Clinical Endoscopy

Original Article

A Nationwide Survey on the Facilities and Personnel for Endoscopic Sedation: Results from 50 Qualified Endoscopy Units of Teaching Hospitals Accredited by the Korean Society of Gastrointestinal Endoscopy (KSGE): Seon-Young Park, Jun Kyu Lee, Jung-Wook Kim, Tae Hee Lee, Chang-Hwan Park, Jae-Yong Jang, Byung-Wook Kim, Byung Ik Jang, the Quality management and Endoscopic sedation committee of Korean Society of Gastrointestinal Endoscopy (KSGE); Clin Endosc 2021;54(6):843-850. Published online July 14, 2021; DOI: https://doi.org/10.5946/ce.2021.014

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Background
/Aims: This study aimed to determine the current status of facilities, equipment, and personnel for endoscopic sedation from endoscopy units of representative hospitals in South Korea.
Methods
A questionnaire survey was conducted on 50 qualified endoscopy units accredited by the Korean Society of Gastrointestinal Endoscopy.
Results
All included endoscopy units had regulations and educational programs regarding sedation training for endoscopists and nursing personnel. There present one assisting nurse during endoscopy in 35 units (70%) and at least two nurses in 12 units (24.0%). All endoscopy units had examination rooms equipped with oxygen supply and suction systems. Endoscopist-directed sedation was performed in 48 units (96.0%). Propofol-based sedation was the most used sedation method. All units had a separate recovery bay. The daily number of patients per bed was greater than 10 in 17 units (34.0%). In 26 (52.0%) units, a single nurse cared for ≥10 patients per day. All the units fulfilled the discharge criteria.
Conclusions
This study presents data regarding endoscopic sedation clinical practice in 50 endoscopy units in South Korea. This study presents the current status of endoscopic sedation clinical practice in 50 qualified endoscopy units accredited by the KSGE, which provide excellent quality management.

Citations

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Awareness of Endoscopy Nurses About Anesthesia Management in the Pediatric Gastrointestinal Endoscopy Unit; A Survey Study
Feyza SEVER, Şamil HIZLI
Turkish Journal of Pediatric Disease.2023; : 412. 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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Commentary

Experience of Endoscopists in Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy Patients: Chang-Hwan Park; Clin Endosc 2020;53(1):7-8. Published online January 30, 2020; DOI: https://doi.org/10.5946/ce.2020.008

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Efficacy and Safety of Percutaneous Transhepatic Cholangioscopy with the Spyglass DS Direct Visualization System in Patients with Surgically Altered Anatomy: A Pilot Study
Hyung Ku Chon, Keum Ha Choi, Sang Hyun Seo, Tae Hyeon Kim
Gut and Liver.2022; 16(1): 111. CrossRef

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Special Review: Korean Society of Gastrointestinal Endoscopy “Accreditation of Qualified Endoscopy Unit” Guideline: Update 2019

Updates on the Sedation for Gastrointestinal Endoscopy: Jun Kyu Lee, Yoo Jin Lee, Jun Hyung Cho, Jong Pil Im, Chang-Hwan Park, Jae-Young Jang, Byung Ik Jang, the Quality Management Committee and the Disinfection Management/Conscious Sedation Committee of Korean Society of Gastrointestinal Endoscopy (KSGE); Clin Endosc 2019;52(5):451-457. Published online September 30, 2019; DOI: https://doi.org/10.5946/ce.2019.172

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Sedation, defined as the depressed level of consciousness, induced by drug administration, is widely used for gastrointestinal endoscopy to relieve a patient’s anxiety and discomfort. In addition, successful procedure is anticipated with control of unintended movements. Endoscopic sedation, however, cannot be free from the risk of serious adverse events, e.g., cardiopulmonary compromise. Therefore, principles on personnel, facility and equipment, as well as performance itself, should be followed to prevent unfavorable incidents. In this article, sedation guidelines for the Accreditation of Qualified Endoscopy Units, issued by the Korean Society of Gastrointestinal Endoscopy, are presented.

