Clinical Endoscopy

Focused Review Series: Image-Enhanced Endoscopy: Update on Clinical Practice

Current Status of Image-Enhanced Endoscopy for Early Identification of Esophageal Neoplasms: Shin Hee Kim, Su Jin Hong; Clin Endosc 2021;54(4):464-476. Published online July 26, 2021; DOI: https://doi.org/10.5946/ce.2021.186

Advanced esophageal cancer is known to have a poor prognosis. The early detection of esophageal neoplasms, including esophageal dysplasia and early esophageal cancer, is highly important for the accurate treatment of the disease. However, esophageal dysplasia and early esophageal cancer are usually subtle and can be easily missed. In addition to the early detection, proper pretreatment evaluation of the depth of invasion of esophageal cancer is very important for curative treatment. The progression of non-invasive diagnosis via image-enhanced endoscopy techniques has been shown to aid the early detection and estimate the depth of invasion of early esophageal cancer and, as a result, may provide additional opportunities for curative treatment. Here, we review the advancement of image-enhanced endoscopy-related technologies and their role in the early identification of esophageal neoplasms.

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Application of artificial intelligence-assisted endoscopic detection of early esophageal cancer
Qing Li, Bing-Rong Liu
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Original Articles

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, Korean Society of Gastrointestinal Endoscopy Endoscopic Submucosal Dissection Research Group; Clin Endosc 2020;53(2):196-205. Published online October 25, 2019; DOI: https://doi.org/10.5946/ce.2019.123

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Background
/Aims: The purpose of this study was to investigate the risk factors and long-term clinical outcomes of non-curative resection (NCR) in a large-scale patient population.
Methods
We retrospectively analyzed the clinical data of 3,094 patients who underwent endoscopic submucosal dissection (ESD) of early gastric cancer from March 2005 to March 2018 at 13 institutions in Korea. We analyzed the risk factors for NCR and the survival between patients with curative resection and those with NCR with no additional treatment.
Results
The NCR rate was 21.4% (661/3,094). In multivariate regression analysis, the risk factors affecting NCR with ESD were old age, undifferentiated tumor, tumor location in the upper body, tumor size ≥2 cm, and presence of an ulcer. In Cox proportional hazard regression analysis, tumor size ≥2 cm, submucosal invasion, positive horizontal margin, and lymphovascular invasion were risk factors for local recurrence. In Kaplan-Meier analysis, there was no statistically significant difference in the overall survival between the two groups (log-rank p=0.788). However, disease-specific survival was significantly lower in the NCR group (log-rank p=0.038).
Conclusions
Clinicians should be aware of the risk factors for NCR and local recurrence after ESD for early gastric cancer, and should consider providing additional treatment after NCR.

