Clinical Endoscopy

Reviews

Drainage for fluid collections post pancreatic surgery and acute pancreatitis: similar but different?: Yousuke Nakai, Saburo Matsubara, Tsuyoshi Mukai, Tsuyoshi Hamada, Takashi Sasaki, Hirotoshi Ishiwatari, Susumu Hijioka, Hideyuki Shiomi, Mamoru Takenaka, Takuji Iwashita, Atsuhiro Masuda, Tomotaka Saito, Hiroyuki Isayama, Ichiro Yasuda, for the WONDERFUL study group in Japan; Received October 3, 2023 Accepted November 1, 2023 Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.254 [Epub ahead of print]

Abstract PDF PubReader ePub: Postoperative pancreatic fistulas (POPFs) are common adverse events that occur after pancreatic surgery. Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) is a first-line treatment, similar to that for pancreatic fluid collection (PFCs) after acute pancreatitis. However, some POPFs do not develop fluid collections depending on the presence or location of the surgical drain, whereas others develop fluid collections, such as postoperative fluid collections (POPFCs). Although POPFCs are similar to PFCs, the strategy and modality for POPF management need to be modified according to the presence of fluid collections, surgical drains, and surgical type. As discussed for PFCs, the indications, timing, and selection of interventions or stents for EUS-D have not been fully elucidated for POPFs. In this review, we discuss the management of POPFs and POPFCs in comparison with PFCs due to acute pancreatitis and summarize the topics that should be addressed in future studies.

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Management of complications related to colorectal endoscopic submucosal dissection: Tae-Geun Gweon, Dong-Hoon Yang; Clin Endosc 2023;56(4):423-432. Published online July 27, 2023; DOI: https://doi.org/10.5946/ce.2023.104

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Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

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International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
Is there a best choice of equipment for colorectal endoscopic submucosal dissection?
Francesco Cocomazzi, Sonia Carparelli, Nunzia Labarile, Antonio Capogreco, Marco Gentile, Roberta Maselli, Jahnvi Dhar, Jayanta Samanta, Alessandro Repici, Cesare Hassan, Francesco Perri, Antonio Facciorusso
Expert Review of Medical Devices.2024; 21(7): 561. CrossRef
IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. 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
Clinical meaning of sarcopenia in patients undergoing endoscopic treatment
Hiroyuki Hisada, Yosuke Tsuji, Hikaru Kuribara, Ryohei Miyata, Kaori Oshio, Satoru Mizutani, Hideki Nakagawa, Rina Cho, Nobuyuki Sakuma, Yuko Miura, Hiroya Mizutani, Daisuke Ohki, Seiichi Yakabi, Yu Takahashi, Yoshiki Sakaguchi, Naomi Kakushima, Nobutake
Clinical Endoscopy.2024; 57(4): 446. CrossRef
Endoscopic approaches for the management of giant colonic polyps
Yunho Jung
Clinical Endoscopy.2024; 57(4): 468. CrossRef
Outcome and predictive factors for perforation in orthodontic rubber band-assisted endoscopic submucosal dissection of fibrotic colorectal lesions
Linfu Zheng, Binbin Xu, Fuqiang Wang, Longping Chen, Baoxiang Luo, Zhilin Liu, Xingjie Gao, Linxin Zhou, Rong Wang, Chuanshen Jiang, Dazhou Li, Wen Wang
Scientific Reports.2024;[Epub] CrossRef
Rhabdomyolysis following colorectal endoscopic submucosal dissection: A case report
Ying Chen, Wenxuan Zhang, Junqiang Cai, Min Zhong
Clinical Case Reports.2024;[Epub] CrossRef
International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. CrossRef
Knives Out: Does the Choice of Endoscopic Knife Influence the Outcome of Colorectal Endoscopic Submucosal Dissection?
Yunho Jung
Digestive Diseases and Sciences.2024;[Epub] CrossRef

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Complications of endoscopic resection in the upper gastrointestinal tract: Takeshi Uozumi, Seiichiro Abe, Mai Ego Makiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito; Clin Endosc 2023;56(4):409-422. Published online June 21, 2023; DOI: https://doi.org/10.5946/ce.2023.024

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Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

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International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
Risk factors for intraoperative and delayed perforation related with gastric endoscopic submucosal dissection
Takuya Mimura, Yoshinobu Yamamoto, Haruhisa Suzuki, Kohei Takizawa, Toshiaki Hirasawa, Yoji Takeuchi, Kenji Ishido, Shu Hoteya, Tomonori Yano, Shinji Tanaka, Norihiko Kudara, Masahiro Nakagawa, Yumi Mashimo, Masahiro Ishigooka, Kazutoshi Fukase, Taichi Sh
Journal of Gastroenterology and Hepatology.2024; 39(7): 1358. CrossRef
IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef
International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. 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

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Original Article

Respiratory complications during recovery from gastrointestinal endoscopies performed by gastroenterologists under moderate sedation: Inna Eidelman Pozin, Amir Zabida, Moshe Nadler, Guy Zahavi, Dina Orkin, Haim Berkenstadt; Clin Endosc 2023;56(2):188-193. Published online January 10, 2023; DOI: https://doi.org/10.5946/ce.2022.033

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Background
/Aims: Data on the incidence of adverse respiratory events during recovery from gastrointestinal endoscopy are limited. The aim of this study was to investigate the incidence of these complications.
Methods
In this retrospective cohort study, data were obtained from the electronic records of 657 consecutive patients, who underwent gastroenterological procedures under sedation.
Results
Pulse oximetry oxygen saturation (SpO2) <90% for <60 seconds occurred in 82 patients (12.5%) and in 11 patients (1.7%), SpO2 of <90% for >60 seconds occurred in 79 patients (12.0%) and in 11 patients (1.7%), and SpO2 <75% occurred in four patients (0.6%) and in no patients during the procedure and recovery period, respectively. No major complications were noted. The occurrence of desaturation during recovery was correlated with desaturation during the procedure (p<0.001). American Society of Anesthesiologists score (odds ratio [OR], 1.867; 95% confidence interval [CI], 1.008–3.458), ischemic heart disease (OR, 1.815; 95% CI, 0.649–5.080), hypertension (OR, 1.289; 95% CI, 0.472–3.516), and diabetes mellitus (OR, 2.406; 95% CI, 0.950–6.095) increased the occurrence of desaturation during recovery.
Conclusions
We found no major complications during recovery after balanced propofol-based sedation administered by a gastroenterologist-nurse team. Patients with the identified risk predictors must be monitored carefully.

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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

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Review

Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections: Chi Hyuk Oh, Jun Kyu Lee, Tae Jun Song, Jin-Seok Park, Jae Min Lee, Jun Hyuk Son, Dong Kee Jang, Miyoung Choi, Jeong-Sik Byeon, In Seok Lee, Soo Teik Lee, Ho Soon Choi, Ho Gak Kim, Hoon Jai Chun, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(4):505-521. Published online July 27, 2021; DOI: https://doi.org/10.5946/ce.2021.185

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Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.