Citations

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Nurse-Administered Propofol Sedation Training Curricula and Propofol Administration in Digestive Endoscopy Procedures
Andrea Minciullo, Lucia Filomeno
Gastroenterology Nursing.2024; 47(1): 33. CrossRef
Sedation reversal trends at outpatient ambulatory endoscopic center vs in-hospital ambulatory procedure center using a triage protocol
Saqib Walayat, Peter Stadmeyer, Azfar Hameed, Minahil Sarfaraz, Paul Estrada, Mark Benson, Anurag Soni, Patrick Pfau, Paul Hayes, Brittney Kile, Toni Cruz, Deepak Gopal
World Journal of Gastrointestinal Endoscopy.2024; 16(7): 413. CrossRef
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
Clinical Endoscopy.2022; 55(2): 234. CrossRef
Endoscopist-Driven Sedation Practices in South Korea: Re-evaluation Considering the Nationwide Survey in 2019
Seon-Young Park, Jun Kyu Lee, Chang-Hwan Park, Byung-Wook Kim, Chang Kyun Lee, Hong Jun Park, Byung Ik Jang, Dong Uk Kim, Jin Myung Park, Jae Min Lee, Young Sin Cho, Hyung Ku Chon, Seung Young Seo, Woo Hyun Paik
Gut and Liver.2022; 16(6): 899. CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef
Pain Intensity at Injection Site during Esophagogastroduodenoscopy Using Long- and Medium-Chain versus Long-Chain Triglyceride Propofol: A Randomized Controlled Double-Blind Study
Joon Seop Lee, Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Yoo Jin Lee, Ju Yup Lee
Gut and Liver.2021; 15(4): 562. CrossRef
A Nationwide Survey on the Facilities and Personnel for Endoscopic Sedation: Results from 50 Qualified Endoscopy Units of Teaching Hospitals Accredited by the Korean Society of Gastrointestinal Endoscopy (KSGE)
Seon-Young Park, Jun Kyu Lee, Jung-Wook Kim, Tae Hee Lee, Chang-Hwan Park, Jae-Yong Jang, Byung-Wook Kim, Byung Ik Jang
Clinical Endoscopy.2021; 54(6): 843. CrossRef
Risk Factors for Prolonged Hospital Stay after Endoscopy
Toshihiro Nishizawa, Shuntaro Yoshida, Osamu Toyoshima, Tatsuya Matsuno, Masataka Irokawa, Toru Arano, Hirotoshi Ebinuma, Hidekazu Suzuki, Takanori Kanai, Kazuhiko Koike
Clinical Endoscopy.2021; 54(6): 851. CrossRef

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Focused Review Series: Pancreatobiliary endoscopy in altered gastointestinal anatomy

Endoscopic Retrograde Cholangiopancreatography in Post Gastrectomy Patients: Chang-Hwan Park; Clin Endosc 2016;49(6):506-509. Published online November 29, 2016; DOI: https://doi.org/10.5946/ce.2016.124

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Endoscopic retrograde cholangiopancreatography (ERCP) in post-gastrectomy patients with Billroth II (BII) reconstruction and Roux-en-Y (RY) reconstruction presents a challenge to therapeutic endoscopists. Major difficulties, including intubation to the ampulla of Vater, selective cannulation, and ampullary intervention, must be overcome in these patients. Recent data have shown that device-assisted ERCP allows for high success rates in these patients because various devices are useful for overcoming major difficulties. Therefore, good knowledge of postoperative anatomy and various devices is mandatory before performing ERCP procedures for post-gastrectomy patients.

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Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer: A prospective case–control study
Zhen Wu, Zhi-Gang Zhou, Ling-Yu Li, Wen-Jing Gao, Ting Yu
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Experience of endoscopic retrograde cholangiopancreatography with side-viewing duodenoscope in patients with previous gastric surgery
Mehmet Emin Gürbüz, Dursun Özgür Karakaş
Turkish Journal of Surgery.2022; 38(2): 149. CrossRef
Efficacy and safety of the rotatable sphincterotome during ERCP in patients with prior Billroth II gastrectomy (with videos)
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Surgical Endoscopy.2021; 35(8): 4849. CrossRef
Single Balloon Enteroscopy-Guided Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy: Long vs. Short Type
Chang-Hwan Park
The Korean Journal of Pancreas and Biliary Tract.2021; 26(3): 181. CrossRef
The feasibility of cap‐assisted routine adult colonoscope for therapeutic endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y reconstruction after total gastrectomy
Jian Bo Ni, Mei Ying Zhu, Kai Li, Wei Ming Dai, Lun Gen Lu, Xin Jian Wan, Rong Wan, Xiao Bo Cai
Journal of Digestive Diseases.2021; 22(12): 721. CrossRef
Challenges in ERCP post-Billroth II gastrectomy: Is it the scope, tools or technique?
IhabI El Hajj, Mohammad Al-Haddad
Saudi Journal of Gastroenterology.2019;[Epub] CrossRef
Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article
Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
Journal of Digestive Diseases.2019; 20(12): 631. CrossRef
Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
Saudi Journal of Gastroenterology.2019; 25(6): 355. CrossRef

