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; Clin Endosc 2024;57(6):735-746. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.254

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.

Citations

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Risk Factors for Perforation in Endoscopic Treatment for Early Colorectal Cancer: A Nationwide ENTER-K Study
Ik Hyun Jo, Hyun Gun Kim, Young-Seok Cho, Hyun Jung Lee, Eun Ran Kim, Yoo Jin Lee, Sung Wook Hwang, Kyeong-Ok Kim, Jun Lee, Hyuk Soon Choi, Yunho Jung, Chang Mo Moon
Gut and Liver.2025; 19(1): 95. CrossRef
Unexpected Discovery at Resection Site: Plasmablastic Lymphoma After Polypectomy
Ryan Njeim, Mohammad Abureesh, Yashna Singh, Youssef El Douaihy
ACG Case Reports Journal.2025; 12(3): e01633. CrossRef
Risk Factors, Clinical Course, and Management of Delayed Perforation After Colorectal Endoscopic Submucosal Dissection: A Large-Scale Multicenter Study
Naohisa Yoshida, Ryohei Hirose, Ken Inoue, Yoshikazu Inagaki, Yutaka Inada, Takayuki Motoyoshi, Ritsu Yasuda, Hikaru Hashimoto, Hiroyuki Yoriki, Toshifumi Tsuji, Kohei Fukumoto, Daisuke Hasegawa, Yasutaka Morimoto, Takaaki Murakami, Reo Kobayashi, Naoto I
Digestive Diseases and Sciences.2025;[Epub] CrossRef
Therapeutic and Prophylactic Closure Post-Endoscopic Submucosal Dissection (ESD): A Unicentric Descriptive Analysis
E Maderuelo Gonzalez, R Marcé Colomet, F N García, F Valentin Gomez, D de Frutos, J Santiago Garcia, A Herreros De Tejada Echanojauregui
Endoscopy.2025; 57(S 02): S365. 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
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; 69(11): 4014. CrossRef
Safety and Efficacy of Endoscopic Submucosal Dissection for Rectal Neoplasms Extending to the Dentate Line
Harishankar Gopakumar, Dushyant Singh Dahiya, Peter V. Draganov, Mohamed O. Othman, Neil R. Sharma
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Establishing a nomogram for predicting the risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal tumors
FuCheng Bian, KunShi Li, GuangYu Bian, XiuMei Li
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Endoscopic submucosal dissection for superficial ultra-low rectal tumors: outcomes and predictive factors for procedure difficulty
Yinxin Wu
American Journal of Cancer Research.2024; 14(12): 5784. CrossRef
Orthodontic Rubber Band Traction Improves Trainees' Learning Curve of Colorectal Endoscopic Submucosal Dissection: A Prospective Randomized Study
Linfu Zheng, Longping Chen, Binbin Xu, Baoxiang Luo, Fuqiang Wang, Zhilin Liu, Xingjie Gao, Linxin Zhou, Jiawei Chen, Longke Xie, Yaping Hou, Dazhou Li, Wen Wang
American Journal of Gastroenterology.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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The Current Landscape of Endoscopic Submucosal Training in the United States
Mike T. Wei, Shai Friedland, Joo Ha Hwang
Current Gastroenterology Reports.2025;[Epub] CrossRef
Gastric polyps are not created equal: Know your enemy
Fady Daniel
World Journal of Gastroenterology.2025;[Epub] CrossRef
Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Hye Kyung Jeon, Gwang Ha Kim
Gut and Liver.2025; 19(1): 19. CrossRef
Diagnosis and treatment of three synchronous early squamous cell carcinomas of the esophagus: case report
A.A. Paratovskaya, M.Yu. Agapov, N.A. Belinskaya, T.F. Savostyanov, E.E. Topuzov
Russian Journal of Evidence-Based Gastroenterology.2025; 14(1): 104. 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
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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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