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Pancreatic Pseudocyst after Fully Covered Self-expandable Metallic Stent Placement: A Case Report
Mitsuhito Koizumi, Sho Ishikawa, Kaori Marui, Masahito Kokubu, Yusuke Okujima, Yuki Numata, Yoshiki Imamura, Teru Kumagi, Yoichi Hiasa
Internal Medicine.2024;[Epub] CrossRef
Neutrophil Gelatinase-Associated Lipocalin for the Differentiation of Mucinous Pancreatic Cystic Lesions
Miruna Patricia Olar, Maria Iacobescu, Sorana D. Bolboacă, Cristina Pojoga, Ofelia Moșteanu, Radu Seicean, Ioana Rusu, Oana Banc, Cristina Adela Iuga, Andrada Seicean
International Journal of Molecular Sciences.2024; 25(6): 3224. CrossRef
Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis
S Giri, S Bhrugumalla, S Gangadhar, S Angadi
Acta Gastro Enterologica Belgica.2024; 87(1): 1. CrossRef
Use of an endoscopic powered debridement device for treatment of post-surgical fatty pancreatic necrosis
Judy Daboul, Shiab Mussad, Anna Cecilia Amaral, Waleed K. Hussain, Peter J. Lee, Samuel Han
Clinical Endoscopy.2024; 57(3): 412. CrossRef
Single double pigtail plastic stent (DPT) is equally effective to two double pigtail plastic stent for endoscopic ultrasonography-guided drainage of "symptomatic peripancreatic fluid collection with 30 % or less necrotic debris"
Hemanta Kumar Nayak, Shubham Gupta, Manas Kumar Panigrahi, Abhijeet Rai, Saswati Kar, Mansi Chaudhary, Ajay Ghosh, Taraprasad Tripathy, Bramhadatta Pattnaik, Subash Chandra Samal
Pancreatology.2024;[Epub] CrossRef
Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
Clinical Endoscopy.2024; 57(5): 588. CrossRef
Endoscopic ultrasound-guided drainage for local complications related to pancreatitis
Hyung Ku Chon, Seong-Hun Kim
International Journal of Gastrointestinal Intervention.2023; 12(1): 7. CrossRef
A preferable modality for the differentiation of peripancreatic fluid collections: Endoscopic ultrasound
Ning Xu, Longsong Li, Danqi Zhao, Zixin Wang, Xueting Wang, Runzi Wang, Yanbo Zeng, Lei Zhang, Ning Zhong, Ying Lv, Enqiang Linghu, Ningli Chai
Endoscopic Ultrasound.2022; 11(4): 291. CrossRef
Disconnected pancreatic duct syndrome in acute pancreatitis
A.V. Fedorov, V.N. Ektov, M.A. Khodorkovsky
Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (8): 83. CrossRef
Single balloon enteroscopy-guided endoscopic retrograde pancreatography for the treatment of a symptomatic pancreatic pseudocyst complicated by pancreaticojejunostomy stricture: A case report
Eunae Cho, Chang-Hwan Park, Seo Yeon Cho
Medicine.2022; 101(43): e31293. CrossRef

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Case Report

A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection: Paraskevas Gkolfakis, Marc-André Bureau, Marianna Arvanitakis, Jacques Devière, Daniel Blero; Clin Endosc 2022;55(1):141-145. Published online April 16, 2021; DOI: https://doi.org/10.5946/ce.2021.033

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A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient’s symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

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Management of leakage and fistulas after bariatric surgery
Stephen A. Firkins, Roberto Simons-Linares
Best Practice & Research Clinical Gastroenterology.2024; 70: 101926. CrossRef
Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
Obesity Surgery.2022; 32(2): 342. CrossRef

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Original Articles

Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors: Naoki Okano, Yoshinori Igarashi, Ken Ito, Saori Mizutani, Hiroki Nakagawa, Kouji Watanabe, Yuuto Yamada, Kensuke Yoshimoto, Yuusuke Kimura, Susumu Iwasaki, Kensuke Takuma, Seiichi Hara, Yuui Kishimoto; Clin Endosc 2021;54(5):706-712. Published online March 10, 2021; DOI: https://doi.org/10.5946/ce.2020.208

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Background
/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding.
Methods
We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared.
Results
A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively.
Conclusions
HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.

Citations

Citations to this article as recorded by

Endoscopic papillectomy for ampullary lesions of minor papilla
Kien Vu Trung, Christian Heise, Einas Abou-Ali, Francesco Auriemma, Elias Karam, Sophia E. van der Wiel, Marco J. Bruno, Fabrice Caillol, Marc Giovannini, Viliam Masaryk, Uwe Will, Andrea Anderloni, Enrique Pérez-Cuadrado-Robles, Ana Dugic, Benjamin Meier
Gastrointestinal Endoscopy.2024; 99(4): 587. CrossRef
Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort
Kien Vu Trung, Einas Abou-Ali, Fabrice Caillol, Woo H. Paik, Bertrand Napoleon, Viliam Masaryk, Sophia E. van der Wiel, Enrique Pérez-Cuadrado-Robles, Nicolas Musquer, Asif Halimi, Kevin Soares, Francois R. Souche, Steffen Seyfried, Maria C. Petrone, Stef
Endoscopy.2023; 55(08): 709. CrossRef
Updates in endoscopic management of ampullary and duodenal adenomas
Pravallika Chadalavada, Tilak Upendra Shah
Current Opinion in Gastroenterology.2023; 39(6): 496. CrossRef
Submucosal Epinephrine Injection Before Endoscopic Papillectomy: Less is More?
Roy L.J. van Wanrooij, Jeanin E. van Hooft
Clinical Endoscopy.2021; 54(5): 627. CrossRef

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The Use of Endoscopic Clipping in Preventing Delayed Complications after Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumors: Jee Young An, Byung-Wook Kim, Joon Sung Kim, Jae-Myung Park, Tae Ho Kim, Jaesin Lee; Clin Endosc 2021;54(4):563-569. Published online November 24, 2020; DOI: https://doi.org/10.5946/ce.2020.109

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic resection (ER) has recently been accepted as the standard treatment modality for superficial nonampullary duodenal tumors (SNADTs). However, the procedure can cause adverse events such as perforation and bleeding. This study aimed to investigate the efficacy of prophylactic clipping in the prevention of delayed complications.
Methods
A retrospective review of the medical records of patients who underwent ER for SNADT from 3 centers was performed. Patients were divided into 2 groups: the immediate clipping group (ICG) and the no clipping group (NCG). Various baseline characteristics and factors associated with the appearance of delayed complications, such as size of the lesion, tumor location, histologic type, and co-morbidities, were compared between the two groups.
Results
A total of 99 lesions from 99 patients were included in this study. Fifty-two patients were allocated into ICG and 47 patients were allocated into NCG. Delayed bleeding occurred in 1 patient from ICG and in 8 patients from NCG. Delayed perforation occurred in 1 patient from ICG and in 3 patients from NCG. There were no procedure-related deaths in both groups.
Conclusions
Although the use of endoscopic clipping seemed to reduce the risk of developing delayed complications, further studies using a prospective design is required.