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Original Article

Predictors of Rebleeding in Upper Gastrointestinal Dieulafoy Lesions: Sang-Hun Park, Du-Hyeon Lee, Chang-Hwan Park, Jin Jeon, Ho-Jun Lee, Sung-Uk Lim, Seon-Young Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew; Clin Endosc 2015;48(5):385-391. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.385

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Background/Aims

Dieulafoy lesions (DLs) are a rare but significant cause of upper gastrointestinal bleeding. We aimed to define the clinical significance of rebleeding and identify the predictors of rebleeding and mortality in upper gastrointestinal Dieulafoy lesions (UGIDLs).

Methods

Patients diagnosed with UGIDLs between January 2004 and June 2013 were retrospectively evaluated. Multivariate logistic regression analyses were performed to define the predictors of rebleeding and mortality in patients with UGIDLs.

Results

The study group consisted of 81 male and 36 female patients. Primary hemostasis was achieved in 115 out of 117 patients (98.3%) with various endoscopic therapies. Rebleeding occurred in 10 patients (8.5%). The mortality rate was significantly higher in patients with rebleeding than in those without rebleeding (30.0% vs. 4.7%, p=0.020). Multivariate logistic regression analysis revealed that kidney disease (p=0.006) and infection (p=0.005) were significant predictors of rebleeding in UGIDLs and that kidney disease (p=0.004) and platelet count (p=0.013) were significant predictors of mortality.

Conclusions

Rebleeding has an important prognostic significance in patients with UGIDLs. Kidney disease and infection are major predictors of rebleeding and mortality in patients with UGIDLs.

Citations

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Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding
Sang Yong Jo, Jin Hee Noh, Boram Cha, Ji Yong Ahn, Seung‐pyo Oh, Jun‐young Seo, Hee Kyong Na, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon‐Yong Jung
Journal of Gastroenterology and Hepatology.2023; 38(6): 888. CrossRef
Intragastric Single-Port Surgery: An Innovative and Multipurpose Technique for the Therapy of Upper Digestive Tract Lesions
Renjie Li, Wilfried Veltzke-Schlieker, Andreas Adler, Mahmoud Ismail, Harun Badakhshi, Ricardo Zorron
Surgical Innovation.2022; 29(1): 56. CrossRef
Outcomes in Severe Upper GI Hemorrhage from Dieulafoy’s Lesion with Monitoring of Arterial Blood Flow
B. Nulsen, D. M. Jensen, T. O. G. Kovacs, K. A. Ghassemi, M. Kaneshiro, G. S. Dulai, R. Jutabha, J. A. Gornbein
Digestive Diseases and Sciences.2021; 66(10): 3495. CrossRef
Hybrid surgical technologies in the treatment of patients with Dieulafoy’s lesion complicated by recurrent gastrointestinal bleeding
S.E. Voskanyan, M.V. Shabalin, A.I. Artemyev, I.Yu. Kolyshev, Z. Bogoevich, A.N. Bashkov, E.V. Naidenov
Endoskopicheskaya khirurgiya.2020; 26(1): 40. CrossRef
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Paulo Massinha, Inês Cunha, Luís Tomé
GE - Portuguese Journal of Gastroenterology.2020; 27(4): 237. CrossRef
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Najmeh Aletaha, Hoda Hamid, Niloofar Ayoobi Yazdi, Reza Taslimi, Bijan Shahbazkhani, Pardis Ketabi Moghadam
Middle East Journal of Digestive Diseases.2019; 11(4): 225. CrossRef
Lesión de Dieulafoy en estómago como causa de sangrado gastrointestinal alto: presentación de un caso
Jairo Alonso Sierra-Avendaño, Fabián Andrés Mejía-Casadiegos, María Paula Pérez-Barón, Gabriel Eduardo Pérez-García
Revista Médicas UIS.2019; 32(1): 27. CrossRef
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Michael A. Chang, Thomas J. Savides
Gastrointestinal Endoscopy Clinics of North America.2018; 28(3): 291. CrossRef
Refractory Gastric Hemorrhage from Caliber Persistent Arteries of the Left Inferior Phrenic Artery
Takahiro Hosoi, Norihiro Yuasa, Eiji Takeuchi, Hideo Miyake, Hidemasa Nagai, Yuichiro Yoshioka, Masataka Okuno, Takayuki Minami, Kanji Miyata, Masahiko Fujino
The Japanese Journal of Gastroenterological Surgery.2017; 50(2): 112. CrossRef