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Risk factors for pathological upgrading and noncurative resection in patients with gastric mucosal lesions after endoscopic submucosal dissection
Pingjiang Wang, Xu Zhao, Ruicai Wang, Dong Xu, Haiping Yang
BMC Gastroenterology.2024;[Epub] CrossRef
Pathology Reporting of Gastric Endoscopic Resections: Recommendations From the International Collaboration on Cancer Reporting
Chanjuan Shi, Fleur Webster, Iris D. Nagtegaal, Michael J. Bourke, Seung-mo Hong, M. Priyanthi Kumarasinghe, Alfred K. Lam, Gregory Lauwers, Maria O’Donovan, Rachel S. van der Post, Tetsuo Ushiku, Michael Vieth, Christina Selinger
Gastroenterology.2023; 164(7): 1039. CrossRef
Nomogram for pre-procedural prediction of non-curative endoscopic resection in patients with early gastric cancer
So Young Han, Hong Jin Yoon, Jie-Hyun Kim, Hye Sun Lee, Jaeyoung Chun, Young Hoon Youn, Hyojin Park
Surgical Endoscopy.2023; 37(6): 4594. 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
Cancer Patient Perception Survey to Develop Korean Medicine Clinical Practice Guidelines for Gastric Cancer
Dong Hyeon Kim, Jong Hee Kim, Ji Hye Park, Hwa Seung Yoo, Hyeong Joon Jeon, So Jung Park
Journal of Physiology & Pathology in Korean Medicine.2023; 37(4): 81. CrossRef
Endoscopic treatment for early gastric cancer
Ji Yong Ahn
Journal of the Korean Medical Association.2022; 65(5): 276. 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
Endoscopic diagnosis of early gastric cancer
Dong Chan Joo, Gwang Ha Kim
Journal of the Korean Medical Association.2022; 65(5): 267. CrossRef
Long‑term outcome of the endoscopic submucosal dissection of early gastric cancer: A comparison between patients with and without liver cirrhosis
Seung Kim, Moon Joo, Ah-Young Yoo, Seong Kim, Won Kim, Beom Lee, Jong Park, Hoon Chun, Sang Lee
Oncology Letters.2022;[Epub] CrossRef
Clinico-pathologic determinants of non-e-curative outcome following en-bloc endoscopic submucosal dissection in patients with early gastric neoplasia
Kidane Siele Embaye, Chao Zhang, Matiwos Araya Ghebrehiwet, Zhihao Wang, Fengdi Zhang, Liwei Liu, Shenghui Qin, Lingzhi Qin, Jun Wang, Xi Wang
BMC Cancer.2021;[Epub] CrossRef
Factors associated with overall survival in early gastric cancer patients who underwent additional surgery after endoscopic submucosal dissection
Zhi Zheng, Fan-Di Bu, Hao Chen, Jie Yin, Rui Xu, Jun Cai, Jun Zhang, Hong-Wei Yao, Zhong-Tao Zhang
World Journal of Clinical Cases.2021; 9(10): 2192. CrossRef
Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study
Chang Seok Bang, Ji Yong Ahn, Jie-Hyun Kim, Young-Il Kim, Il Ju Choi, Woon Geon Shin
Journal of Medical Internet Research.2021; 23(4): e25053. CrossRef
Population Attributable Fraction of Helicobacter pylori Infection–Related Gastric Cancer in Korea: A Meta-Analysis
Yoon Park, Moran Ki
Cancer Research and Treatment.2021; 53(3): 744. CrossRef
Very low rate of residual neoplasia after non-curative endoscopic submucosal dissection: a western single-center experience
João Santos-Antunes, Margarida Marques, Fátima Carneiro, Guilherme Macedo
European Journal of Gastroenterology & Hepatology.2021; 33(9): 1161. CrossRef
Editors' Choice of Noteworthy Clinical Endoscopy Publications in the First Decade
Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
Clinical Endoscopy.2021; 54(5): 633. CrossRef
Non-Curative Resection: Should Clinicians Consider Providing Additional Surgery for All Patients?
Waku Hatta, Takuji Gotoda, Atsushi Masamune
Clinical Endoscopy.2020; 53(2): 109. CrossRef
Protocol for expanded indications of endoscopic submucosal dissection for early gastric cancer in China: a multicenter, ambispective, observational, open-cohort study
Zhi Zheng, Jie Yin, Ziyu Li, Yingjiang Ye, Bo Wei, Xin Wang, Yantao Tian, Mengyi Li, Qian Zhang, Na Zeng, Rui Xu, Guangyong Chen, Jie Zhang, Peng Li, Jun Cai, Hongwei Yao, Jun Zhang, Zhongtao Zhang, Shutian Zhang
BMC Cancer.2020;[Epub] CrossRef
Predictive Factors and Long-Term Outcomes of Early Gastric Carcinomas in Patients with Non-Curative Resection by Endoscopic Submucosal Dissection

Ping Xu, Yun Wang, Yini Dang, Qin Huang, Jianhua Wang, Weifeng Zhang, Yifeng Zhang, Guoxin Zhang
Cancer Management and Research.2020; Volume 12: 8037. CrossRef

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Bleeding after Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis: A Multicenter Propensity Score-Matched Analysis: In Kyung Yoo, Chan Gyoo Kim, Young Ju Suh, Younkyung Oh, Gwang Ho Baik, Sun Moon Kim, Young Dae Kim, Chul-Hyun Lim, Jung Won Jeon, Su Jin Hong, Byoung Wook Bang, Joon Sung Kim, Jun-Won Chung; Clin Endosc 2020;53(4):452-457. Published online October 25, 2019; DOI: https://doi.org/10.5946/ce.2019.107

