2024; 16(6): 1238. CrossRef
Exploring Intestinal Permeability: Concept, Diagnosis, Connection to Bowel Disease, and Iron Deficiency
Olesja Basina, Aleksejs Derovs, Jeļena Derova, Sandra Lejniece
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences..2024; 78(4): 244. CrossRef
American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations
Larissa L. Fujii-Lau, Nirav C. Thosani, Mohammad Al-Haddad, Jared Acoba, Curtis J. Wray, Rodrick Zvavanjanja, Stuart K. Amateau, James L. Buxbaum, Audrey H. Calderwood, Jean M. Chalhoub, Nayantara Coelho-Prabhu, Madhav Desai, Sherif E. Elhanafi, Douglas S
Gastrointestinal Endoscopy.2023; 98(5): 685. CrossRef
In Vivo Click Chemistry Enables Multiplexed Intravital Microscopy
Jina Ko, Kilean Lucas, Rainer Kohler, Elias A. Halabi, Martin Wilkovitsch, Jonathan C. T. Carlson, Ralph Weissleder
Advanced Science.2022;[Epub] CrossRef
Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling
Woo Hyun Paik
International Journal of Gastrointestinal Intervention.2022; 11(3): 96. CrossRef

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A Novel Aerosol-Exposure Protection Mask for Patients During Upper Endoscopy: Soo-Jeong Cho; Clin Endosc 2022;55(2):208-209. Published online March 29, 2022; DOI: https://doi.org/10.5946/ce.2022.064

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Fecal Calprotectin as a Surrogate Marker for Mucosal Healing After Initiating the Therapeutic Anti-Tubercular Trial: Satimai Aniwan; Clin Endosc 2022;55(2):210-212. Published online March 14, 2022; DOI: https://doi.org/10.5946/ce.2022.063

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Predicting Malignancy by Peroral Pancreatoscopy of an Intraductal Papillary Mucinous Neoplasm with a Dilated Main Pancreatic Duct: Is Seeing Enough?: Yun Nah Lee, Jong Ho Moon; Clin Endosc 2022;55(2):213-214. Published online February 23, 2022; DOI: https://doi.org/10.5946/ce.2022.065

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Perception of Gastrointestinal Endoscopy Personnel on Society Recommendations on Personal Protective Equipment, Case Selection, and Scope Cleaning During Covid-19 Pandemic: An International Survey Study: Parit Mekaroonkamol, Kasenee Tiankanon, Rapat Pittayanon, Wiriyaporn Ridtitid, Fariha Shams, Ghias Un Nabi Tayyab, Julia Massaad, Saurabh Chawla, Stanley Khoo, Siriboon Attasaranya, Nonthalee Pausawasdi, Qiang Cai, Thawee Ratanachu-ek, Pradermchai Kongkham, Rungsun Rerknimitr; Clin Endosc 2022;55(2):215-225. Published online September 29, 2021; DOI: https://doi.org/10.5946/ce.2021.051

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: The Thai Association for Gastrointestinal Endoscopy published recommendations on safe endoscopy during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the practicality and applicability of the recommendations and the perceptions of endoscopy personnel on them.
Methods
A validated questionnaire was sent to 1290 endoscopy personnel globally. Of these, the data of all 330 responders (25.6%) from 15 countries, related to the current recommendations on proper personal protective equipment (PPE), case selection, scope cleaning, and safety perception, were analyzed. Ordinal logistic regression was used to determine the relationships between the variables.
Results
Despite an overwhelming agreement with the recommendations on PPE (94.5%) and case selection (95.5%), their practicality and applicability on PPE recommendations and case selection were significantly lower (p=0.001, p=0.047, p<0.001, and p=0.032, respectively). Factors that were associated with lower sense of safety in endoscopy units were younger age (p=0.004), less working experience (p=0.008), in-training status (p=0.04), and higher national prevalence of COVID-19 (p=0.003). High prevalent countries also had more difficulty implementing the guidelines (p<0.001) and they considered the PPE recommendations less practical and showed lower agreement with them (p<0.001 and p=0.008, respectively). A higher number of in-hospital COVID-19 patients was associated with less agreement with PPE recommendations (p=0.039).
Conclusions
Using appropriate PPE and case selection in endoscopic practice during a pandemic remains a challenge. Resource availability and local prevalence are critical factors influencing the adoption of the current guidelines.