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The Effect of Tegoprazan on the Treatment of Endoscopic Resection-Induced Artificial Ulcers: A Multicenter, Randomized, Active-Controlled Study
Byung-Wook Kim, Jong Jae Park, Hee Seok Moon, Wan Sik Lee, Ki-Nam Shim, Gwang Ho Baik, Yun Jeong Lim, Hang Lak Lee, Young Hoon Youn, Jun Chul Park, In-Kyung Sung, Hyunsoo Chung, Jeong Seop Moon, Gwang Ha Kim, Su Jin Hong, Hyuk Soon Choi
Gut and Liver.2024; 18(2): 257. CrossRef
Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review
Zheng Zhao, Yue Jiao, Shuyue Yang, Anni Zhou, Guiping Zhao, Shuilong Guo, Peng Li, Shutian Zhang
Journal of Translational Internal Medicine.2023; 11(3): 206. CrossRef
Long-term outcomes of endoscopic resection for duodenal neuroendocrine tumors
Kiyoun Yi, Gwang Ha Kim, Su Jin Kim, Cheol Woong Choi, Moon Won Lee, Bong Eun Lee, Geun Am Song
Scientific Reports.2023;[Epub] CrossRef
Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment
Giuseppe Galloro, Angelo Zullo, Gaetano Luglio, Alessia Chini, Donato Alessandro Telesca, Rosa Maione, Matteo Pollastro, Giovanni Domenico De Palma, Raffaele Manta
Clinical Endoscopy.2022; 55(3): 339. CrossRef
Endoscopic Closure After Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumors
Satoshi Tanabe, Takuya Wada
Clinical Endoscopy.2021; 54(4): 453. CrossRef

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Endoscopic Yield, Appropriateness, and Complications of Pediatric Upper Gastrointestinal Endoscopy in an Adult Suite: A Retrospective Study of 822 Children: Manzoor Ahmad Wani, Showkat Ali Zargar, Ghulam Nabi Yatoo, Inaamul Haq, Altaf Shah, Jaswinder Singh Sodhi, Ghulam Mohammad Gulzar, Mushtaq Khan; Clin Endosc 2020;53(4):436-442. Published online April 7, 2020; DOI: https://doi.org/10.5946/ce.2019.118

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Background
/Aims: This study aimed to study the endoscopic yield, appropriateness, and complications of pediatric endoscopy performed by adult gastroenterologists in an adult endoscopic suite.
Methods
This a retrospective study in which records of all the patients less than 18 years of age who underwent endoscopy in the last 5 years were studied. The indications of endoscopy in children were categorized as appropriate or inappropriate per the latest guidelines by American Society for Gastrointestinal Endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Positive endoscopic yield was defined as the presence of any abnormality on endoscopy.
Results
Among the total of 822 children (age <18 years), the most common indications were variceal surveillance/eradication in 157 (19.1%), followed by dyspepsia in 143 (17.4%), upper gastrointestinal (UGI) bleeding in 136 (16.5%), recurrent abdominal pain in 94 (11.4%), unexplained anemia in 74 (9%), recurrent vomiting in 50 (6.08%), chronic refractory gastroesophageal reflux disease in 34 (4.1%) and others; 780 out of 822 endoscopic procedures (94.9%) done in children were appropriate as per the guidelines. The endoscopic yield was 45.8%, highest in patients with UGI bleeding (71.3%), followed by variceal surveillance (54.8%), recurrent vomiting (38%), dyspepsia (37.8%), and recurrent abdominal pain (36%). Minor adverse events occurred in 7.3% of children.
Conclusions
Pediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.

Citations

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Which Alarm Symptoms Are Associated With Abnormal Gastrointestinal Endoscopy Among Thai Children?
Anundorn Wongteerasut
Pediatric Gastroenterology, Hepatology & Nutrition.2024; 27(2): 113. CrossRef
Paediatric gastrointestinal endoscopy in the Asian-Pacific region: Recent advances in diagnostic and therapeutic techniques
James Guoxian Huang, Pornthep Tanpowpong
World Journal of Gastroenterology.2023; 29(18): 2717. CrossRef
Gastrointestinal Bleeding in Children: The Role of Endoscopy and the Sheffield Scoring System in a Resource-Limited Setting
Oluwafunmilayo Funke Adeniyi, Olufunmilayo Adenike Lesi, Emuobor Aghoghor Odeghe, Ganiyat Oyeleke, Nicholas Croft
JPGN Reports.2023; 4(4): e369. CrossRef
Pediatric esophagogastroduodenoscopy in china: indications, diagnostic yield, and factors associated with findings
Shengnan Wang, Xiaoxia Qiu, Jingfang Chen, Hong Mei, Haiyan Yan, Jieyu You, Ying Huang
BMC Pediatrics.2022;[Epub] CrossRef
Safety and Competency are the Main Priorities in Pediatric Endoscopy
Byung-Ho Choe
Clinical Endoscopy.2020; 53(4): 379. CrossRef

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Review

Endoscopic Management of Post-Polypectomy Bleeding: Aditya Gutta, Mark A. Gromski; Clin Endosc 2020;53(3):302-310. Published online September 17, 2019; DOI: https://doi.org/10.5946/ce.2019.062

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Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.

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Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
Hisham Wehbe, Aditya Gutta, Mark A. Gromski
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Original Article

Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients: Erkan Caglar, Deniz Atasoy, Mukaddes Tozlu, Engin Altınkaya, Serkan Dogan, Hakan Senturk; Clin Endosc 2020;53(1):82-89. Published online September 3, 2019; DOI: https://doi.org/10.5946/ce.2019.073

Abstract PDF PubReader ePub

Background
/Aims: Altered anatomy is a challenge in endoscopic retrograde cholangiopancreatography (ERCP) for patients with Billroth II anastomosis. In this study, we investigated the overall success and role of endoscopist experience.
Methods
Data of patients who underwent ERCP between 2014 and 2018 after a previous Billroth II operation were retrieved retrospectively from 2 tertiary ERCP centers. The procedures were performed by 2 endoscopists with different levels of experience. Clinical success was defined as extraction of the stone, placement of a stent through a malignant stricture, and clinical and laboratory improvements in patients.
Results
Seventy-five patients were included. The technical success rate was 83% for the experienced endoscopist and 75% for the inexperienced endoscopist (p=0.46). The mean (±standard deviation) procedure time was 23.8±5.7 min for the experienced endoscopist and 40.68±6.07 min for the inexperienced endoscopist (p<0.001). In total, 3 perforations (4%) were found. The rate of afferent loop perforation was 6.25% (1/16) for the inexperienced endoscopist and 0% (0/59) for the experienced endoscopist (p=0.053).
Conclusions
ERCP in patients who had undergone Billroth II gastrectomy was time consuming for the inexperienced endoscopist who should beware of the unique adverse events related to ERCP in patients with altered anatomy.

