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How to improve the quality of upper gastrointestinal diagnostic endoscopy?
Mário Dinis-Ribeiro, Miguel Areia
Received December 23, 2024  Accepted January 24, 2025  Published online April 8, 2025  
DOI: https://doi.org/10.5946/ce.2024.339    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Upper gastrointestinal endoscopy is commonly performed worldwide and is the gold standard for most upper gastrointestinal tract diseases, particularly cancer. This review will use gastric cancer as an example to tackle how providers can improve the quality of endoscopy being delivered to reduce the missing rate, which may reach up to 10% of cases. In brief, endoscopists must consider pre-, intra-, and post-procedural attitudes to achieve this purpose. “Preparing or planning endoscopy,” cancer as a possible diagnosis in all procedures should be thought. Fasting of patients and the use of mucosal cleaning solutions help ensure mucosal cleansing, while planned sedation increases comfort. During endoscopy, taking time for complete inspection and photodocumentation to assure completeness. Importantly, training and knowledge of cancer (superficial) endoscopic features, particularly using advanced imaging technologies, are of paramount importance, as they are regular post-endoscopy audits of practice that positively impact quality. Finally, human-machine interaction through artificial intelligence has been shown to improve photodocumentation, detection, and auditing, and it may well assure a more homogenous service, particularly among low-performing deliverers.
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Focused Review Series: Image-Enhanced Endoscopy: Update on Clinical Practice
Current Status of Image-Enhanced Endoscopy for Early Identification of Esophageal Neoplasms
Shin Hee Kim, Su Jin Hong
Clin Endosc 2021;54(4):464-476.   Published online July 26, 2021
DOI: https://doi.org/10.5946/ce.2021.186
AbstractAbstract PDFPubReaderePub
Advanced esophageal cancer is known to have a poor prognosis. The early detection of esophageal neoplasms, including esophageal dysplasia and early esophageal cancer, is highly important for the accurate treatment of the disease. However, esophageal dysplasia and early esophageal cancer are usually subtle and can be easily missed. In addition to the early detection, proper pretreatment evaluation of the depth of invasion of esophageal cancer is very important for curative treatment. The progression of non-invasive diagnosis via image-enhanced endoscopy techniques has been shown to aid the early detection and estimate the depth of invasion of early esophageal cancer and, as a result, may provide additional opportunities for curative treatment. Here, we review the advancement of image-enhanced endoscopy-related technologies and their role in the early identification of esophageal neoplasms.

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Focused Review Series: Application of Artificial Intelligence in GI Endoscopy
Artificial Intelligence in Gastrointestinal Endoscopy
Alexander P. Abadir, Mohammed Fahad Ali, William Karnes, Jason B. Samarasena
Clin Endosc 2020;53(2):132-141.   Published online March 30, 2020
DOI: https://doi.org/10.5946/ce.2020.038
AbstractAbstract PDFPubReaderePub
Artificial intelligence (AI) is rapidly integrating into modern technology and clinical practice. Although in its nascency, AI has become a hot topic of investigation for applications in clinical practice. Multiple fields of medicine have embraced the possibility of a future with AI assisting in diagnosis and pathology applications.
In the field of gastroenterology, AI has been studied as a tool to assist in risk stratification, diagnosis, and pathologic identification. Specifically, AI has become of great interest in endoscopy as a technology with substantial potential to revolutionize the practice of a modern gastroenterologist. From cancer screening to automated report generation, AI has touched upon all aspects of modern endoscopy.
Here, we review landmark AI developments in endoscopy. Starting with broad definitions to develop understanding, we will summarize the current state of AI research and its potential applications. With innovation developing rapidly, this article touches upon the remarkable advances in AI-assisted endoscopy since its initial evaluation at the turn of the millennium, and the potential impact these AI models may have on the modern clinical practice. As with any discussion of new technology, its limitations must also be understood to apply clinical AI tools successfully.

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Original Articles
Factors Affecting Endoscopic Curative Resection of Gastric Cancer in the Population-Based Screening Era
Yoon Gwon Mun, Myung-Gyu Choi, Chul-Hyun Lim, Han Hee Lee, Dong Hoon Kang, Jae Myung Park, Kyo Young Song
Clin Endosc 2018;51(5):478-484.   Published online June 1, 2018
DOI: https://doi.org/10.5946/ce.2018.006
AbstractAbstract PDFPubReaderePub
Background
/Aims: Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer.
Methods
We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer.
Results
Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection.
Conclusions
Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer.

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An Ultrathin Endoscope with a 2.4-mm Working Channel Shortens the Esophagogastroduodenoscopy Time by Shortening the Suction Time
Satoshi Shinozaki, Yoshimasa Miura, Yuji Ino, Kenjiro Shinozaki, Alan Kawarai Lefor, Hironori Yamamoto
Clin Endosc 2015;48(6):516-521.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.516
Correction in: Clin Endosc 2016;49(1):100
AbstractAbstract PDFPubReaderePub
Background
/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice.
Methods
To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch.
Results
In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001).
Conclusions
An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.