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Preclinical Efficacy and Clinical Feasibility of a Novel Aerosol-Exposure Protection Mask for Esophagogastroduodenoscopy: Mai Ego Makiguchi, Seiichiro Abe, Yutaka Okagawa, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Okamoto Ryuta, Yutaka Saito; Clin Endosc 2022;55(2):226-233. Published online December 15, 2021; DOI: https://doi.org/10.5946/ce.2021.178-IDEN

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Background
/Aims: This study aimed to assess the efficacy of a novel aerosol-exposure protection (AP) mask in preventing coronavirus disease in healthcare professionals during upper gastrointestinal endoscopy and to evaluate its clinical feasibility.
Methods
In Study 1, three healthy volunteers volitionally coughed with and without the AP mask in a cleanroom. Microparticles were visualized and counted with a specific measurement system and compared with and without the AP mask. In Study 2, 30 patients underwent endoscopic resection with the AP mask covering the face, and the SpO2 was measured throughout the procedure.
Results
In Study 1, the median number of microparticles in volunteers 1, 2, and 3 with and without the AP mask was 8.5 and 110.0, 7.0 and 51.5, and 8.0 and 95.0, respectively (p<0.01). Using the AP mask, microparticles were reduced by approximately 92%. The median distances of microparticle scattering without the AP mask were 60, 0, and 68 in volunteers 1, 2, and 3, respectively. In Study 2, the mean SpO2 was 96.3%, and desaturation occurred in three patients.
Conclusion
The AP mask could provide protection from aerosol exposure and can be safely used for endoscopy in clinical practice.

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Aerosol and Droplet Dispersion Control during Bronchoscopy Using a Newly Developed Oxygen Mask
Yuki Nagamatsu, Masatoshi Kakihana, Yujin Kudo, Wakako Hamanaka, Yohei Kawaguchi, Yuki Yamada, Chiaki Kanno, Sachio Maehara, Masaru Hagiwara, Tatsuo Ohira, Norihiko Ikeda
Respiratory Endoscopy.2024; 2(1): 25. CrossRef
A Novel Aerosol-Exposure Protection Mask for Patients During Upper Endoscopy
Soo-Jeong Cho
Clinical Endoscopy.2022; 55(2): 208. CrossRef

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Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam: Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang, the Committees of Quality Management and Conscious Sedation of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2022;55(2):234-239. Published online October 12, 2021; DOI: https://doi.org/10.5946/ce.2021.126

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Background
/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions.
Methods
This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction.
Results
A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups.
Conclusions
Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

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Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea
Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee
Clinical Endoscopy.2024; 57(4): 476. CrossRef
Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy: a cohort study
Yuan-rui Zhao, Ke-sheng Huang, Guo Hou, Lan Yao, Li-ping Lu, Song Xu, Ying-tao Lian, Zhun Yao, Zhui Yu
World Journal of Emergency Medicine.2023; 14(1): 31. CrossRef
Effective dose of propofol combined with a low-dose esketamine for gastroscopy in elderly patients: A dose finding study using dixon’s up-and-down method
Yuling Zheng, Yafei Xu, Bixin Huang, Ying Mai, Yiwen Zhang, Zhongqi Zhang
Frontiers in Pharmacology.2022;[Epub] CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef

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Risk Stratification in Cancer Patients with Acute Upper Gastrointestinal Bleeding: Comparison of Glasgow-Blatchford, Rockall and AIMS65, and Development of a New Scoring System: Matheus Cavalcante Franco, Sunguk Jang, Bruno da Costa Martins, Tyler Stevens, Vipul Jairath, Rocio Lopez, John J. Vargo, Alan Barkun, Fauze Maluf-Filho; Clin Endosc 2022;55(2):240-247. Published online January 21, 2022; DOI: https://doi.org/10.5946/ce.2021.115