Abstract PDF PubReader ePub

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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Benign biliary stricture caused by transduodenal lumen-apposing metal stent placement for pancreatic acute necrotic collection
Shuhei Shintani, Takuya Okamoto, Kosuke Hiroe, Hidenori Kimura, Hiroto Inoue, Atsushi Nishida, Osamu Inatomi
International Journal of Gastrointestinal Intervention.2025; 14(1): 24. CrossRef
Pancreatic Pseudocyst after Fully Covered Self-expandable Metallic Stent Placement
Mitsuhito Koizumi, Sho Ishikawa, Kaori Marui, Masahito Kokubu, Yusuke Okujima, Yuki Numata, Yoshiki Imamura, Teru Kumagi, Yoichi Hiasa
Internal Medicine.2024; 63(21): 2943. 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 stents 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; 24(7): 1211. 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
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
Clinical Endoscopy.2024; 57(6): 735. 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

Abstract PDF PubReader ePub

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 Article

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

Abstract PDF PubReader ePub

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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Case Report

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

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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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A Rare Case of Severe Diarrhea: Gastrocolic Fistula Caused by Migration of Percutaneous Endoscopic Gastrostomy Tube
Maria Elena Pugliese, Riccardo Battaglia, Antonio Cerasa, Lucia Francesca Lucca
Healthcare.2023; 11(9): 1263. CrossRef
An unusual complication of percutaneous endoscopic gastrostomy and its endoscopic treatment
Noble Thomas, Cherukara Philip Thomas, C. Ganesh Pai
Indian Journal of Gastroenterology.2023; 42(4): 580. CrossRef
How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication?
George Stavrou, Persefoni Gionga, George Chatziantoniou, Georgios Tzikos, Alexandra Menni, Stavros Panidis, Anne Shrewsbury, Katerina Kotzampassi
World Journal of Gastrointestinal Surgery.2023; 15(5): 940. CrossRef
Misplacement of the PEG tube through the transverse colon, an uncommon but possible complication
David Viso Vidal, Francisco Jorquera Plaza
Revista Española de Enfermedades Digestivas.2022;[Epub] CrossRef
Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Paraskevas Gkolfakis, Marianna Arvanitakis, Edward J. Despott, Asuncion Ballarin, Torsten Beyna, Kurt Boeykens, Peter Elbe, Ingrid Gisbertz, Alice Hoyois, Ofelia Mosteanu, David S. Sanders, Peter T. Schmidt, Stéphane M. Schneider, Jeanin E. van Hooft
Endoscopy.2021; 53(02): 178. CrossRef
Een laattijdige complicatie na het plaatsen van een PEG-sonde
H. DEDECKER, T. STEINHAUSER, S. BOUHADAN, O. PETERS, A. BEUNIS
Tijdschrift voor Geneeskunde.2021;[Epub] CrossRef
Complex gastro-colo-cutaneous fistula secondary to a gunshot injury, management and literature review
Maha Al Shaibi, Mohamed Al Abri, Ghaitha Al Mahruqi, Alok Mittal
Trauma Case Reports.2020; 28: 100313. CrossRef
Colocutaneous Fistula after Percutaneous Endoscopic Gastrostomy (PEG) Tube Insertion
Matthew Warner, Muhammad Durrani
Clinical Practice and Cases in Emergency Medicine.2020; 4(4): 632. CrossRef
Rectal Bleeding after Insertion of a Percutaneous Endoscopic Gastrostomy Tube
Ghadeer Alhazmi, Mroj Alsabri, Shahad Alsuwat, Adnan Al-Zangabi, Abdulaziz Al-Zahrani, Mohammed Kareemulla Shariff
Case Reports in Gastroenterology.2020; 14(3): 637. CrossRef
Long-Term Gastrocolocutaneous Fistula after Endoscopic Gastrostomy: How Concerned Should We Be?
Gonçalo Nunes, Gabriel Paiva de Oliveira, João Cruz, Carla Adriana Santos, Jorge Fonseca
GE - Portuguese Journal of Gastroenterology.2019; 26(6): 441. CrossRef
Update on endoscopic enteral access
Kamthorn Yolsuriyanwong, Bipan Chand
Techniques in Gastrointestinal Endoscopy.2018; 20(4): 172. CrossRef

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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

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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.