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Background
/Aims: Frequent bleeding after endoscopic resection (ER) has been reported in patients with end-stage renal disease (ESRD). We aimed to evaluate the association and clinical significance of bleeding with ER in ESRD patients on dialysis.
Methods
Between February 2008 and December 2018, 7,571 patients, including 47 ESRD patients on dialysis who underwent ER for gastric neoplasia, were enrolled. A total of 47 ESRDpatients on dialysis were propensity score-matched 1:10 to 470 non-ESRD patients, to adjust for between-group differences in variables such as age, sex, comorbidities, anticoagulation use, tumor characteristics, and ER method. Matching was performed using an optimal matching algorithm. For the matched data, clustered comparisons were performed using the generalized estimating equation method. Medical records were retrospectively reviewed. Frequency and outcomes of post-ER bleeding were evaluated.
Results
Bleeding was more frequent in the ESRD with dialysis group than in the non-ESRD group. ESRD with dialysis conferred a significant risk of post-ER bleeding (odds ratio, 6.1; 95% confidence interval, 2.7–13.6; p<0.0001). All post-ER bleeding events were controlled using endoscopic hemostasis except in 1 non-ESRD case that needed surgery.
Conclusions
ESRD with dialysis confers a bleeding risk after ER. However, all bleeding events could be managed endoscopically without sequelae. Concern about bleeding should not stop endoscopists from performing ER in ESRD patients on dialysis.

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The Outcomes of Colorectal Endoscopic Submucosal Dissection in Patients with Chronic Kidney Disease: A Honam Association for the Study of Intestinal Disease (HASID) Multicenter Study
Byung Chul Jin, Dong Hyun Kim, Geom-Seog Seo, Sang-Wook Kim, Hyung-Hoon Oh, Hyo-Yeop Song, Seong-Jung Kim, Young-Eun Joo, Jun Lee, Hyun-Soo Kim
Diagnostics.2024; 14(13): 1459. CrossRef
Characteristics of factors contributing to follow-up for suspected delayed bleeding after colorectal endoscopic submucosal dissection
Satsuki Takahashi, Kenichiro Okimoto, Tomoaki Matsumura, Yuhei Oyama, Hayato Nakazawa, Yukiyo Mamiya, Chihiro Goto, Ryosuke Horio, Akane Kurosugi, Michiko Sonoda, Tatsuya Kaneko, Naoki Akizue, Yuki Ohta, Takashi Taida, Keiko Saito, Jun Kato, Naoya Kato
Gastrointestinal Endoscopy.2024;[Epub] CrossRef
Effect of renal insufficiency on the short‐ and long‐term outcomes of endoscopic submucosal dissection for early gastric cancer: Propensity score‐matched analysis
Tae‐Se Kim, Byung‐Hoon Min, Sun‐Young Baek, Kyunga Kim, Yang Won Min, Hyuk Lee, Poong‐Lyul Rhee, Jae J. Kim, Jun Haeng Lee
Digestive Endoscopy.2023; 35(7): 869. CrossRef
Safeness of Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis
Sun-Jin Boo
Clinical Endoscopy.2020; 53(4): 381. CrossRef

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Immunohistochemical Expression of Epithelial-Mesenchymal Transition Markers in Early Gastric Cancer: Cancer Tissue versus Noncancer Tissue: Hee Jae Jung, Su Jin Hong, Shin Hee Kim; Clin Endosc 2019;52(5):464-471. Published online May 22, 2019; DOI: https://doi.org/10.5946/ce.2018.181