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Background
/Aims: Few studies have measured the accuracy of prognostic scores for upper gastrointestinal bleeding (UGIB) among cancer patients. Thereby, we compared the prognostic scores for predicting major outcomes in cancer patients with UGIB. Secondarily, we developed a new model to detect patients who might require hemostatic care.
Methods
A prospective research was performed in a tertiary hospital by enrolling cancer patients admitted with UGIB. Clinical and endoscopic findings were obtained through a prospective database. Multiple logistic regression analysis was performed to gauge the power of each score.
Results
From April 2015 to May 2016, 243 patients met the inclusion criteria. The AIMS65 (area under the curve [AUC] 0.85) best predicted intensive care unit admission, while the Glasgow-Blatchford score best predicted blood transfusion (AUC 0.82) and the low-risk group (AUC 0.92). All scores failed to predict hemostatic therapy and rebleeding. The new score was superior (AUC 0.74) in predicting hemostatic therapy. The AIMS65 (AUC 0.84) best predicted in-hospital mortality.
Conclusions
The scoring systems for prognostication were validated in the group of cancer patients with UGIB. A new score was developed to predict hemostatic therapy. Following this result, future prospective research should be performed to validate the new score.

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Endoscopic Management of Tumor Bleeding
Frances Dang, Marc Monachese
Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 155. CrossRef
Clinical significance of D-dimer, antithrombin III, and Helicobacter pylori infection in acute upper gastrointestinal bleeding
Cong-Biao Cheng, Na Li
World Chinese Journal of Digestology.2024; 32(7): 501. CrossRef
The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed
Sergiu Marian Cazacu, Dragoș Ovidiu Alexandru, Răzvan-Cristian Statie, Sevastița Iordache, Bogdan Silviu Ungureanu, Vlad Florin Iovănescu, Petrică Popa, Victor Mihai Sacerdoțianu, Carmen Daniela Neagoe, Mirela Marinela Florescu
Diagnostics.2023; 13(6): 1188. CrossRef
Progress in the Evaluation of Acute Upper Gastrointestinal Bleeding with AIMS65 Scoring System
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Advances in Clinical Medicine.2023; 13(05): 8163. CrossRef
Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review
Kim Oren Gradel
Journal of Clinical Medicine.2023; 12(19): 6132. CrossRef

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Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms: A Latin American Cohort Study: Fernando Palacios-Salas, Harold Benites-Goñi, Luis Marin-Calderón, Paulo Bardalez-Cruz, Jorge Vásquez-Quiroga, Edgar Alva-Alva, Bryan Medina-Morales, Jairo Asencios-Cusihuallpa; Clin Endosc 2022;55(2):248-255. Published online November 12, 2021; DOI: https://doi.org/10.5946/ce.2021.192

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Background
/Aims: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC.
Methods
We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure.
Results
The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively.
Conclusions
Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.

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Short-Term and Long-Term Outcomes of Liver Cirrhosis in Gastric Neoplasm Patients Undergoing Endoscopic Submucosal Dissection
Xu-Rui Liu, Lian-Shuo Li, Fei Liu, Zi-Wei Li, Xiao-Yu Liu, Wei Zhang, Dong Peng
Journal of Laparoendoscopic & Advanced Surgical Techniques.2023; 33(7): 640. CrossRef
Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
Gwang Ha Kim
World Journal of Gastroenterology.2023; 29(43): 5800. CrossRef
Endoscopic diagnosis of early gastric cancer
Dong Chan Joo, Gwang Ha Kim
Journal of the Korean Medical Association.2022; 65(5): 267. 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

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Value of Fecal Calprotectin Measurement During the Initial Period of Therapeutic Anti-Tubercular Trial: Hyeong Ho Jo, Eun Young Kim, Jin Tae Jung, Joong Goo Kwon, Eun Soo Kim, Hyun Seok Lee, Yoo Jin Lee, Kyeong Ok Kim, Byung Ik Jang, the Crohn’s and Colitis Association in Daegu-Gyeongbuk; Clin Endosc 2022;55(2):256-262. Published online November 5, 2021; DOI: https://doi.org/10.5946/ce.2021.061