Citations

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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

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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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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

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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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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.

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Original Article

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.

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Case Report

Pancreatic Pseudocyst after Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Mass: Kwang Hyun Chung, Ji Kon Ryu, Hong Sang Oh, Ji Yeon Seo, Eunhyo Jin, Dong Hyeon Lee, Yong-Tae Kim, Yong Bum Yoon; Clin Endosc 2012;45(4):431-434. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.431

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Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is well known as a safe diagnostic procedure. We report the first case of pancreatic pseudocyst after EUS-FNA of the pancreatic body mass. A 60-year-old male underwent EUS-FNA for incidentally detected pancreatic solid mass which was suspected as neuroendocrine tumor. Two weeks later, the patient visited emergency room with acute abdominal pain and right upper quadrant tenderness; leukocytosis and elevated C-reactive protein, amylase, and lipase levels were noted. Computed tomography discovered newly developed 11.5×9.5 cm sized cystic mass communicating with the main pancreatic duct. Cyst fluid analysis revealed amylase level of 3,423 U/L and fluid culture isolated Streptococcus parasanguinis. The cystic mass corresponds with pancreatic pseudocyst. FNA induced main pancreatic duct injury and fluid leakage may cause it. Endoscopists who perform EUS-FNA must remember that pancreatic main duct injury can occur as one of severe complications and that it could be treated successfully with endoscopic internal drainage.

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Esophageal Perforation after Change of a Percutaneous Endoscopic Gastrostomy Tube: Seong Wook Heo, M.D., Joong Goo Kwon, M.D., Kyoung Chan Park, M.D., Jung Il Ryu, M.D., Dong Uk Ju, M.D., Kyung Ho Ha, M.D., Jin Tae Jung, M.D. and Ho Gak Kim, M.D.; Korean J Gastrointest Endosc 2011;43(1):1-4. Published online July 28, 2011

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) has become a widely used and safe method for long-term enteral feeding in patients who are unable to tolerate oral feeding. Although a number of complications can occur following PEG placement, most of these complications are not life threatening. Serious complications occur rarely after this procedure and they include peritonitis, visceral perforation, major gastrointestinal bleeding, and necrotizing fasciitis. An esophageal perforation following PEG placement is very rare and predisposing factors include Zenker's or epiphrenic esophageal diverticuli, esophageal strictures, and mass lesions. We recently experienced a case of distal esophageal perforation following a PEG tube change. The predisposing esophageal perforation factor in this case was uncertain, and we successfully treated the patient with surgical intervention. (Korean J Gastrointest Endosc 2011;43:1-4)

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A Case of Gastric Huge Intramucosal Hematoma after Snare Polypectomy: Chang Kyun Lee, M.D., Jae Young Jang, M.D., Young Hwangbo, M.D., Jaejun Shim, M.D., Sung Hoon Jung, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D.,Young Woon Chang, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2008;36(4):219-223. Published online April 30, 2008

Abstract PDF: Endoscopic polypectomy is a widely used therapeutic modality for the treatment of polypoid lesions in the gastrointestinal tract. Postpolypectomy bleeding is the most common procedure-related complication. Bleeding can occur immediately after the polypectomy or be delayed from hours to up to days. The severity of bleeding ranges from slight oozing to spurting arterial bleeding that requires immediate endoscopic hemostasis. Because severe hemorrhage can be a cause of repeat endoscopy, blood transfusion, hospitalization or surgery, endoscopists must carefully observe the patient's symptoms and hemodynamic status after an endoscopic polypectomy. Here, we report a large intramucosal hematoma and subsequent huge ulcer in the stomach as a rare complication of endoscopic snare polypectomy. (Korean J Gastrointest Endosc 2008;36: 219-223)

