Clinical Endoscopy

The role of cap-assisted endoscopy and its future implications: Sol Kim, Bo-In Lee; Clin Endosc 2024;57(3):293-301. Published online February 7, 2024; DOI: https://doi.org/10.5946/ce.2023.051

Cap-assisted endoscopy refers to a procedure in which a short tube made of a polymer (mostly transparent) is attached to the distal tip of the endoscope to enhance its diagnostic and therapeutic capabilities. It is reported to be particularly useful in: (1) minimizing blind spots during screening colonoscopy, (2) providing a constant distance from a lesion for clear visualization during magnifying endoscopy, (3) accurately assessing the size of various gastrointestinal lesions, (4) preventing mucosal injury during foreign body removal, (5) securing adequate workspace in the submucosal space during endoscopic submucosal dissection or third space endoscopy, (6) providing an optimal approach angle to a target, and (7) suctioning mucosal and submucosal tissue with negative pressure for resection or approximation. Here, we review various applications of attachable caps in diagnostic and therapeutic endoscopy and their future implications.

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A retrospective single-center study of transnasal ileus tube insertion accompanied with cap-assisted endoscopic advancement for malignant adhesive bowel obstruction
Su-Yu Chen, Rui Huang, Yu Zhang, Zhao-Fei Xie, He Huang, Hong Shi
Scientific Reports.2024;[Epub] CrossRef

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Cap-Assisted Technique versus Conventional Methods for Esophageal Food Bolus Extraction: A Comparative Study: Mahmoud Wahba, Ghada Habib, Ahmed El Mazny, May Fawzi, Mohamed A. Elfeki, Seham Sabry, Mahommad ELbaz, Sayed M Seif El Nasr; Clin Endosc 2019;52(5):458-463. Published online July 8, 2019; DOI: https://doi.org/10.5946/ce.2019.042

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Background
/Aims: Food bolus impaction is the most common form of esophageal foreign body impaction observed in adults. Clinical guidelines recommend using the push technique or retrieval methods in such cases. The push technique can cause injuries in certain clinical situations. Notably, conventional retrieval methods are time and effort consuming. Cap-assisted endoscopic extraction of an impacted food bolus is an easy and effective technique; however, more data are needed for its validation. This study compared the capassisted extraction technique with conventional methods.
Methods
This prospective observational multicenter study compared the success and en bloc removal rates, total procedure time, and adverse events in both techniques..
Results
The study included 303 patients who underwent food bolus extraction. The push technique was used in 87 patients (28.7%) and a retrieval procedure in 216 patients (71.3%). Cap-assisted extraction was performed in 106 patients and retrieval using conventional methods in 110 patients. The cap-assisted technique was associated with a higher rate of en bloc removal (80.2% vs. 15%, p<0.01), shorter procedure time (6.9±3.5 min vs. 15.7±4.1 min, p<0.001), and fewer adverse events (0/106 vs. 9/110, p<0.001).
Conclusions
Cap-assisted extraction showed no adverse events, higher efficacy, and a shorter procedure time compared with conventional retrieval procedures.