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Background
/Aims: The diagnosis of intestinal tuberculosis (ITB) is often challenging. Therapeutic anti-tubercular trial (TATT) is sometimes used for the diagnosis of ITB. We aimed to evaluate the changing pattern of fecal calprotectin (FC) levels during TATT in patients with ITB.
Methods
A retrospective review was performed on the data of 39 patients who underwent TATT between September 2015 and November 2018 in five university hospitals in Daegu, South Korea. The analysis was performed for 33 patients with serial FC measurement reports.
Results
The mean age of the participants was 48.8 years. The final diagnosis of ITB was confirmed in 30 patients based on complete mucosal healing on follow-up colonoscopy performed after 2 months of TATT. Before starting TATT, the mean FC level of the ITB patients was 170.2 μg/g (range, 11.5-646.5). It dropped to 25.4 μg/g (range, 11.5-75.3) and then 23.3 μg/g (range, 11.5-172.2) after one and two months of TATT, respectively. The difference in mean FC before and one month after TATT was statistically significant (p<0.001), and FC levels decreased to below 100 μg/g in all patients after one month of TATT.
Conclusions
All ITB patients showed FC decline after only 1 month of TATT, and this finding correlated with complete mucosal healing in the follow-up colonoscopy after 2 months of TATT.

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Primary Gastric Tuberculosis in an Immunocompetent Patient: The Truth Lying beneath the Surface
Fábio Pereira Correia, Luísa Martins Figueiredo, Luís Carvalho Lourenço, Sofia Santos, Rita Theias Manso, David Horta
GE - Portuguese Journal of Gastroenterology.2024; 31(3): 191. CrossRef
New diagnostic strategies to distinguish Crohn's disease and gastrointestinal tuberculosis
Himanshu Narang, Saurabh Kedia, Vineet Ahuja
Current Opinion in Infectious Diseases.2024;[Epub] CrossRef
Evidence-based approach to diagnosis and management of abdominal tuberculosis
Daya Krishna Jha, Mythili Menon Pathiyil, Vishal Sharma
Indian Journal of Gastroenterology.2023; 42(1): 17. CrossRef
Fecal Calprotectin as a Surrogate Marker for Mucosal Healing After Initiating the Therapeutic Anti-Tubercular Trial
Satimai Aniwan
Clinical Endoscopy.2022; 55(2): 210. CrossRef

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Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones: Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada; Clin Endosc 2022;55(2):263-269. Published online November 12, 2021; DOI: https://doi.org/10.5946/ce.2021.153

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Background
/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP.
Methods
This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses.
Results
Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS.
Conclusions
Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

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Advancements in Research on Challenges in Selective Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP)
天雨张
Journal of Clinical Personalized Medicine.2024; 03(01): 100. CrossRef
The impact of transpancreatic precut sphincterotomy on the quality of ERCP in a low-volume setting
Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Jiann-Hwa Chen
Gastrointestinal Endoscopy.2024; 99(5): 747. CrossRef
Morphology of the papilla can predict procedural safety and efficacy of ERCP—a systematic review and meta-analysis
Edina Tari, Endre Botond Gagyi, Anett Rancz, Dániel Sándor Veres, Szilárd Váncsa, Péter Jenő Hegyi, Krisztina Hagymási, Péter Hegyi, Bálint Erőss
Scientific Reports.2024;[Epub] CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Hyung Ku Chon, Ki-Hyun Kim, Tae Jun Song, Dong-Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyun Chung, Jin Lee, Miyoung Choi
Gut and Liver.2024; 18(4): 564. CrossRef
En face position of the major duodenal papilla using a reopenable clip during endoscopic retrograde cholangiopancreatography
Hirokazu Saito, Akiko Ikebata, Shunpei Hashigo
Digestive Endoscopy.2023;[Epub] CrossRef
Criterios 5-5-2 de canulación biliar y complicaciones post colangiopancreatografía retrógrada endoscópica: Experiencia en un hospital de referencia, Perú
Wilmer Gustavo Quiroga Purizaca, Diego Ricardo Páucar Aguilar, Jackeline Amparo Barrientos Pérez, Isamar Benyi Gutiérrez Córdova, Renato Garrido Acedo, Daniel Andrei Vargas Blácido
Revista de Gastroenterología del Perú.2023; 43(2): e1461. CrossRef
Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center
K. Ben Abdallah, L. Hamzaoui, M. Mahmoudi, I. Cherif, A. Ben Mohamed, M. Yakoubi, A. Khsiba, M. Medhioub, M.M. Azouz
Heliyon.2022; 8(12): e12526. CrossRef