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Background
/Aims: Epithelial-mesenchymal transition (EMT) is a developmental process, wherein the epithelial cells show reduced intercellular adhesions and acquire migratory fibroblastic properties. EMT is associated with downregulation in epithelial marker expression, abnormal translocation of E-cadherin, and upregulation in mesenchymal marker expression. Here, we investigated the immunohistochemical (IHC) expression of EMT markers in early gastric cancer (EGC) between cancer and noncancer tissues.
Methods
Tissue samples were prospectively obtained from 19 patients with EGC that underwent endoscopic submucosal dissection (ESD). We compared the expression level of transforming growth factor (TGF)-β, vascular endothelial growth factor (VEGF), E-cadherin, α-smooth muscle actin (α-SMA), and vimentin between cancer and noncancer tissues using IHC. Among the 19 patients, 15 patients had follow-up biopsy at 3 months after ESD for EGC.
Results
Cancer tissues presented higher values of EMT mesenchymal markers (α-SMA/vimentin/TGF-β/VEGF) than the noncancerous tissues (p<0.05) that were significantly low after ESD (p<0.05). No significant correlation was reported for tumor location and initial Helicobacter pylori infection.
Conclusions
The mesenchymal expression of EMT markers was higher in the cancerous tissues than in the noncancer tissues.

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Gastric Carcinoma with low ROR alpha, low E- Cadherin and High LAPTM4B Immunohistochemical Profile; is associated with unfavorable prognosis in Egyptian patients
Shereen Nagib El Mashad, Mona Abd El Halim Kandil, Taysseer Abd El-Hamid Talab, Abd El Naby Saied Abd El Naby, Mervat Mahmoud Sultan, Ahmed Sohaib, Aiat Shaban Hemida
Journal of Immunoassay and Immunochemistry.2024; 45(1): 50. CrossRef
Hematological, histomorphological, and immunohistochemical diagnosis of bilateral testicular Sertoli cell tumor in a Mongrel dog: a case history
Samson Eneojo Abalaka, Zakariya Audu
Comparative Clinical Pathology.2024; 33(4): 511. CrossRef
MiR-522-3p Targets Transcription Factor 4 to Overcome Cisplatin Resistance of Gastric Cells
Guofeng Ma, Wen Xue, Jie Ni, Ran Tao, Xiangya Ding
Journal of Oncology.2022; 2022: 1. CrossRef
Investigating Helicobacter pylori-related pyloric hypomotility: functional, histological, and molecular alterations
Aya Aly Ashraf, Sarah Mahmoud Gamal, Hend Ashour, Basma Emad Aboulhoda, Laila Ahmed Rashed, Inas Anas Harb, Gaber Hassan Abdelfattah, Eman Ahmed El-Seidi, Heba Mohamed Shawky
American Journal of Physiology-Gastrointestinal and Liver Physiology.2021; 321(5): G461. CrossRef

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Efficacy of Albis for the Prevention of Gastric Mucosal Injury Concomitant with the Use of Low-Dose Aspirin: A Prospective, Randomized, Placebo-Controlled Study: Sang Gyun Kim, Nayoung Kim, Sung Kwan Shin, In Kyung Sung, Su Jin Hong, Hyo-Jin Park; Clin Endosc 2017;50(2):179-184. Published online May 19, 2016; DOI: https://doi.org/10.5946/ce.2016.031

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Background
/Aims: Long-term use of aspirin can be a risk factor of peptic ulcer diseases. The aim of this study was to evaluate the efficacy of Albis (Daewoong Pharmaceutical Co., Ltd.) for the prevention of gastric mucosal injury caused by aspirin.
Methods
Aspirin users were enrolled and randomized into the Albis or placebo group. Screening and follow-up endoscopy were performed for modified Lanza scores (MLSs). Primary outcome was measured by the incidence rate of peptic ulcer, and secondary outcomes were measured by the incidence rate of gastritis, improvement in MLS and subjective symptoms.
Results
In total, 81 aspirin users were randomized, 43 in the Albis group and 38 in the placebo group. There was no incidence of peptic ulcer in both groups. The incidence of gastritis was significantly higher in the placebo group (44.4% vs. 10.0%, p=0.003); however, the scores of mucosal edema, hyperemia and hemorrhage were not statistically different between the two groups (p>0.05). The frequency of subjective symptoms were more improved in the Albis group than in the placebo group (p=0.023).
Conclusions
The incidence of gastritis was lower in the group that received low-dose aspirin and Albis. The development of peptic ulcer due to long-term use of aspirin might be prevented with concomitant use of Albis.

