Clinical Endoscopy

Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea: Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo‐In Lee, Jin Il Kim, Han Hee Lee; Received May 3, 2024 Accepted June 1, 2024 Published online September 23, 2024; DOI: https://doi.org/10.5946/ce.2024.110 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement.
Methods
All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings.
Results
The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved.
Conclusions
This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.

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Current status and clinical outcome of endoscopic hemostatic powder in gastrointestinal bleeding: a retrospective multicenter study: Zie Hae Lim, Seung In Seo, Dae-Seong Myung, Seung Han Kim, Han Hee Lee, Selen Kim, Bo-In Lee; Clin Endosc 2024;57(5):620-627. Published online March 8, 2024; DOI: https://doi.org/10.5946/ce.2023.179

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Background
/Aims: Few multicenter studies have investigated the efficacy of hemostatic powders in gastrointestinal (GI) bleeding. We aimed to investigate the clinical outcomes of hemostatic powder therapy and the independent factors affecting rebleeding rates.
Methods
We retrospectively recruited patients who underwent a new hemostatic adhesive powder (UI-EWD; Next-Biomedical) treatment for upper and lower GI bleeding between January 1, 2020 and March 1, 2023. We collected patients’ medical records and bleeding lesions. The primary outcomes were clinical and technical success rates, and the secondary outcomes were early, delayed, and refractory bleeding, mortality, and factors affecting early rebleeding rates.
Results
This study enrolled 135 patients (age: 67.7±13.6 years, male: 74.1%) from five hospitals. Indications for UI-EWD were peptic ulcers (51.1%), post-procedure-related bleeding (23.0%), and tumor bleeding (19.3%). The clinical and technical success rates were both 97%. The early, delayed, and refractory rebleeding rates were 19.3%, 11.1%, and 12.8%, respectively. Initially elevated blood urea nitrogen (BUN) levels (p=0.014) and Forrest classification IA or IB compared with IIA or IIB (p=0.036) were factors affecting early rebleeding.
Conclusions
UI-EWD showed high clinical and technical success rates; however, rebleeding after UI-EWD therapy in patients with initially high BUN levels and active bleeding, according to the Forrest classification, should be considered.

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Endoscopic hemostatic powder as a salvage treatment for acute gastrointestinal bleeding
Duc Trong Quach
Clinical Endoscopy.2024; 57(5): 606. CrossRef

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Colon stenting as a bridge to surgery in obstructive colorectal cancer management: Dong Hyun Kim, Han Hee Lee; Clin Endosc 2024;57(4):424-433. Published online March 8, 2024; DOI: https://doi.org/10.5946/ce.2023.138

Abstract PDF PubReader ePub: Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

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The pattern of metachronous recurrence after endoscopic submucosal dissection for gastric adenocarcinoma and dysplasias: Sunah Suk, Yeon Joo Seo, Dae Young Cheung, Han Hee Lee, Jin Il Kim, Soo-Heon Park; Clin Endosc 2023;56(4):470-478. Published online April 18, 2023; DOI: https://doi.org/10.5946/ce.2022.259

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Background
/Aims: Metachronous recurrence incidences and risk factors following endoscopic submucosal dissection (ESD) for gastric adenocarcinoma and dysplasias were investigated.
Methods
Retrospective review of electronic medical records of patients who underwent gastric ESD at The Catholic University of Korea, Yeouido St. Mary’s Hospital.
Results
A total of 190 subjects were enrolled for analysis during the study period. The mean age was 64.4 years-old and the male sex occupied 73.7%. The mean observation period following ESD was 3.45 years. The annual incidence rate of metachronous gastric neoplasms (MGN) was about 3.96%. The annual incidence rate was 5.36% for the low-grade dysplasia group, 6.47% for the high-grade dysplasia group, and 2.74% for the EGC group. MGN was more frequent in the dysplasia group than in the EGC group (p<0.05). For those with MGN development, the mean time interval from ESD to MGN was 4.1 (±1.8) years. By using the Kaplan–Meier model, the estimated mean MGN free survival time was 9.97 years (95% confidence interval, 8.53–11.40) The histological types of MGN were not related to the primary histology types.
Conclusions
MGN following ESD developed in 3.96% annually and MGN was more frequent in the dysplasia group. The histological types of MGN did not correlate with those of primary neoplasm.