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Cap-Assisted Endoscopic Esophageal Foreign Body Removal Is Safe and Efficacious Compared to Conventional Methods
Zohaib Ahmed, Syeda Faiza Arif, Stephanie Lin Ong, Joyce Badal, Wade Lee-Smith, Anas Renno, Yaseen Alastal, Ali Nawras, Muhammad Aziz
Digestive Diseases and Sciences.2023; 68(4): 1411. CrossRef
Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis
Zahid Ijaz Tarar, Umer Farooq, Matthew L Bechtold, Yezaz A Ghouri
World Journal of Meta-Analysis.2023; 11(1): 38. CrossRef
Endoscopy in Pediatric Eosinophilic Esophagitis
Ramy Sabe, Girish Hiremath, Kenneth Ng
Gastrointestinal Endoscopy Clinics of North America.2023; 33(2): 323. CrossRef
Bolusobstruktionen im Ösophagus – Eine Analyse über 5 Jahre
Jürgen Heise, Christian Kreysel, Michael Blank, Philipp Euler, Ilka Melchior, Michaela Johnen, Manfred Planker, Antje Ballauff, Martina Czypull, Thomas Frieling
Zeitschrift für Gastroenterologie.2023; 61(12): 1603. CrossRef
Comparable Efficacy for Push Versus Pull Technique in Esophageal Food Impaction: Systematic Review with Meta-Analysis
Manesh Kumar Gangwani, Muhammad Aziz, Dushyant Singh Dahiya, Abeer Aziz, Fnu Priyanka, Rahul Karna, Wade Lee-Smith, Zohaib Ahmed, Faisal Kamal, Sumant Inamdar, Yaseen Alastal, Douglas Adler
Digestive Diseases and Sciences.2023; 68(8): 3354. CrossRef
Distal Endoscopic Attachments
Pankaj N. Desai, Chintan N. Patel, Mayank Kabrawala, Subhash Nanadwani, Rajiv Mehta, Ritesh Prajapati, Nisharg Patel, Mohit Sethia
Journal of Digestive Endoscopy.2022; 13(04): 243. CrossRef
Comparison of Cap-Assisted vs Conventional Endoscopic Technique for Management of Food Bolus Impaction in the Esophagus: Results of a Multicenter Randomized Controlled Trial
Marie Ooi, Tuan Duong, Richard Holman, Dep Huynh, Abdulnasser Lafta, Florian Grimpen, Mark Appleyard, Chris K. Rayner, Nam Q. Nguyen
American Journal of Gastroenterology.2021; 116(11): 2235. CrossRef
Üst gastrointestinal sistem yabancı cisimleri ve gıda takılmalarında endoskopi deneyimimiz
Tolga DÜZENLİ, Hüseyin KÖSEOĞLU
Endoskopi Gastrointestinal.2020; 28(Sayı: 3): 95. CrossRef

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Technical Feasibility of a Guidetube for Various Endoscopic Procedures in Human Gastrointestinal Simulators: Dong Seok Lee, Byeong Gwan Kim, Kook Lae Lee, Yong Jin Jung, Ji Won Kim; Clin Endosc 2019;52(3):247-251. Published online November 9, 2018; DOI: https://doi.org/10.5946/ce.2018.147

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Background
/Aims: Many gastrointestinal (GI) endoscopic procedures are difficult and cumbersome owing to the limitation of currently available endoscopic devices. This study aimed to develop an endoscopic guidetube for multipurpose endoscopic procedures and assess its use in a realistic GI endoscopic simulator.
Methods
The guidetube used is a soft overtube composed of neoprene and is designed to assist various endoscopic procedures on demand. In total, 15 types of procedures were performed in GI simulators. Four procedures were performed in the stomach model and 11 in the colon model. The procedures include repeated endoscopic insertion and foreign body removal in various positions. The mean insertion and procedure time were assessed in each session. All procedures were performed by 5 expert endoscopists.
Results
Endoscopic procedures with the new guidetube were faster and more effective than the conventional endoscopic techniques. The mean insertion time of the endoscope with the guidetube was significantly shorter than that without the guidetube. The guidetube was safely inserted without scratch using low pushing force. Objects of various sizes larger than the endoscopic channel were easily removed by the guidetube-assisted endoscopic procedures.
Conclusions
This preliminary study shows that guidetube-assisted endoscopic procedures are faster, easier, safer and cheaper than conventional endoscopic procedures.

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Efficacy of an assistive guide tube for improved endoscopic access to gastrointestinal lesions: an in vivo study in a porcine model
Dong Seok Lee, Jeong-Sik Byeon, Sang Gyun Kim, Ji Won Kim, Kook Lae Lee, Ji Bong Jeong, Yong Jin Jung, Hyoun Woo Kang
Clinical Endoscopy.2024; 57(1): 82. CrossRef
Technical feasibility of a newly designed bendable forceps for difficult endoscopic tissue samplings (with video)
Dong Seok Lee, Ji Won Kim, Kook Lae Lee, Byeong Gwan Kim, Su Hwan Kim, Jeong-Sik Byeon
Surgical Endoscopy.2020; 34(10): 4692. CrossRef
Usefulness of an Overtube Device in Gastrointestinal Endoscopy
Seung Han Kim
Clinical Endoscopy.2019; 52(3): 203. 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

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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.