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Xiaojianzhong decoction attenuates gastric mucosal injury by activating the p62/Keap1/Nrf2 signaling pathway to inhibit ferroptosis
Juan Chen, Jiaxiang Zhang, Ting Chen, Shengchuan Bao, Jingtao Li, Hailiang Wei, Xin Hu, Yan Liang, Fanrong Liu, Shuguang Yan
Biomedicine & Pharmacotherapy.2022; 155: 113631. CrossRef
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Satoru Shinoda, Kouji Yamamoto, Kouji Tahata, Sadao Tomizawa
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Case Report

"Cat Scratch Colon" in a Patient with Ischemic Colitis: Eui Ju Park, Joon Seong Lee, Tae Hee Lee, Dae Han Choi, Eui Bae Kim, Seong Ran Jeon, Su Jin Hong, Jin-Oh Kim; Clin Endosc 2015;48(2):178-180. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.178

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"Cat scratch colon" is a gross finding characterized by hemorrhagic mucosal scratches on colonoscopy. It is usually associated with a normal colon and is rarely associated with collagenous colitis. In a previous report, cat scratch colon was noted in the cecum and ascending colon, but has also been observed in the distal transverse colon. The patient in this study was also diagnosed with ischemic colitis that may have played a role in the development of cat scratch colon.

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An unexpected finding of cat scratch colon in a screening colonoscopy
Natalia Mora Cuadrado, Noelia Alcaide Suárez, Beatriz Antolín Melero, Beatriz Burgueño Gómez, Miguel Durà Gil, Luis Ignacio Fernández Salazar, José Manuel González Hernández
Gastroenterología y Hepatología (English Edition).2019; 42(3): 172. CrossRef
Hallazgo inesperado de colon en arañazo de gato en una colonoscopia de cribado
Natalia Mora Cuadrado, Noelia Alcaide Suárez, Beatriz Antolín Melero, Beatriz Burgueño Gómez, Miguel Durà Gil, Luis Ignacio Fernández Salazar, José Manuel González Hernández
Gastroenterología y Hepatología.2019; 42(3): 172. CrossRef

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Original Article

Survey of Endoscope Reprocessing in Korea: Jeong Bae Park, Jae Nam Yang, Yun Jeong Lim, Ja Seol Koo, Jae Young Jang, Sang Hoon Park, Su Jin Hong, Sang-Woo Kim, Hoon Jai Chun, Disinfection Management Committee of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2015;48(1):39-47. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.39

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Background/Aims

There is a growing emphasis on quality management in endoscope reprocessing. Previous surveys conducted in 2002 and 2004 were not practitioner-oriented. Therefore, this survey is significant for being the first to target actual participants in endoscope reprocessing in Korea.

Methods

This survey comprised 33 self-filled questions, and was personally delivered to nurses and nursing auxiliaries in the endoscopy departments of eight hospitals belonging to the society. The anonymous responses were collected after 1 week either by post or in person by committee members.

Results

The survey included 100 participants. In the questionnaire addressing compliance rates with the reprocessing guideline, the majority (98.9%) had a high compliance rate compared to 27% of respondents in 2002 and 50% in 2004. The lowest rate of compliance with a reprocessing procedure was reported for transporting the contaminated endoscope in a sealed container. Automated endoscope reprocessors were available in all hospitals. Regarding reprocessing time, more than half of the subjects replied that reprocessing took more than 15 minutes (63.2%).

Conclusions

The quality management of endoscope reprocessing has improved as since the previous survey. A national survey expanded to include primary clinics is required to determine the true current status of endoscope reprocessing.