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Submucosal Saline-Epinephrine Injection in Colonoscopic Polypectomy: What is the Proper Application?: Sang Huyb Lee, M.D., Kyoung Soo Lee, M.D., Yeol Keun Woo, M.D., Byong Duk Ye, M.D., Jong Yeul Lee, M.D., Su Cheol Park, M.D., Kwang Hyuck Lee, M.D.*, Young Soo Park, M.D.*, Jin-Hyeok Hwang, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M.D.*, Dong Ho Lee, M; Korean J Gastrointest Endosc 2006;33(2):77-84. Published online August 30, 2006

Abstract PDF: Background
/Aims: Indications for submucosal saline- epinephrine injection (SSEI) for prevention of postpolypectomy bleeding, in the colon, is variable among endoscopists. The aim of this study was to determine the proper indication for SSEI. Methods: Clinical data of 1,745 polypectomies was evaluated. Postpolypectomy bleeding after snare polypectomy were evaluated in 1,039 polypectomies. Subgroup analysis was performed in 4 subgroups by size (≤8 mm or ＞8 mm) and gross morphology (pedunculated or sessile), also. Results: Submucosal saline-epinephrine injection was used in 679 snare polypectomies. The size of polyps was 9.5⁑4.3 mm. Distribution of polyps showed left side shift in the colon. Sessile polyps (79.4%) and benign adenoma (75.3%) were predominant. Twenty seven episodes (2.6%) of bleeding occurred after snare polypectomy. Rectal polyp, malignant polyp and procedure without SSEI increased bleeding after snare polypectomy with odds ratio 4.71, 10.48 and 3.44, respectively. However, SSEI significantly reduced the bleeding only in patients who had ＞8 mm sized sessile polyps with odds ratio 16.41 regardless of location and histopathology. Conclusions: SSEI should be performed in colonoscopic snare polypectomy for ＞8 mm sized sessile polyps, and might be performed in others for prevention of bleeding at the discretion of the clinician. (Korean J Gastrointest Endosc 2006;33:77⁣84)

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Two Cases of Intussusception Occurring through the Stoma after Gastric Surgery: Sung-Jo Bang, M.D., Do Ha Kim, M.D., Gin Hyug Lee, M.D.*, Jeong-Sik Byeon, M.D.*,; Korean J Gastrointest Endosc 2004;28(4):183-187. Published online April 30, 2004

Abstract PDF: Intussusception is a rare but potentially serious complication of gastric surgery, and 6
case
s have been reported in Korea. Diagnosis can be made by endoscopy, upper gastrointestinal series or computed tomography, but it needs a high index of suspicion for diagnosis. Early diagnosis and prompt surgical intervention is mandatory to avoid mortality. We report two cases of intussusception occurring through the stoma after gastric surgery. A 58-year-old woman presented with epigastric pain and vomiting followed by hematemesis, 30 years after gastrojejunostomy for pyloric obstruction caused by duodenal ulcer. Endoscopy showed jejunogastric intussusception and CT scan was compatible with the diagnosis. She was managed by segmental resection and anastomosis of the jejunum. Another 60-year-old man presented with epigastric pain and hematemesis, 7 years after total gastrectomy with a Roux-en-Y anastomosis for advanced gastric cancer. He was diagnosed as having chronic type jejunal intussusception by endoscopy and CT scan, and intussusception was resolved spontaneously. (Korean J Gastrointest Endosc 2004;28: 183 ⁣187)

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위수술 후 수술 문합부에 발생한 장중첩증 2예: Korean J Gastrointest Endosc 2003;27(5):459-459. Published online November 20, 2003

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악성 담도폐쇄 환자에서 내시경적 배액관 삽입 후 단기합병증 발생에 대한 연구: Korean J Gastrointest Endosc 2003;27(5):417-417. Published online November 20, 2003

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간경변증 환자의 총담관 결석 제거에 있어서 EST와 EPBD의 합병증 비교: Korean J Gastrointest Endosc 2003;27(5):416-416. Published online November 20, 2003

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