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Practical application of the modification in endoscopic retrograde cholangiopancreatography treated common bile duct stones in patients with Billroth II gastroenterostomy in Vietnam
Tran Thi Anh Tuyet, Nguyen Van Thai, Nguyen Tien Thinh, Mai Thanh Binh
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Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography
Ru-Yi Wang, Zhen Fan
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Efficacy and safety of a single-use cholangioscope for percutaneous transhepatic cholangioscopy
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Case Report

Removal of a Trigger Cord Stuck between Bands during Endoscopic Multiple-Band Ligation for Treating Esophageal Variceal Hemorrhage: Nam Seok Ham, Danbi Lee, Sung Hyun Won, Jeongseok Kim, Seokjung Jo, Sangyoung Yi, Seol So; Clin Endosc 2020;53(2):230-231. Published online July 24, 2019; DOI: https://doi.org/10.5946/ce.2019.076

Abstract PDF Supplementary Material PubReader ePub: Endoscopic variceal ligation is the preferred endoscopic treatment method for esophageal variceal bleeding. The incidence of complications such as chest pain, bleeding, stricture formation, and aspiration pneumonia is low. We report a case wherein a malfunctioning multiple-band ligator could have potentially caused damage to the esophageal varices and massive bleeding. The equipment was safely removed using scissors and forceps. To the best of our knowledge, this is the first published report detailing the management of a case of esophageal variceal bleeding.

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Review

Anesthetic Consideration for Peroral Endoscopic Myotomy: Yun-Sic Bang, Chunghyun Park; Clin Endosc 2019;52(6):549-555. Published online July 10, 2019; DOI: https://doi.org/10.5946/ce.2019.033

Abstract PDF PubReader ePub

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

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Focused Review Series: Endoscopic Submucosal Dissection for Colorectal Tumors

Management of Complications of Colorectal Submucosal Dissection: Eun Ran Kim, Dong Kyung Chang; Clin Endosc 2019;52(2):114-119. Published online March 29, 2019; DOI: https://doi.org/10.5946/ce.2019.063

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure- related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication.

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Case Reports

Air Embolism during Upper Endoscopy: A Case Report: Yin Fang, Junbei Wu, Feng Wang, Lihong Cheng, Yunhong Lu, Xiaofei Cao; Clin Endosc 2019;52(4):365-368. Published online March 13, 2019; DOI: https://doi.org/10.5946/ce.2018.201

Abstract PDF PubReader ePub

Air embolism is a rare complication of upper endoscopy and potentially causes life-threatening events. A 67-year-old man with a history of surgery of cardiac carcinoma and pancreatic neuroendocrine tumor underwent painless upper endoscopy because of tarry stools. During the procedure, air embolism developed, which caused decreased pulse oxygen saturation and delayed sedation recovery. He recovered with some weakness of the left upper limb in the intensive care unit without hyperbaric oxygen therapy. The etiology, clinical manifestations, and treatments of air embolism are discussed based on the literature reports. Although air embolism is uncommon in endoscopic examinations, the patients’ outcomes could be improved if clinicians are alert to this potential complication, and promptly start proper diagnostic and therapeutic measures.

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Gastrocolocutaneous Fistula: An Unusual Case of Gastrostomy Tube Malfunction with Diarrhea: Junghwan Lee, Jinyoung Kim, Ha il Kim, Chung Ryul Oh, Sungim Choi, Soomin Noh, Hee Kyong Na, Hwoon-Yong Jung; Clin Endosc 2018;51(2):196-200. Published online August 31, 2017; DOI: https://doi.org/10.5946/ce.2017.062

Abstract PDF PubReader ePub

A gastrocolocutaneous fistula is a rare complication of percutaneous endoscopic gastrostomy (PEG). We report a case of a gastrocolocutaneous fistula presenting with intractable diarrhea and gastrostomy tube malfunction. A 62-year-old woman with a history of multiple system atrophy was referred to us because of PEG tube malfunction. Twenty days prior to presentation, the patient started developing sudden diarrhea within minutes after starting PEG feeding. Fluoroscopy revealed that the balloon of the PEG tube was located in the lumen of the transverse colon with the contrast material filling the colon. Subsequently, the PEG tube was removed and the opening of the gastric site was endoscopically closed using hemoclips. Clinicians should be aware of gastrocolocutaneous fistula as one of the complications of PEG insertion. Sudden onset of diarrhea, immediately after PEG feedings, might suggest this complication, which can be effectively treated with endoscopic closure.

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Focused Review Series: Roles of Bariatric Endoscopy in Obesity Treatment

Endoscopic Approach for Major Complications of Bariatric Surgery: Moon Kyung Joo; Clin Endosc 2017;50(1):31-41. Published online December 23, 2016; DOI: https://doi.org/10.5946/ce.2016.140

Abstract PDF PubReader ePub

As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.

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Focused Review Series: Pancreatobiliary endoscopy in altered gastointestinal anatomy

Challenges of Endoscopic Management of Pancreaticobiliary Complications in Surgically Altered Gastrointestinal Anatomy: Tin Moe Wai, Eun Young Kim; Clin Endosc 2016;49(6):502-505. Published online November 29, 2016; DOI: https://doi.org/10.5946/ce.2016.146

Abstract PDF PubReader ePub: Pancreaticobiliary complications following various surgical procedures, including liver transplantation, are not uncommon and are important causes of morbidity and mortality. Therapeutic endoscopy plays a substantial role in these patients and can help to avoid the need for reoperation. However, the endoscopic approach in patients with surgically altered gastrointestinal (GI) anatomy is technically challenging because of the difficulty in entering the enteral limb to reach the target orifice to manage pancreaticobiliary complications. Additional procedural complexity is due to the need of special devices and accessories to obtain successful cannulation and absence of an elevator in forward-viewing endoscopes, which is frequently used in this situation. Once bilioenteric anastomosis is reached, the technical success rates achieved in expert hands approach those of patients with intact GI anatomy. The success of endoscopic therapy in patients with surgically altered GI anatomy depends on multiple factors, including the expertise of the endoscopist, understanding of postoperative anatomic changes, and the availability of suitable scopes and accessories for endoscopic management. In this issue of Clinical Endoscopy, the focused review series deals with pancreatobiliary endoscopy in altered GI anatomy such as bilioenteric anastomosis and post-gastrectomy.