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Case Report

Eosinophilic Gastroenteritis Due to Rhus Ingestion Presenting with Gastrointestinal Hemorrhage: Wonsuk Choi, Seon-Young Park, Chan Choi, Kyuman Cho, Chang-Hwan Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew; Clin Endosc 2015;48(2):174-177. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.174

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Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen.

Citations

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Systemic contact dermatitis induced by Rhus allergens in Korea: exercising caution in the consumption of this nutritious food
S. J. Park, J. W. Park, K. Y. Park, K. Li, S. J. Seo, B. J. Kim, K. H. Yoo
Clinical and Experimental Dermatology.2021; 46(2): 324. CrossRef
Upper Gastrointestinal Bleeding as the First Presentation of Eosinophilic Gastrointestinal Disease
Elif Ozdogan, Latife Doganay Caglayan, Ozlem Mizikoglu, Cigdem Arikan
JPGN Reports.2020; 1(2): e017. CrossRef
Severe upper gastrointestinal bleeding due to eosinophilic gastritis
Valentín Gonzalez-Canalizo, Nerea Segues, Andrea Medina, Silvia Torrente, Vanessa Aguilar-Gama, Paula Ortega, Luis Bujanda
Gastroenterología y Hepatología.2019; 42(5): 307. CrossRef
Severe upper gastrointestinal bleeding due to eosinophilic gastritis
Valentín Gonzalez-Canalizo, Nerea Segues, Andrea Medina, Silvia Torrente, Vanessa Aguilar-Gama, Paula Ortega, Luis Bujanda
Gastroenterología y Hepatología (English Edition).2019; 42(5): 307. CrossRef

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Original Article

A Comparison of Clinical Characteristics between Medically-treated Patients and Surgically-treated Patients with Ischemic Colitis: Nam-Chul Jin, Hyun-Soo Kim, Dae-Hyun Kim, Young-A Song, Yeon-Ju Kim, Tae-Jin Seo, Sun-Young Park, Chang-Hwan Park, Young-Eun Joo, Sung-Kyu Choi, Jong-Sun Rew; Clin Endosc 2011;44(1):38-43. Published online September 30, 2011; DOI: https://doi.org/10.5946/ce.2011.44.1.38

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Background/Aims

Ischemic colitis (IC) is usually a self-limiting disease. But, it can cause necrosis that requires urgent surgical treatment. We sought to evaluate clinical difference in IC patients between medical and surgical treatment groups, and to identify prognostic factors for adverse outcomes.

Methods

We conducted a retrospective analysis of clinical characteristics in patients with IC treated in Chonnam National University Hospital between May 2001 and April 2010. A total of 81 patients with IC were enrolled. We classified the patients into two groups-a medical treatment group and a surgical treatment group-and evaluated their clinical features, treatment outcomes and mortality.

Results

Absence of hematochezia, vomiting, abdominal tenderness, abdominal rebound tenderness, heart rate over 90 beats/min, systolic blood pressure less than 100 mm Hg, hyponatremia and increased LDH or serum creatinine level were observed more frequently in surgically-treated patients (p<0.05). Most cases in the medically-treated group resolved without complications (98.3%). But, about half of the cases (52.4%) of the surgically-treated group resolved and the mortality rate was 47.6%.

Conclusions

In patients with ischemic colitis, several clinical factors are associated with surgical treatment. Although IC is often selflimited, our data suggests that special attention and aggressive therapy is warranted in treating these patients.

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