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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

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Intramural Gastric Abscess Caused by a Toothpick Presenting as a Subepithelial Tumor: Wang Guk Oh, Mun Chul Kim, Hyun Ju Yoon, Jae Woo Park, Min A Yang, Cheon Beom Lee, Ji Woong Kim, Jin Woong Cho; Clin Endosc 2014;47(3):254-257. Published online May 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.3.254

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In the present report, we describe an unusual case of an intramural gastric abscess caused by a foreign body, detected in the form of a subepithelial tumor. A 64-year-old woman was referred to our gastroenterology clinic for further evaluation of a gastric subepithelial tumor. The patient presented with a 1-month history of sustained dull epigastric pain. Esophagogastroduodenoscopy revealed an ill-demarcated, round, smooth, protruding lesion with a small central erosion on the great curvature of the proximal antrum. Endoscopic ultrasonography indicated the presence of an ovoid, heterogeneous, hypoechoic lesion with small echogenic foci located in the submucosa and muscularis propria layers. An abdominal computed tomography scan showed focal gastric wall thickening and regional lymph node enlargement. Endoscopic submucosal dissection was performed for definite diagnosis and management. Thus, we detected a toothpick and removed it using grasping forceps. The final diagnosis was an intramural gastric abscess caused by a toothpick.

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Intramural gastric abscesses in a dog
I. Otero Balda, M. Augusto, C. Lassaigne, M. P. Maurin
Journal of Small Animal Practice.2024; 65(7): 596. CrossRef
Case report: Surgical treatment of pyloric obstruction with intramural gastric abscess induced by fragmented crystalline foreign materials in a dog
Jihun Kim, Hyunglak Son, Sungin Lee
Frontiers in Veterinary Science.2024;[Epub] CrossRef
Diagnostic challenges in differentiating intramural gastric abscess from gastric cancer
Youwei Chen, Yong Han, Jing Du
Medicine.2018; 97(43): e12756. CrossRef
Forgotten Swallowed Wooden Toothpick Detected on Ultrasound
Gauri R. Khorjekar, Michael C. Hill, Olena Hartwell, Nadia J. Khati
Ultrasound Quarterly.2015; 31(3): 227. 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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A Case of a Colon Perforation Due to a Soft Rectal Foreign Body: Jeong Hwa Lee, M.D., Sang Bum Kang, M.D., Dong Cheon Ha, M.D., Ki Huyn Kwon, M.D., Seung Woo Lee, M.D., Yeon Soo Kim, M.D., Dong Soo Lee, M.D. and Soon Woo Nam, M.D.; Korean J Gastrointest Endosc 2011;43(1):52-55. Published online July 28, 2011

Abstract PDF: Numerous foreign bodies in the rectum have been reported in the literature. Their removal can be challenging depending on the size and shape of the objects and their anatomical location in the rectum. A 64-year-old man presented to the emergency department after inserting a sausage into his rectum. He had some rectal discomfort and lower abdominal pain. There were no signs of bowel perforation. We attempted to extract the sausage impacted in the recto-sigmoid junction by colonoscopy using a snare and grasping forceps but failed to extract the foreign body. Unfortunately, a colon perforation had occurred, and the sausage was eventually extracted by performing a colostomy at the recto-sigmoid junction with primary repair. We report this case of a soft rectal foreign body impacted in the recto-sigmoid colon complicated by a colon perforation with a literature review. (Korean J Gastrointest Endosc 2011;43:52-55)

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Endoscopic Foley Balloon Extraction of an Esophageal Foreign Body: Jinou Kim, M.D., Jung Hoon Song, M.D., Hee Bae Wang, M.D., Eun Ho Jeong, M.D., Soo Hyung Ryu, M.D.^*, Jung Hwan Lee, M.D.^*, You Sun Kim, M.D.^* and Jeong Seop Moon, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):369-372. Published online June 21, 2011

Abstract PDF: Esophageal foreign bodies should be retrieved as soon as possible, as they may cause complications such as bleeding, perforation, and respiratory distress. Flexible endoscopy is the preferred method, because it is effective and safe, but rigid esophagoscopy or a surgical procedure should be considered if flexible endoscopy fails. Extraction with a Foley balloon is an effective method for removing blunt foreign bodies from the esophagus. The general technique used is to insert the catheter into the esophagus through the nose or mouth, place it in the distal part of the foreign body, balloon the catheter, and remove the foreign body by pulling the catheter out. This procedure is generally performed under fluoroscopy, but a few reports have used Foley balloon extraction during endoscopy. We report a case of an elderly woman with a blunt foreign body in the upper esophagus. After failing to remove the object by endoscopy, we removed it with a Foley balloon under endoscopy.