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Original Articles

Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Neoplasms: Jung Soo Park, Young Hoon Youn, Jae Jun Park, Jie-Hyun Kim, Hyojin Park; Clin Endosc 2016;49(2):168-175. Published online February 12, 2016; DOI: https://doi.org/10.5946/ce.2015.080

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic treatment has been broadly applied to superficial esophageal neoplasms. Endoscopic submucosal dissection (ESD) allows for high rates of en bloc resection, precise histological assessment, and low rates of local recurrence. The aim of this study was to evaluate the outcomes of ESD for superficial esophageal neoplasms.
Methods
We retrospectively reviewed 36 esophageal ESDs for superficial squamous neoplasms in 32 patients between March 2009 and August 2014 at Gangnam Severance Hospital.
Results
The median patient age was 64 years, and 30 men were included. The indications were early squamous cell carcinoma in 26 lesions, adenoma with high-grade dysplasia in five lesions, and low-grade dysplasia in five lesions. The en bloc resection and R0 resection rates were 97.2% (35 of 36) and 91.7% (33 of 36), respectively. Microperforation and post-ESD bleeding occurred in 5.6% (2 of 36) and 5.6% (2 of 36), respectively. Post-ESD esophageal strictures developed in five patients (13.9%). Five patients (15.6%) had an additional treatment after ESD (concurrent chemoradiation therapy in three, radiation therapy in one, and surgery in one patient). There was no disease-specific mortality during the median follow-up of 31 months.
Conclusions
Favorable clinical outcomes were observed in ESD for superficial esophageal squamous neoplasms. Esophageal ESD could be a good treatment option in terms of efficacy and safety.

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Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model: Joung-Ho Han, Myounghwan Kim, Tae Hoon Lee, Hyun Kim, Yunho Jung, Seon Mee Park, Heebok Chae, Seijin Youn, Ji Yun Shin, In-Kwang Lee, Tae Soo Lee, Seok Hwa Choi; Clin Endosc 2015;48(6):534-541. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.534

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Background
/Aims: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model.
Methods
We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination.
Results
The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis.
Conclusions
EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

Citations

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Endoscopic Management of Iatrogenic Colon Perforation
Yunho Jung
Clinical Endoscopy.2020; 53(1): 29. CrossRef
Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report
Dae Hoon Kim, Hanlim Choi, Ki Bae Kim, Hyo Yung Yun, Joung-Ho Han
World Journal of Clinical Cases.2019; 7(20): 3271. CrossRef
Endoscopic management of iatrogenic gastrointestinal perforations
Kan Wang, Jihao Shi, Linna Ye
Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41. CrossRef
Endoscopic Band Ligation Is Able to Close Perforations Caused by Colonoscopy: A Porcine Model Study
Yidong Yang, Xianyi Lin, Siwei Tan, Xiaoli Huang, Zijun Xie, Xuan Xu, Yiming Lei, Bin Wu
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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Factors for Endoscopic Submucosal Dissection in Early Colorectal Neoplasms: A Single Center Clinical Experience in China: Yu-Qi He, Xin Wang, Ai-Qin Li, Lang Yang, Jian Zhang, Qian Kang, Shan Tang, Peng Jin, Jian-Qiu Sheng; Clin Endosc 2015;48(5):405-410. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.405

Abstract PDF PubReader ePub

Background/Aims

Early colorectal (CR) neoplasm can be cured by endoscopic submucosal dissection (ESD), but clinical experience and factors associated with complications from ESD for CR neoplasms in China have not been reported.

Methods

Seventy-eight cases of early CR neoplasm treated with endoscopic resection performed between December 2012 and December 2013 at Beijing Military General Hospital were included. Factors associated with ESD complications and procedure times were evaluated.

Results

The en bloc resection rate was 88.5% (69/78), tumor size was 32.1±10.7 mm, and procedure time was 71.8±49.5 minutes. The major complication was perforation, which occurred in 8.97% of the ESD procedures. Multivariate logistic regression analysis indicated that only tumor size (p=0.022) was associated with ESD perforation. Tumor size (p<0.001) and the non-lifting sign (p=0.017) were independent factors for procedure time, and procedure time (p=0.016) was a key factor for en bloc resection. After a median 10 months (range, 4 to 16) of follow-up, no patients had local recurrence.

Conclusions

This study indicated that ESD is an applicable method for large early CR neoplasm in the colon and rectum. Tumor size and the non-lifting sign might be considerable factors for increased complication rate and procedural time of ESD.

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Feng Gu, Wei Jiang, Jingyi Zhu, Lei Ma, Boyuan He, Huihong Zhai
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A large multicenter cohort on the use of full-thickness resection device for difficult colonic lesions
Y. Ichkhanian, K. Vosoughi, D. L. Diehl, I. S. Grimm, T. W. James, A. W. Templeton, K. Hajifathalian, J. L. Tokar, J. B. Samarasena, N. El Hage Chehade, J. Lee, K. Chang, M. Mizrahi, M. Barawi, S. Irani, S. Friedland, P. Korc, A. A. Aadam, M. A. Al-Haddad
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Yervant Ichkhanian, Tobias Zuchelli, Andrew Watson, Cyrus Piraka
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Juliana B. Santos, Moacyr R.C. Nobre, Cleyton Z. Oliveira, Adriana V. Safatle-Ribeiro, Fabio Kawaguti, Bruno Martins, Sergio C. Nahas, Ulysses Ribeiro, Lanjing Zhang, Fauze Maluf-Filho
European Journal of Gastroenterology & Hepatology.2021; 33(1S): e33. CrossRef
Colo-rectal endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD®): A multicenter Italian experience
G. Andrisani, P. Soriani, M. Manno, M. Pizzicannella, F. Pugliese, M. Mutignani, R. Naspetti, L. Petruzziello, F. Iacopini, C. Grossi, P. Lagoussis, S. Vavassori, F. Coppola, A. La Terra, S. Ghersi, P. Cecinato, G. De Nucci, R. Salerno, M. Pandolfi, G. Co
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Dane Christina Daoud, Nicolas Suter, Madeleine Durand, Mickael Bouin, Bernard Faulques, Daniel von Renteln
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Arthur Schmidt, Torsten Beyna, Brigitte Schumacher, Alexander Meining, Hans-Juergen Richter-Schrag, Helmut Messmann, Horst Neuhaus, David Albers, Michael Birk, Robert Thimme, Andreas Probst, Martin Faehndrich, Thomas Frieling, Martin Goetz, Bettina Riecke
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Lorenzo Fuccio, Alessandro Repici, Cesare Hassan, Thierry Ponchon, Pradeep Bhandari, Rodrigo Jover, Konstantinos Triantafyllou, Daniele Mandolesi, Leonardo Frazzoni, Cristina Bellisario, Franco Bazzoli, Prateek Sharma, Thomas Rösch, Douglas K Rex
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Comparison of Clinical Outcomes Associated with Pull-Type and Introducer-Type Percutaneous Endoscopic Gastrostomies: Sin Won Lee, Jeong Hoon Lee, Hyungjin Cho, Yeonjung Ha, Hyun Lim, Ji Yong Ahn, Kwi Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2014;47(6):530-537. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.530