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Peroral Pancreatoscopy with Videoscopy and Narrow-Band Imaging in Intraductal Papillary Mucinous Neoplasms with Dilatation of the Main Pancreatic Duct: Yui Kishimoto, Naoki Okano, Ken Ito, Kensuke Takuma, Seiichi Hara, Susumu Iwasaki, Kensuke Yoshimoto, Yuto Yamada, Koji Watanabe, Yusuke Kimura, Hiroki Nakagawa, Yoshinori Igarashi; Clin Endosc 2022;55(2):270-278. Published online December 6, 2021; DOI: https://doi.org/10.5946/ce.2021.083; Correction in: Clin Endosc 2023;56(2):261

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Background
/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs.
Methods
POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up.
Results
A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin.
Conclusions
In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

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Pancreatoscopy-Guided Endotherapies for Pancreatic Diseases
Yuri Hanada, Raj J. Shah
Gastrointestinal Endoscopy Clinics of North America.2024; 34(3): 417. CrossRef
Peroral pancreatoscopy with videoscopy and narrow-band imaging in intraductal papillary mucinous neoplasms with dilatation of the main pancreatic duct
Yui Kishimoto, Naoki Okano, Ken Ito, Kensuke Takuma, Seiichi Hara, Susumu Iwasaki, Kensuke Yoshimoto, Yuto Yamada, Koji Watanabe, Yusuke Kimura, Hiroki Nakagawa, Yoshinori Igarashi
Clinical Endoscopy.2023; 56(2): 261. CrossRef
Predicting Malignancy by Peroral Pancreatoscopy of an Intraductal Papillary Mucinous Neoplasm with a Dilated Main Pancreatic Duct: Is Seeing Enough?
Yun Nah Lee, Jong Ho Moon
Clinical Endoscopy.2022; 55(2): 213. CrossRef

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Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Evaluation of Abdominal Lymphadenopathy of Unknown Etiology: Nonthalee Pausawasdi, Kotchakon Maipang, Tassanee Sriprayoon, Phunchai Charatcharoenwitthaya; Clin Endosc 2022;55(2):279-286. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.218-IDEN

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Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology.
Methods
The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed.
Results
A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred.
Conclusions
EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

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Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy
Taha Yaseen, Abbas Ali Tasneem, Syed Mudassir Laeeq, Zain Majid, Nasir Hassan Luck
Euroasian journal of hepato-gastroenterology.2024; 14(1): 40. CrossRef
Choosing needles wisely: 19-G conventional vs. Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for malignant lymphoma diagnosis and classification
Kajornvit Raghareutai, Worapoth Yingyongthawat, Nonthalee Pausawasdi
Clinical Endoscopy.2024; 57(4): 473. CrossRef
Diagnostic role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in abdominal lymphadenopathy of unknown etiology
Wenli Wang, Chaoqun Han, Xin Ling, Xianwen Guo, Jun Liu, Rong Lin, Zhen Ding
Frontiers in Medicine.2023;[Epub] CrossRef
Detection of Lymphadenopathy as a Precursor to Autoimmune Liver Diseases Before Clinical Hepatitis Became Apparent: A Report of Two Cases
Hiroshi Okano, Hiroki Tanaka, Shimpei Matsusaki, Katsumi Mukai, Akira Nishimura, Kana Asakawa, Youichirou Baba, Tetsuya Murata
Cureus.2023;[Epub] CrossRef
Mediastinal Nodal Staging Performance of Combined Endobronchial and Esophageal Endosonography in Lung Cancer Cases: A Systematic Review and Meta-Analysis
Xiaozhen Liu, Kun Yang, Weihong Guo, Muqi Ye, Shaozhong Liu
Frontiers in Surgery.2022;[Epub] CrossRef
Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis
Hasan Maulahela, Achmad Fauzi, Kaka Renaldi, Qorina P Srisantoso, Amirah Jasmine
JGH Open.2022; 6(11): 745. CrossRef