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Research Progress in ESD Treatment of Early Gastric Cancer
亭贺
Advances in Clinical Medicine.2024; 14(02): 4201. CrossRef
Optimal Surveillance of Metachronous Gastric Lesion after Endoscopic Resection of Early Gastric Cancer
Dong Chan Joo, Gwang Ha Kim
Gut and Liver.2024; 18(5): 781. CrossRef

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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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Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study: Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim; Clin Endosc 2021;54(3):390-396. Published online September 10, 2020; DOI: https://doi.org/10.5946/ce.2020.096

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Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

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Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study
Toshiki Horii, Sho Suzuki, Akihiro Sugita, Misa Yamauchi, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
Journal of Gastroenterology and Hepatology.2023; 38(5): 752. CrossRef
Comparison of the clinical efficacy of cold snare polypectomy using a thin-wire snare and thick-wire snare for small colorectal polyps
Hong Jin Yoon, Yunho Jung, Young Sin Cho, Il-Kwun Chung
International Journal of Gastrointestinal Intervention.2023; 12(4): 183. CrossRef
Big Issues on Small Polyps: An Ideal Device, But Is It for an Ideal Indication?
Yoji Takeuchi
Clinical Endoscopy.2021; 54(3): 297. CrossRef
Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence
Raquel Ortigão, Jochen Weigt, Ahmed Afifi, Diogo Libânio
United European Gastroenterology Journal.2021; 9(8): 938. CrossRef

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Image-Enhanced Endoscopy in Lower Gastrointestinal Diseases: Present and Future: Han Hee Lee, Bo-In Lee; Clin Endosc 2018;51(6):534-540. Published online November 30, 2018; DOI: https://doi.org/10.5946/ce.2018.187

Abstract PDF PubReader ePub

From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.

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From Staining Techniques to Artificial Intelligence: A Review of Colorectal Polyps Characterization
Kareem Khalaf, Mary Raina Angeli Fujiyoshi, Marco Spadaccini, Tommy Rizkala, Daryl Ramai, Matteo Colombo, Alessandro Fugazza, Antonio Facciorusso, Silvia Carrara, Cesare Hassan, Alessandro Repici
Medicina.2024; 60(1): 89. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
Yunho Jung
The Korean Journal of Internal Medicine.2024; 39(4): 563. CrossRef
Classification and endoscopic diagnosis of colorectal polyps
Ji Hyun Kim, Sung Chul Park
Journal of the Korean Medical Association.2023; 66(11): 633. CrossRef
Evaluation of the Serrated Lesions Detection Rate and Its Role as a Colonoscopy Quality Criteria
Conceição de Maria Aquino Vieira Clairet, José Luis Braga De Aquino, Laurent Martial Clairet
Journal of Coloproctology.2021; 41(03): 228. CrossRef
Impact of new techniques on adenoma detection rate based on meta-analysis data
Chih-Wei Tseng, FelixW Leung, Yu-Hsi Hsieha
Tzu Chi Medical Journal.2020; 32(2): 131. CrossRef

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Factors Affecting Endoscopic Curative Resection of Gastric Cancer in the Population-Based Screening Era: Yoon Gwon Mun, Myung-Gyu Choi, Chul-Hyun Lim, Han Hee Lee, Dong Hoon Kang, Jae Myung Park, Kyo Young Song; Clin Endosc 2018;51(5):478-484. Published online June 1, 2018; DOI: https://doi.org/10.5946/ce.2018.006

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Background
/Aims: Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer.
Methods
We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer.
Results
Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection.
Conclusions
Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer.

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A model established using marital status and other factors from the Surveillance, Epidemiology, and End Results database for early stage gastric cancer
Lixiang Zhang, Baichuan Zhou, Panquan Luo, Aman Xu, Wenxiu Han, Zhijian Wei
Journal of Investigative Medicine.2022; 70(6): 1373. CrossRef
Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea
Si Hyung Lee, Min Cheol Kim, Seong Woo Jeon, Kang Nyeong Lee, Jong Jae Park, Su Jin Hong
Clinical Endoscopy.2020; 53(2): 196. CrossRef
The More, the Better: Is This True in Endoscopy for Gastric Cancer Screening?
Seong Woo Jeon
Clinical Endoscopy.2018; 51(5): 402. CrossRef

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