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Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5‐year experience in an endoscopy center
Shu‐Hui Chen, Theophile Liu, Huei‐Wen Lai, Hui‐Lan Chang, Hsu‐Heng Yen
Advances in Digestive Medicine.2022; 9(2): 103. CrossRef
A nationwide survey on the effectiveness of training on endoscope reprocessing within the national cancer screening program in Korea
Hye Young Shin, Da Hun Jang, Jae Kwan Jun
American Journal of Infection Control.2021; 49(8): 1031. CrossRef
Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey
Giancarlo Spinzi, Angelo Milano, Piero Brosolo, Paola Da Massa Carrara, Maurizio Labardi, Alberto Merighi, Luisa Riccardi, Francesco Torresan, Maurizio Capelli
Endoscopy International Open.2021; 09(11): E1627. CrossRef
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Hee Seok Moon, Eun Kwang Choi, Ji Hyun Seo, Jeong Seop Moon, Ho June Song, Kyoung Oh Kim, Jong Jin Hyun, Sung Kwan Shin, Beom Jae Lee, Sang Heon Lee
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Yu Kyung Cho, Jeong Seop Moon, Dong Su Han, Yong Chan Lee, Yeol Kim, Bo Young Park, Il-Kwun Chung, Jin-Oh Kim, Jong Pil Im, Jae Myung Cha, Hyun Gun Kim, Sang Kil Lee, Hang Lak Lee, Jae Young Jang, Eun Sun Kim, Yunho Jung, Chang Mo Moon
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Adequacy of Reprocessing Gastrointestinal Endoscopes in Korea Hospitals
YoungOk Kim, Jae Sim Jeong
Journal of Korean Biological Nursing Science.2016; 18(4): 288. CrossRef
Role of Clinical Endoscopy in Emphasizing Endoscope Disinfection
Ji Kon Ryu, Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ki Baik Hahm
Clinical Endoscopy.2015; 48(5): 351. CrossRef
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Young-Seok Cho
Clinical Endoscopy.2015; 48(1): 1. CrossRef

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Review

A Review of Current Disinfectants for Gastrointestinal Endoscopic Reprocessing: Sanghoon Park, Jae Young Jang, Ja Seol Koo, Jeong Bae Park, Yun Jeong Lim, Su Jin Hong, Sang-Woo Kim, Hoon Jai Chun, Disinfection Management Committee, The Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2013;46(4):337-341. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.337

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Gastrointestinal endoscopy is gaining popularity for diagnostic and therapeutic purposes. However, concerns over endoscope-related nosocomial infections are increasing, together with interest by the general public in safe and efficient endoscopy. For this reason, reprocessing the gastrointestinal endoscope is an important step for effective performance of endoscopy. Disinfectants are essential to the endoscope reprocessing procedure. Before selecting an appropriate disinfectant, their characteristics, limitations and means of use must be fully understood. Herein, we review the characteristics of several currently available disinfectants, including their uses, potency, advantages, and disadvantages. Most disinfectants can be used to reprocess gastrointestinal endoscopes if the manufacturer's guidelines are followed. The selection and use of a suitable disinfectant depends on the individual circumstances of each endoscopy suite.

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Original Articles

Peroral Endoscopic Myotomy for Treatment of Achalasia: Initial Results of a Korean Study: Byung Hoo Lee, Kwang Yeun Shim, Su Jin Hong, Gene Hyun Bok, Jun-Hyung Cho, Tae Hee Lee, Joo Young Cho; Clin Endosc 2013;46(2):161-167. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.161

Abstract PDF PubReader ePub

Background/Aims

Achalasia is a rare esophageal motility disorder. Recently, a novel endoscopic technique, peroral endoscopic myotomy (POEM), was introduced as an alternative treatment for achalasia. We report the results and short term outcomes of POEM for patients with achalasia.

Methods

POEM was performed in 13 patients with achalasia. The procedure consisted of creating a submucosal tunnel followed by endoscopic myotomy of circular muscle bundles. The mucosal entry was closed by conventional hemostatic clips. A validated clinical symptom score (Eckardt score) and high resolution manometry were used to evaluate the outcomes.

Results

Both the clinical score of achalasia, as well as the resting lower esophageal sphincter (LES) pressure, were significantly reduced after POEM. Mean posttreatment Eckardt score was 0.4±0.7, compared to 6.4±1.9 prior to the treatment (p=0.001). The mean pretreatment and posttreatment LES pressure was 30.3 and 15.3 mm Hg, respectively (p=0.007). Following POEM, symptomatic relief from dysphagia without reflux symptoms was observed in all patients (13/13). No serious complications related to POEM were encountered.