Abstract PDF PubReader ePub

Background/Aims

Percutaneous endoscopic gastrostomy (PEG) is a method of providing enteral nutrition using endoscopy. The PEG techniques differ according to the insertion method, and include the pull type, push type, and introducer type. The aim of this study was to compare the clinical outcomes associated with the pull-type and introducer-type PEG insertion techniques, which included the adverse events, at our tertiary care center in Korea.

Methods

We retrospectively reviewed 141 cases that had undergone PEG insertion at our center from January 2009 to June 2012. The indications for PEG insertion and the acute and chronic complications caused by each type of PEG insertion were analyzed.

Results

The indications for PEG insertion in our cohort included neurologic disease (58.7%), malignancy (21.7%), and other indications (19.6%). Successful PEG insertions were performed on 136 cases (96.5%), and there were no PEG-associated deaths. Bleeding was the most frequent acute complication (12.8%), and wound problems were the most frequent chronic complications (8.8%). There were no statistically significant differences between the pull-type and introducer-type PEG insertion techniques in relation to complication rates in our study population.

Conclusions

PEG insertion is considered a safe procedure. The pull-type and introducer-type PEG insertion techniques produce comparable outcomes, and physicians may choose either of these approaches according to the circumstances.

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Reviews

Colonic Stent-Related Complications and Their Management: Seung-Hee Han, Jong Hoon Lee; Clin Endosc 2014;47(5):415-419. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.415

Abstract PDF PubReader ePub

Since its introduction in the early 1990s, the self-expandable metal stent (SEMS) has been increasingly used for the management of malignant colorectal obstruction, not only as a palliative method but also as a preoperative treatment in surgical candidates. However, more recently, concerns have been raised over stent complication rates. Early complications include pain, perforation, and rectal bleeding, and late complications include stent migration and stent obstruction. With the increasing use of SEMS for treatment, physicians need to be more aware of complications occurring after the placement of these stents. This review covers the technical considerations and management of complications after colonic stenting.

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Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements: Itaru Saito, Yosuke Tsuji, Yoshiki Sakaguchi, Keiko Niimi, Satoshi Ono, Shinya Kodashima, Nobutake Yamamichi, Mitsuhiro Fujishiro, Kazuhiko Koike; Clin Endosc 2014;47(5):398-403. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.398

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) for early gastric cancer is a well-established procedure with the advantage of resection in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location of the lesion. However, gastric ESD is a more difficult and meticulous technique, and also requires a longer procedure time, than conventional endoscopic mucosal resection. These factors naturally increase the risk of various complications. The two most common complications accompanying gastric ESD are bleeding and perforation. These complications are known to occur both intraoperatively and postoperatively. However, there are other rare but serious complications related to gastric ESD, including aspiration pneumonia, stenosis, venous thromboembolism, and air embolism. Endoscopists should have sufficient knowledge about such complications and be prepared to deal with them appropriately, as successful management of complications is necessary for the successful completion of the entire ESD procedure.

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Preparation of High-Risk Patients and the Choice of Guidewire for a Successful Endoscopic Retrograde Cholangiopancreatography Procedure: Tae Hoon Lee, Young Kyu Jung, Sang-Heum Park; Clin Endosc 2014;47(4):334-340. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.334

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for the diagnosis and treatment of pancreatobiliary diseases. However, ERCP-related complications such as pancreatitis, cholangitis, hemorrhage, and perforation may be problematic. For a successful and safe ERCP, preprocedural evaluations of the patients and intervention-related risk factors are needed. Furthermore, in light of the recent population aging and increase in chronic cardiopulmonary diseases in Korea, precautions including endoscopic sedation and prevention of cardiopulmonary complications should be considered. In this literature review, we describe these risk factors and the use of endoscopic sedation. In addition, we reviewed the commonly available guidewires, including their materials and options, used as a basic accessory for ERCP procedures.

Citations

Citations to this article as recorded by

Structural factors influencing the clinical performance of 0.025-inch guidewires for pancreatobiliary endoscopy: An experimental study
Takehiko Koga, Naoaki Tsuchiya, Yusuke Ishida, Takanori Kitaguchi, Keisuke Matsumoto, Makoto Fukuyama, Satoki Kojima, Norihiro Kojima, Fumihito Hirai
Endoscopy International Open.2024; 12(05): E666. CrossRef
Racial disparities in endoscopic retrograde cholangiopancreatography (ERCP) utilization in the United States: are we getting better?
Dushyant Singh Dahiya, Abhilash Perisetti, Neil Sharma, Sumant Inamdar, Hemant Goyal, Amandeep Singh, Laura Rotundo, Rajat Garg, Chin-I Cheng, Sailaja Pisipati, Mohammad Al-Haddad, Madhusudhan Sanaka
Surgical Endoscopy.2023; 37(1): 421. CrossRef
Comparison of guidewires for successful cannulation of biliary stenosis and targeting of biliary branches in ERCP
Masanori Kobayashi, Hiromune Katsuda, Kazuo Ohtsuka, Ryuichi Okamoto
Endoscopy International Open.2023; 11(09): E805. CrossRef
Prevention of Post-ERCP Pancreatitis: Pro-gress in Different Procedural Techniques
永烜张
Advances in Clinical Medicine.2022; 12(11): 10124. CrossRef
Bedside Percutaneous Approach in a Critically Ill ICU Patient with Complex Pancreatobiliary Disorder Followed by Endoscopic Approach: Lessons Learnt from a Tertiary Referral Center
Cosmas Rinaldi Adithya Lesmana, Caecilia Herjuningtyas, Sri Inggriani, Yulia Estu Pratiwi, Laurentius A. Lesmana
Case Reports in Gastroenterology.2021; 15(1): 210. CrossRef
Technical Reports of Endoscopic Retrograde Cholangiopancreatography Guidewires on the Basis of Physical Properties
Chang-Il Kwon, Dong Hee Koh, Tae Jun Song, Won Suk Park, Dong Hang Lee, Seok Jeong
Clinical Endoscopy.2020; 53(1): 65. CrossRef
PREDICTIVE FACTORS FOR POST-ERCP BLEEDING. INFLUENCE OF DIRECT ORAL ANTICOAGULANTS
Ernesto Parras Castañera, Pelayo Rodríguez López, Alberto Álvarez Delgado, Fernando Muñoz Núñez, Fernando Geijo Martínez, Antonio Velasco Guardado
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef
Current approaches to the treatment of complications of endoscopic transpapillary interventions
S. G. Shapovaliyants, S. A. Budzinskiy, E. D. Fedorov, M. V. Bordikov, M. A. Zakharova
Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery.2019; 24(2): 74. CrossRef
Efficacy of midazolam‐ versus propofol‐based sedations by non‐anesthesiologists during therapeutic endoscopic retrograde cholangiopancreatography in patients aged over 80 years
Su Jung Han, Tae Hoon Lee, Sang‐Heum Park, Young Sin Cho, Yun Nah Lee, Yunho Jung, Hyun Jong Choi, Il‐Kwun Chung, Sang‐Woo Cha, Jong Ho Moon, Young Deok Cho, Sun‐Joo Kim
Digestive Endoscopy.2017; 29(3): 369. CrossRef
Pancreatic Stenting Reduces Post-ERCP Pancreatitis and Biliary Sepsis in High-Risk Patients: A Randomized, Controlled Study
He-Kun Yin, Hai-En Wu, Qi-Xiang Li, Wei Wang, Wei-Lin Ou, Harry Hua-Xiang Xia
Gastroenterology Research and Practice.2016; 2016: 1. CrossRef
Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy
Tae Hoon Lee, Sang-Heum Park
Clinical Endoscopy.2016; 49(5): 467. CrossRef
Highlights from the 50th Seminar of the Korean Society of Gastrointestinal Endoscopy
Eun Young Kim, Il Ju Choi, Kwang An Kwon, Ji Kon Ryu, Seok Ho Dong, Ki Baik Hahm
Clinical Endoscopy.2014; 47(4): 285. CrossRef