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Acute Liver Failure Secondary to Hepatic Infiltration of Malignant Melanoma: Yujin Lee, Jaekwang Lee, Hyunsoo Kim, Changkeun Park, Jaekwon Jung, Daejin Kim, Yun Jin Chung, Hanjun Ryu; Clin Endosc 2022;55(2):287-291. Published online April 1, 2021; DOI: https://doi.org/10.5946/ce.2020.272

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Acute liver failure due to malignant melanoma is uncommon. We presents a case of acute liver failure secondary to hepatic infiltration of a malignant melanoma. An 86-year-old man was admitted with elevated liver enzymes and an increased lactate dehydrogenase level. His condition progressed to acute liver failure, but the etiology of liver failure was unclear. Esophagogastroduodenoscopy was performed to evaluate dyspepsia, which showed signs indicative of malignant melanoma. Based on the endoscopy findings and elevated liver enzyme levels, liver biopsy was performed to confirm the presence of malignant melanoma. Hepatic infiltration of malignant melanoma was observed histologically. However, massive and diffuse liver metastasis is very rare and difficult to identify on imaging studies. If the etiology of liver failure is unclear, diffuse metastatic melanoma infiltration should be considered as differential diagnosis. Early liver biopsy can help to clarify the diagnosis.

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HEPATOPATHY SECONDARY TO INFILTRATION BY MALIGNANT MELANOMA: DIAGNOSTIC VALUE OF LIVER BIOPSY
Alejandro García Martínez, Álvaro Morales Prado, Jorge Martínez-Echevarría Gil-Delgado, Daniel Mateos Millán
Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef
Tumor lysis syndrome with hepatic failure- A rare presentation of undiagnosed metastatic melanoma
Nicholas Cochran-Caggiano, Brandon Zaffuto, Ryan Dean
JEM Reports.2023; 2(1): 100009. CrossRef
Acute liver failure secondary to malignant infiltration: A single center experience
Rocío González Grande, Ana Bravo Aranda, Inmaculada Santaella Leiva, Susana López Ortega, Miguel Jiménez Pérez
Seminars in Oncology.2023; 50(3-5): 71. CrossRef

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Endoscopic Treatment of Iatrogenic Perforation of Sigmoid Diverticulum: A Case Report of Multidisciplinary Management: Giacomo Emanuele Maria Rizzo, Giuseppina Ferro, Giovanna Rizzo, Giovanni Di Carlo, Alessandro Cantone, Gaetano Giuseppe Di Vita, Carmelo Sciumè; Clin Endosc 2022;55(2):292-296. Published online June 7, 2021; DOI: https://doi.org/10.5946/ce.2021.005

Abstract PDF PubReader ePub: Iatrogenic perforations are severe complications of gastrointestinal endoscopy; therefore, their management should be adequately planned. A 77-year-old man with a history of diverticulosis underwent a colonoscopy for anemia. During the procedure, an iatrogenic perforation occurred suddenly in the sigmoid colon, near a severe angle among the numerous diverticula. Through-the-scope clips were immediately applied to treat it and close mucosal edges. Laboratory tests showed increased levels of inflammation and infection, and although there were no complaints of abdominal pain, the patient had an extremely distended abdomen. A multidisciplinary board began management based on a conservative approach. Pneumoperitoneum was treated with computed tomography-assisted drainage. After 72 hours, his intestinal canalization and laboratory tests were normal. Though this adverse event is rare, a multidisciplinary board should be promptly gathered upon occurrence, even if the patient appears clinically stable, to consider a conservative approach and avoid surgical treatment.

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Successful Removal of a Difficult Common Bile Duct Stone by Percutaneous Transcholecystic Cholangioscopy: Hyunsuk Lee, Sang Hyub Lee, Gunn Huh, Yeji Kim, Saebeom Hur, Moonhaeng Hur, Minwoo Lee, Byeongyun Ahn; Clin Endosc 2022;55(2):297-301. Published online May 4, 2021; DOI: https://doi.org/10.5946/ce.2020.301

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Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. We report a case of a large CBD stone that was successfully removed using percutaneous transcholecystic cholangioscopy.