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  • 3 Web of Science
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Review
Korean Guidelines for Colorectal Cancer Screening and Polyp Detection
Bo-In Lee, Sung Pil Hong, Seong-Eun Kim, Se Hyung Kim, Hyun-Soo Kim, Sung Noh Hong, Dong-Hoon Yang, Sung Jae Shin, Suck-Ho Lee, Dong Il Park, Young-Ho Kim, Hyun Jung Kim, Suk-Kyun Yang, Hyo Jong Kim, Hae Jeong Jeon, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management
Clin Endosc 2012;45(1):25-43.   Published online March 31, 2012
DOI: https://doi.org/10.5946/ce.2012.45.1.25
AbstractAbstract PDFSupplementary MaterialPubReaderePub

Now colorectal cancer is the second most common cancer in males and the fourth most common cancer in females in Korea. Since most of colorectal cancers occur after the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. The guideline was developed by the Korean Multi-Society Take Force and we tried to establish the guideline by evidence-based methods. Parts of the statements were draw by systematic reviews and meta-analyses. Herein we discussed epidemiology of colorectal cancers and adenomas in Korea and optimal methods for screening of colorectal cancer and detection of adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

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  • Impact of family history of colorectal cancer on age‐specific prevalence of colorectal neoplasia
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    American Journal of Gastroenterology.2019; 114(2): 322.     CrossRef
  • Bowel preparation for colonoscopy may decrease the levels of testosterone in Korean men
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  • Appropriate Surveillance Interval after Colonoscopic Polypectomy in Patients Younger than 50 Years
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    Elias F. Onyoh, Wen-Feng Hsu, Li-Chun Chang, Yi-Chia Lee, Ming-Shiang Wu, Han-Mo Chiu
    Current Gastroenterology Reports.2019;[Epub]     CrossRef
  • Colonic Intramucosal Cancer in the Interposed Colon Treated with Endoscopic Mucosal Resection: A Case Report and Review of Literature
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    Clinical Endoscopy.2019; 52(4): 377.     CrossRef
  • IMMUNOCHROMATOGRAPHIC TEST FOR DETECTION OF FECAL OCCULT BLOOD
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  • Abdominal Obesity is More Predictive of Advanced Colorectal Neoplasia Risk Than Overall Obesity in Men
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  • Stool-Based miR-92a and miR-144* as Noninvasive Biomarkers for Colorectal Cancer Screening
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    Oncology.2019; 97(3): 173.     CrossRef
  • Association between family history of colorectal cancer and the risk of metachronous colorectal neoplasia following polypectomy in patients aged < 50 years
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    Journal of Gastroenterology and Hepatology.2019; 34(2): 383.     CrossRef
  • Risk of metachronous neoplasia on surveillance colonoscopy in young patients with colorectal neoplasia
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  • Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations
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  • Stages of Adoption for Fecal Occult Blood Test and Colonoscopy Tests for Colorectal Cancer Screening in Korea
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    Cancer Research and Treatment.2018; 50(2): 416.     CrossRef
  • Anatomical distribution and detection rate of colorectal neoplasms according to age in the colonoscopic screening of a Korean population
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    Annals of Surgical Treatment and Research.2018; 94(1): 36.     CrossRef
  • The prognostic implications of primary tumor location on recurrence in early-stage colorectal cancer with no associated risk factors
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    International Journal of Colorectal Disease.2018; 33(6): 719.     CrossRef
  • A combination of clinical risk stratification and fecal immunochemical test is useful for identifying persons with high priority of early colonoscopy
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    Digestive and Liver Disease.2018; 50(3): 254.     CrossRef
  • Guideline Adherence to Colonoscopic Surveillance Intervals after Polypectomy in Korea: Results from a Nationwide Survey
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    Gut and Liver.2018; 12(4): 426.     CrossRef
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    Gastrointestinal Endoscopy.2018; 88(4): 715.     CrossRef
  • A simple scoring model for advanced colorectal neoplasm in asymptomatic subjects aged 40–49 years
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    BMC Gastroenterology.2017;[Epub]     CrossRef
  • The fecal immunochemical test has high accuracy for detecting advanced colorectal neoplasia before age 50
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    Digestive and Liver Disease.2017; 49(5): 557.     CrossRef
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    Gastrointestinal Endoscopy.2015; 81(3): 637.     CrossRef
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    BMC Gastroenterology.2014;[Epub]     CrossRef
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    Digestive Diseases and Sciences.2014; 59(9): 2236.     CrossRef
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    Cancer Epidemiology, Biomarkers & Prevention.2014; 23(3): 499.     CrossRef
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    Translational Oncology.2013; 6(3): 290.     CrossRef
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