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Case Reports

Fatal Cerebral Air Embolism Due to a Patent Foramen Ovale during Endoscopic Retrograde Cholangiopancreatography: Adam Bastovansky, Claudia Stöllberger, Josef Finsterer; Clin Endosc 2014;47(3):275-280. Published online May 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.3.275

Abstract PDF PubReader ePub

Fatal air embolism to the cerebrum during an endoscopic retrograde cholangiopancreatography (ERCP) has not been reported in a patient with a biliodigestive anastomosis and multiresistant extended-spectrum β-lactamase Escherichia coli (ESBL) bacteremia. A 59-year-old woman with a history of laparoscopic cholecystectomy and iatrogenic injury of the right choledochal duct, choledochojejunostomy (biliodigestive anastomosis), recurrent cholangitis, revision of the biliodigestive anastomosis, recurrent liver abscesses, and recurrent stenting of stenotic bile ducts, was admitted because of fever and tenderness of the right upper quadrant. On ERCP, a previously deployed covered Wallstent was replaced. Blood cultures grew ESBL. After stent removal 8 days later, the patient did not wake up and developed arterial hypotension and respiratory insufficiency, requiring mechanical ventilation. Computed tomography scans showed extensive air embolism to the liver, heart, and cerebrum. She died 1 day later. Although the exact pathogenesis of the fatal cerebral air embolism remains speculative, the nonphysiological anatomy and chronic infection with ESBL may have been contributory factors.

Citations

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Carbon Dioxide Embolism Resulting From Liver Laceration During Peritoneal Optical Trocar Entry
Andrea C Lin, Elizabeth J Olecki, Meghan L Good, Christopher Cowart, Jeffery S Scow
Cureus.2022;[Epub] CrossRef
Fatal air embolism during gastrointestinal endoscopy in a 5 -year- old girl
Kalagi Dana, Alalawi Shahd, Al Shawa M. Anas, Habib Zakaria
Journal of Pediatric Surgery Case Reports.2021; 74: 102017. CrossRef
A rare but lethal complication: Post-endoscopic retrograde cholangiopancreatography cerebral arterial gas embolism
Hin San Chow, Clarence Mak, Wai Yin Chu, Kwok Fai Cheung
International Journal of Gastrointestinal Intervention.2021; 10(4): 192. CrossRef
When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism after Endoscopic Retrograde Cholangiopancreatography
Konstantinos Ekmektzoglou, Georgios Alexandrakis, Konstantinos Dimopoulos, Panagiotis Tsibouris, Chrysostomos Kalantzis, Erasmia Vlachou, Periklis Apostolopoulos
Case Reports in Gastroenterology.2021; 15(1): 456. CrossRef
Massive cerebral air embolism following percutaneous transhepatic biliary drainage
Jae Ho Lee, Ha Young Lee, Myung Kwan Lim, Young Hye Kang
Medicine.2021; 100(52): e28389. CrossRef
Systemic air embolism after endoscopy without vessel injury – A summary of reported cases
Peter Voigt, Stefan Schob, Sebastian Gottschling, Thomas Kahn, Alexey Surov
Journal of the Neurological Sciences.2017; 376: 93. CrossRef
Multiple small hemorrhagic infarcts in cerebral air embolism: a case report
Masaya Togo, Taku Hoshi, Ryosuke Matsuoka, Yukihiro Imai, Nobuo Kohara
BMC Research Notes.2017;[Epub] CrossRef
Acute Air Embolism during Retrograde Cholangiography for Postoperative Recurrent Cholangitis Due to Intraductal Residual Meals after Choledochoduodenostomy
Osamu Miyoshi, Shu Nakano
The Japanese Journal of Gastroenterological Surger.2015; 48(5): 463. CrossRef

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A Needle Penetrating the Stomach Cavity after Acupuncture: Sin Won Lee, Ji Yong Ahn, Won Jung Choi, Eun Jin Kim, Seung-Hyeon Bae, Yun Sik Choi, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2014;47(3):258-261. Published online May 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.3.258

Abstract PDF PubReader ePub

Although acupuncture is known as a safe procedure that is widely used in many countries, complications including infection, hemorrhage, hematoma, pneumothorax, nerve damage, and cardiac tamponade have been reported. A needle penetrating the stomach after acupuncture, however, is very rare. Here, we report the case of 47-year-old woman who experienced abdominal pain 2 days after receiving acupuncture. Upper gastrointestinal endoscopy identified an approximately 2.5-cm long needle in the posterior wall of the antrum. The needle was removed endoscopically using rat tooth forceps with no complications.