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PERcutaneous transhepatic CHOLangioscopy using a new single‐operator short cholangioscope (PERCHOL): European feasibility study
Enrique Pérez‐Cuadrado‐Robles, Simon Phillpotts, Michiel Bronswijk, Claudio Cim Conrad, Cecilia Binda, Laurent Monino, Kirill Basiliya, Marcus Hollenbach, Apostolis Papaefthymiou, Hadrien Alric, Lucille Quénéhervé, Alessandro Di Gaeta, Mathieu Pioche, Ari
Digestive Endoscopy.2024; 36(6): 719. CrossRef
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Chukwunonso Ezeani, Samuel O. Igbinedion, Kwabena Asafo-Agyei, Erik A. Holzwanger, Sultan Mahmood, Mandeep S. Sawhney, Tyler M. Berzin, Moamen Gabr, Douglas K. Pleskow
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Colangioscopia percutánea utilizando SpyGlass Discover para el manejo de coledocolitiasis difícil en anatomía alterada: reporte de caso
V. Sánchez-Cerna, G. Araujo-Almeyda, J. Aliaga-Ramos, T. Reyes-Mugruza, W. Celedonio-Campos
Revista de Gastroenterología de México.2024; 89(3): 451. CrossRef
Percutaneous cholangioscopy utilizing SpyGlass Discover for difficult-to-treat choledocholithiasis in an altered anatomy: A case report
V. Sánchez-Cerna, G. Araujo-Almeyda, J. Aliaga-Ramos, T. Reyes-Mugruza, W. Celedonio-Campos
Revista de Gastroenterología de México (English Edition).2024; 89(3): 451. CrossRef

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Endoscopic Ultrasound-Guided Transgastric Puncture and Drainage of an Adrenal Abscess in an Immunosuppressed Patient: Carlos Andrés Regino, Jean Paul Gómez, Gabriel Mosquera-Klinger; Clin Endosc 2022;55(2):302-304. Published online November 16, 2021; DOI: https://doi.org/10.5946/ce.2021.090

Abstract PDF PubReader ePub: Adrenal gland infection is a clinical entity of great importance, but it is a largely unrecognized pathology. Immunosuppressed individuals are at a higher risk of presentation. Herein, we describe a young female patient, recently diagnosed with HIV, who presented with severe sepsis due to methicillin-resistant Staphylococcus aureus, associated with a left adrenal abscess. She was initially treated with antibiotics; however, due to the persistence of the systemic inflammatory response and bacteremia, endoscopic ultrasound-guided drainage was performed. This procedure was successful in resolving the clinical situation. Endoscopic ultrasound-guided adrenal gland drainage can be a safe, efficacious, and minimally invasive option for managing antibiotic-refractory adrenal abscesses in immunosuppressed patients.

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Endoscopic Ultrasonography Findings for Brunner’s Gland Hamartoma in the Duodenum: Kyong Joo Lee, Bonil Park, Hee Man Kim; Clin Endosc 2022;55(2):305-309. Published online April 28, 2021; DOI: https://doi.org/10.5946/ce.2020.259

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Brunner’s gland hamartomas: Not always benign
Manar Shmais, Ahmad Mousawi, Fadi Mourad, Ala I. Sharara
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Pablo Olcina Domínguez, Luis Estela Villa, Arancha Villadóniga Sánchez, Rocío Avellana Moreno, Sergio Gil Rojas, Jesús García-Cano Lizcano
Revista Española de Enfermedades Digestivas.2021;[Epub] CrossRef

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Large Jejunal Phytobezoar with Small Bowel Obstruction Treated by Single-Balloon Enteroscopy: Eun Young Park, Dong Hoon Baek, Bong Eun Lee, Gwang Ha Kim, Geun Am Song; Clin Endosc 2022;55(2):310-312. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.215

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A Rare Cause of Subepithelial Tumor in the Gastric Fundus: Da Mi Kim, Gwang Ha Kim, Kyungbin Kim; Clin Endosc 2022;55(2):313-314. Published online February 25, 2022; DOI: https://doi.org/10.5946/ce.2022.039

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Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?: Han Hee Lee; Clin Endosc 2022;55(2):315-317. Published online February 21, 2022; DOI: https://doi.org/10.5946/ce.2021.264

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