Clinical Endoscopy

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Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions: Hung Leng Kaan, Khek Yu Ho; Clin Endosc 2020;53(5):541-549. Published online February 17, 2020; DOI: https://doi.org/10.5946/ce.2019.161

Standard polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are established techniques for the treatment of gastrointestinal tumors. However, resection of submucosal tumors via ESD often results in low rates of microscopically margin-negative (R0) resection and high rates of perforation. Endoscopic full thickness resection (EFTR) overcomes this adverse event and aids in the therapeutic management of complex tumors.
Multiple techniques for EFTR have been developed, each with its own advantages and disadvantages. Submucosal tunneling and nonexposed techniques are generally preferable, because the layer of overlying intact mucosa reduces the incidence of intraperitoneal contamination by the gastric fluid and dissemination of the tumor cells. However, adoption of EFTR by endoscopists in clinical practice remains low. The major challenge seems to be the technical difficulty in performing laparoscopic and/or endoscopic suturing using the currently available instruments.
We developed a novel robotic endoscopic platform with suturing capabilities to overcome the technical challenges of suturing. This platform allows easy maneuvering and triangulation of the instruments, thus facilitating endoscopic suturing using robotic arms. Our studies have demonstrated that this robotic endoscopic platform with suturing capabilities is an effective and safe method for performing EFTR with endoscopic suturing.

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New endoscopic closure technique, “internal traction–assisted suspended closure,” for GI defect closure: a pilot study (with video)
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Effect of endoscopic full-thickness resection assisted by distal serosal turnover with floss traction for gastric submucosal masses
Tian-Wen Liu, Xiao-Feng Lin, Shu-Ting Wen, Jing-Yi Xu, Zhao-Li Fu, Shu-Min Qin
World Journal of Clinical Cases.2024; 12(16): 2738. CrossRef
Laparoscopy-assisted nonexposed endoscopic full-thickness resection for local resection after endoscopic submucosal dissection
Deepak Madhu, Yohei Minato, Susumu Banjoya, Nao Takeuchi, Shunya Takayanagi, Kohei Ono, Motomu Tanaka, Ken Ohata
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Jin Woong Cho
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Serosal overturning assisted endoscopic full‐thickness mucosal resection of extraneous giant mass at the esophagogastric junction
Shumin Qin, Xiaofeng Lin, Shuting Wen, Tianwen Liu
Clinical Case Reports.2024;[Epub] CrossRef
Using Robotic Endoscopic Platforms to Perform Gastric Endoscopic Submucosal Dissection – Benefits and Future Development
Hung Leng Kaan, Khek Yu Ho
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Cem Simsek, Hung Leng Kaan, Hiroyuki Aihara
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Qinbo Cai, Huafeng Fu, Lele Zhang, Minxuan Shen, Shaoxiong Yi, Rongman Xie, Wentong Lan, Wenqing Dong, Xiaolian Chen, Jie Zhang, Xun Hou, Yulong He, Dongjie Yang
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Endoscopic Resection with One-Port Placement: A Newly Developed Technique for the Safe Management of Advanced Endoscopic Resection for Gastric Gastrointestinal Stromal Tumors
Atsushi Sawada, Kingo Hirasawa, Chiko Sato, Sho Sato, Tsutomu Sato, Kazuya Sugimori, Chikara Kunisaki, Shin Maeda
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Li-Jun Zhou, Fei Xing, Dan Chen, Yan-Na Li, Shoaib Mohammad Rafiq
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Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
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Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
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Clinical adoption of robotics in endoscopy: Challenges and solutions
Hung Leng Kaan, Khek Yu Ho
JGH Open.2020; 4(5): 790. CrossRef

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Robotics for Advanced Therapeutic Colonoscopy: Jennie Y Y Wong, Khek Yu Ho; Clin Endosc 2018;51(6):552-557. Published online August 21, 2018; DOI: https://doi.org/10.5946/ce.2018.089