Citations

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Review on Intraperitoneal Acupuncture and Needling Depth
Soyeon Kim
Korean Journal of Acupuncture.2023; 40(3): 55. CrossRef
An Observational Study Using Ultrasound to Assess Allowable Needle Insertion Range of Acupoint CV12
Hongmin Chu, Jaehyo Kim, Seongjun Park, Jaehyun Kim, Jung-Han Lee, Won-Bae Ha, Hyun-Jong Jung, Seung-bum Yang, Cheol-hyun Kim, Jun Yong Park, Kyung-ho Kang, Sangkwan Lee, Sanghun Lee
Healthcare.2022; 10(9): 1707. CrossRef
Literature Review on Adverse Events (2012-2015) associated with Acupuncture and Moxibustion
Nobutatsu FURUSE, Akihito UEHARA, Masaaki SUGAWARA, Toshiya YAMAZAKI, Hisashi SHINBARA, Hitoshi YAMASHITA
Zen Nihon Shinkyu Gakkai zasshi (Journal of the Japan Society of Acupuncture and Moxibustion).2017; 67(1): 29. CrossRef
Retrospective study using MRI to measure depths of acupuncture points in neck and shoulder region
Pei-Chi Chou, Yu-Chuen Huang, Chun-Jen Hsueh, Jaung-Geng Lin, Heng-Yi Chu
BMJ Open.2015; 5(7): e007819. CrossRef
An Alternative to Current Therapies of Functional Dyspepsia: Self‐Administrated Transcutaneous Electroacupuncture Improves Dyspeptic Symptoms
Ting Ji, Xueliang Li, Lin Lin, Liuqin Jiang, Meifeng Wang, Xiaopin Zhou, Ranran Zhang, Jiande DZ Chen, Jieyun Yin
Evidence-Based Complementary and Alternative Medicine.2014;[Epub] CrossRef

7,657 View
68 Download
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5 Crossref

Original Articles

Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection: Bashar Qumseya, Abraham M. Panossian, Cynthia Rizk, David Cangemi, Christianne Wolfsen, Massimo Raimondo, Timothy Woodward, Michael B. Wallace, Herbert Wolfsen; Clin Endosc 2014;47(2):155-161. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.155

Abstract PDF PubReader ePub

Background/Aims

Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied.

Methods

We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors.

Results

Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007).

Conclusions

Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure.

Citations

Citations to this article as recorded by

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Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone: Ka Young Kim, Jimin Han, Ho Gak Kim, Byeong Suk Kim, Jin Tae Jung, Joong Goo Kwon, Eun Young Kim, Chang Hyeong Lee; Clin Endosc 2013;46(6):637-642. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.637

Abstract PDF PubReader ePub

Background/Aims

Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.

Methods

Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ≥11 mm and follow-up longer than 6 months were included.

Results

There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.

Conclusions

Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Citations

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Review

Unusual Complications Related to Endoscopic Retrograde Cholangiopancreatography and Its Endoscopic Treatment: Chang-Il Kwon, Sang Hee Song, Ki Baik Hahm, Kwang Hyun Ko; Clin Endosc 2013;46(3):251-259. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.251

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP)-induced complications, once occurred, can lead to significant morbidity. Commonly 5% to 10% of patients experience procedure related complications such as post-ERCP pancreatitis, biliary hemorrhage, and cholangitis, in descending order. However, complications such as perforation, pneumothorax, air embolism, splenic injury, and basket impaction are rare but are associated with high mortality if occurred. Such unexpected unusual complications might extend the length of hospitalization, require urgent surgical intervention, and put the patient in miserable condition leading to permanent disability or mortality. Although these ERCP-induced complications can be minimized by a skilled operator using advanced techniques and devices, the occurrence of unusual complications are hard to expect and induce very difficult management condition. In this review, we will focus on the uncommon complications related to ERCP. This review is also aimed at suggesting optimal endoscopic treatment strategies for several complications based on our institutional experiences.

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Clinical Journal of Gastroenterology.2018; 11(2): 167. CrossRef
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Gustavo Adolfo Reyes, Renzo Pinto Carta, Fernando Sierra Arango, Luis Felipe Cabrera Vargas
Revista Colombiana de Gastroenterología.2018; 33(4): 464. CrossRef
Cerebral air embolism after ERCP
Sonia Trabanco, Sara Pardo, Mónica Williams, Javier Diaz, Cristina Ruiz
Journal of Clinical Anesthesia.2017; 36: 133. CrossRef
Bilateral Pneumothoraces as a Complication of Endoscopic Retrograde Cholangiopancreatography
Douglas E. Rappaport, Joshua J. Solano, Jonathan A. Edlow
The Journal of Emergency Medicine.2017; 52(4): 573. CrossRef
Cholangitis after endoscopic retrograde cholangiopancreatography: a rare complication?
Armando Peixoto, Marco Silva, Guilherme Macedo
Revista Española de Enfermedades Digestivas.2017;[Epub] CrossRef
Training in Endoscopy: Endoscopic Retrograde Cholangiopancreatography
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The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature
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BMC Pediatrics.2017;[Epub] CrossRef
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Hong Ja Kim, Seon Mee Park
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Upper gastrointestinal endoscopy: expected post-procedural findings and adverse events
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Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations
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Clinical Endoscopy.2016; 49(4): 376. CrossRef
Complications of ERCP
Rupjyoti Talukdar
Best Practice & Research Clinical Gastroenterology.2016; 30(5): 793. CrossRef
Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury
M. Ezzedien Rabie, Saad Al Faris, Ali Nasser, Abdul Aziz Shahir, Yasser Al Mahdi, Mansour Youssef Al Asmari
Case Reports in Surgery.2015; 2015: 1. CrossRef
Retroperitoneales Emphysem nach endoskopischer retrograder Cholangiopankreatikographie
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Duodenal Perforations After Endoscopic Retrograde Cholangiopancreatography
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Cirugía Española (English Edition).2015; 93(6): 403. CrossRef
Perforaciones duodenales tras colangiopancreatografía retrógrada endoscópica
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Cirugía Española.2015; 93(6): 403. CrossRef
Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy
Harith M. Alkhateeb, Thaer J. Aljanabi, Khairallh H. Al-azzawi, Taha A. Alkarboly
International Journal of Surgery Case Reports.2015; 16: 7. CrossRef
Cross-sectional imaging of common and unusual complications after endoscopic retrograde cholangiopancreatography
Massimo Tonolini, Alessandra Pagani, Roberto Bianco
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Acute Air Embolism during Retrograde Cholangiography for Postoperative Recurrent Cholangitis Due to Intraductal Residual Meals after Choledochoduodenostomy
Osamu Miyoshi, Shu Nakano
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Early endoscopic ultrasonography in acute biliary pancreatitis: A prospective pilot study
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World Journal of Gastroenterology.2015; 21(36): 10427. CrossRef
ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture: a case report
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Air Embolism after Endoscopic Retrograde Cholangiopancreatography in a Patient with Budd Chiari Syndrome
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Case Reports in Critical Care.2014; 2014: 1. CrossRef
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Clinical Endoscopy.2013; 46(5): 522. CrossRef

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