Conclusions

Based upon our initial experience, the authors believe that POEM is a feasible, safe, and effective treatment and may possibly substitute established treatments of refractory achalasia.

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The Early Onset of Disease May Be a Risk Factor for Decreased Bone Mineral Density in Patients with Inflammatory Bowel Disease: Hwa Jong Kim, Su Jin Hong, Young Woo Jeon, Jae Pil Han, Seung Hyo Han, Jee Heon Kang, Jae Woong Tae, Hee Sook Lim, Hee Kyung Kim, Bong Min Ko, Moon Sung Lee; Clin Endosc 2013;46(1):71-76. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.71

Abstract PDF PubReader ePub

Background/Aims

The pathogenesis of bone loss in patients with inflammatory bowel disease (IBD) is complex, multifactorial, and only partly understood. We aimed to examine the extent and risk factors of bone mass reduction and to analyze the impact of early onset of a disease before attaining peak bone mass in IBD patients.

Methods

We compared the risk factors for osteoporosis and BMD at the lumbar spine and the hip bone in IBD patients.

Results

A total of 44 patients with IBD were enrolled. Twenty-one and 23 patients were diagnosed as IBD before and after the age of 30 and designated as group A and group B, respectively. Group A had significant bone mass reduction at the lumbar spine than group B (BMD, 1.01±0.10 vs. 1.14±0.17, p<0.01; T-score, -1.22±0.84 vs. -0.08±1.39, p<0.01; Z-score, -1.11±0.81 vs. -0.03±1.32, p<0.01, respectively). Multivariate analysis showed that patients diagnosed as IBD before the age of 30 had possible risk factor of bone mass reduction (hazard ratio, 3.96; p=0.06).

Conclusions

Bone mass reduction was more severe in patients who were diagnosed with IBD before the age of 30 than in those diagnosed after the age of 30.

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Case Report

Aortoenteric Fistula Diagnosed by Double Balloon Enteroscopy: A Case Report: Hyung Geun Yoon, Bong Min Ko, Jae Woong Tae, Su Jin Hong, Jong Ho Moon, Jin Oh Kim, Joon Seong Lee, Moon Sung Lee; Clin Endosc 2013;46(1):106-109. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.106

Abstract PDF PubReader ePub

A secondary aortoenteric fistula (AEF) is a direct communication between the gastrointestinal tract and the aorta in a patient who has undergone major surgery on the aorta, often an aorta graft operation. We experienced a patient who had undergone graft interposition for abdominal aortic aneurysm and was admitted due to three episodes of hematemesis and following hamatochezia. Gastroscopy, colonoscopy, and radioactive iodine scan failed to identify the bleeding site in the patient. He was diagnosed with AEF by double balloon enteroscopy and recovered after surgical intervention.

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Commentary

Peroral Endoscopic Myotomy in a Porcine Model: A Step to Achalasia Patients: Su Jin Hong; Clin Endosc 2013;46(1):1-2. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.1

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Case Report

A Hypereosinophilic Syndrome Presenting as Eosinophilic Colitis: Young Woo Jeon, Su Jin Hong, Hwa Jong Kim, Jae Pil Han, Hee Kyung Kim, Bong Min Ko, Sung Kyu Park, Moon Sung Lee; Clin Endosc 2012;45(4):444-447. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.444

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Hypereosinophilic syndrome (HES) has three defining features: marked hypereosinophilia for at least 6 months, no confirmed etiology for the eosinophilia, and eosinophilia-related symptoms or organ dysfunction. However, a shorter period of hypereosinophilia with symptoms requiring eosinophil-lowering therapy is also acceptable. We report a case of HES presenting as eosinophilic colitis. Although hypereosinophilia was present for 3 months, this patient needed to be treated with eosionphil-lowering therapy for severe hematochezia. After systemic corticosteroid therapy, symptoms caused by organ involvement were dramatically improved.

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