Abstract PDF PubReader ePub

Although colonoscopy was originally a diagnostic imaging procedure, it has now expanded to include an increasing range of therapeutic interventions. These procedures require precise maneuvers of instruments, execution of force, efficient transmission of force from the operator to the point of application, and sufficient dexterity in the mobilization of endoscopic surgical instruments. The conventional endoscope is not designed to support technically demanding endoscopic procedures. In case of colonoscopy, the tortuous anatomy of the colon makes inserting, moving, and orientating the endoscope difficult. Exerting excessive pressure can cause looping of the endoscope, pain to the patient, and even perforation of the colon. To mitigate the technical constraints, numerous technically enhanced systems have been developed to enable better control of instruments and precise delivery of force in the execution of surgical tasks such as apposing, grasping, traction, counter-traction, and cutting of tissues. Among the recent developments are highly dexterous robotic master and slave systems, computer-assisted or robotically enhanced conventional endoscopes, and autonomously driven locomotion devices that can effortlessly traverse the colon. Developments in endoscopic instrumentations have overcome technical barriers and opened new horizons for further advancements in therapeutic interventions. This review describes examples of some of these systems in the context of their applications to advanced therapeutic colonoscopy.

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Endoscopic Submucosal Dissection of Large Pseudo-Polyps in the Right Colon Using a Novel Articulating Grasper With a Double-Balloon Endolumenal Surgical Platform: An Ex Vivo Study in a Porcine Colorectal Model
Shinya Urakawa, Kota Momose, Yohei Kono, Teijiro Hirashita, Makoto Nishimura, Jeffrey W. Milsom
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Alaa Eldin Abdelaal, Prateek Mathur, Septimiu E. Salcudean
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Diogo Turiani Hourneaux de Moura, Hiroyuki Aihara, Pichamol Jirapinyo, Galileu Farias, Kelly E. Hathorn, Ahmad Bazarbashi, Amit Sachdev, Christopher C. Thompson
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188 Download
14 Web of Science
18 Crossref

Raman Spectroscopy for the Endoscopic Diagnosis of Esophageal, Gastric, and Colonic Diseases: Neel Sharma, Nobuyoshi Takeshita, Khek Yu Ho; Clin Endosc 2016;49(5):404-407. Published online September 22, 2016; DOI: https://doi.org/10.5946/ce.2016.100

Abstract PDF PubReader ePub

Globally white-light endoscopy with biopsy sampling is the gold standard diagnostic modality for esophageal, gastric, and colonic pathologies. However, there is overwhelming evidence to highlight the deficiencies of an approach based predominantly on eyeball visualization. Biopsy sampling is also problematic due in part to excessive sampling and hence attendant cost. Various innovations are currently taking place in the endoscopic domain to aid operators in diagnosis forming. These include narrow band imaging which aims to enhance the surface anatomy and vasculature, and confocal laser endomicroscopy which provides real time histological information. However, both of these tools are limited by the skill of the operator and the extensive learning curve associated with their use. There is a gap therefore for a new form of technology that relies solely on an objective measure of disease and reduces the need for biopsy sampling. Raman spectroscopy (RS) is a potential platform that aims to satisfy these criteria. It enables a fingerprint capture of tissue in relation to the protein, DNA, and lipid content. This focused review highlights the strong potential for the use of RS during endoscopic gastroenterological examination.

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Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations: Nobuyoshi Takeshita, Khek Yu Ho; Clin Endosc 2016;49(5):438-443. Published online August 30, 2016; DOI: https://doi.org/10.5946/ce.2016.104

Abstract PDF PubReader ePub

Full-thickness gastrointestinal defects such as perforation, anastomotic leak, and fistula are severe conditions caused by various types of pathologies. They are more likely to require intensive care and a long hospital stay and have high rates of morbidity and mortality. After intentional full-thickness opening of hollow organs for natural orifice transluminal endoscopic surgery, safe and secure closure is urgently required. The currently available advanced endoscopic closing techniques have a major role in the treatment of full-thickness gastrointestinal defects. Appropriate usage of these techniques requires taking into account their advantages and limitations during practical application. We reviewed the available endoscopic modalities, including endoscopic clips, stents, vacuum-assisted closure, gap filling, and suturing devices, discussed their advantages and limitations when treating full-thickness gastrointestinal defects, and explored emerging innovations, including a novel endoluminal surgical platform for versatile suturing and a cell-laden scaffold for effective gap filling. Although these emerging technologies still require further pre-clinical and clinical trials to assess their feasibility and efficacy, the available modalities may be replaced and refined by these new techniques in the near future.

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