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A Case of Duodenal Wall Abscess Caused by a Foreign Body: Byoung Hoon Ji, M.D., Ji Hoon Yoon, M.D., Jin Ho Lee, M.D., Hee Ryong Lee, M.D., Seong Min Yu, M.D., Min Dae Kim, M.D., Young Il Choi, M.D.^* and Il Seon Lee, M.D.^†; Korean J Gastrointest Endosc 2011;42(6):383-387. Published online June 12, 2011

Abstract PDF: Duodenal abscess is a form of phlegmonous enterocolitis and is a rarely reported disease throughout the entire world. Duodenal abscess mostly develops from complications of duodenal ulcer perforation, and may result in a clinically fatal course because it is difficult to differentiate from some diseases such as gastric ulcer, gastric cancer, hepatobiliary disorders etc.. The therapeutic gold standard is surgical intervention including abscess removal and drainage. We experienced a
case
of duodenal abscess that expressed non-specific symptoms, weight loss and epigastric pain, and diagnosed by gastrointestinal endoscopy, abdominal computed tomography. We successfully treated it through surgical intervention with intravenous antibiotics.

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A Bowel Perforation That Developed during the Transanal Extraction of a Large Rectal Foreign Body: Keun-Suk Yang, M.D., Joung-Ho Han, M.D.^*, Sunyoung Kim, M.D., Woo Hyung Choi, M.D., Hong-Soon Jung, M.D., Eun Chung, M.D., HyenJeong Jeon, M.D.^* and Seijin Youn, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):406-409. Published online May 25, 2011

Abstract PDF: Rectal foreign bodies are rare clinical problem in South Korea. Although many foreign bodies can be extracted safely using endoscopic procedures, some patients require surgery. Here we describe the case of a 35-year-old male who presented with a rectosigmoid foreign body, a large carrot measuring 28×7 cm. Sigmoidoscopy revealed a carrot in the upper rectum extending to the sigmoid colon. Endoscopic removal failed. The surgeon unsuccessfully attempted to extract the carrot using various tools without spinal anesthesia. During the extraction attempt, the patient complained of sudden abdominal pain, and a simple x-ray revealed pneumoperitoneum. An emergency colotomy and removal of the foreign body was performed, followed by primary repair of the perforation and a colostomy. Three months later, the colostomy was repaired.

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A Case of a Pharyngeal Impacted Fish Bone Foreign Body Detected by Finger Palpation: Heung Up Kim, M.D., Hyung Joo Song, M.D., Eun Kwang Choi, M.D., Yoo-Kyung Cho, M.D. and Byung-Cheol Song, M.D.; Korean J Gastrointest Endosc 2011;42(4):228-231. Published online April 28, 2011

Abstract PDF: Emergent endoscopy is needed in cases of a fish bone foreign body in the upper gastrointestinal tract. A fish bone foreign body is common in the oral cavity and pharynx and has a high rate of complications because of the characteristic shape. A diagnosis is very difficult when the foreign body penetrates and impacts the surrounding tissue. Computed tomography is useful for the diagnosis; however, direct removal would be impossible if the foreign body was not localized during endoscopy. If the foreign body is anchored to the oral cavity and pharynx, finger palpation is useful to find the impacted fish bone. We report here on a case of an endoscopically missed pharyngeal impacted fish bone foreign body that was finally detected by finger palpation and successfully removed by rescue endoscopy. (Korean J Gastrointest Endosc 2011;42:228-231)

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A Case of Fishbone-induced Esophageal Perforation Closed by Endoscopic Clipping: Joung Muk Leem, M.D., Joung-Ho Han, M.D.*, Byeong Seong Ko, M.D.*, Mi Sung Kim, M.D.*, Ji Young Park, M.D.*, Woo Hyung Choi, M.D.*, Sei Jin Youn, M.D. and Seon Mee Park, M.D.; Korean J Gastrointest Endosc 2010;41(3):151-154. Published online September 30, 2010

Abstract PDF: Esophageal perforation continues to be associated with high mortality - 20% to 30% - despite advances in surgical techniques. Traditional surgery has been the mainstay of treatment for perforation, but recent advances in endoscopic closure devices has increased therapeutic options for selected patients. Our patient had a fishbone-induced esophageal perforation. He was treated successfully with endoscopic clipping, antibiotics and parenteral nutrition. We report this case and provide a review of the relevant literature. (Korean J Gastrointest Endosc 2010; 41:151-154)

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Two Cases of Foreign Body-induced Esophageal Perforation That Were Treated by Endoscopic Clipping and Non-surgical Management: Jung Bok Park, M.D., Won Ki Bae, M.D., Hyoung Don Lee, M.D., Jung Hoon Kim, M.D., Nam-Hoon Kim, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Young Soo Moon, M.D.; Korean J Gastrointest Endosc 2010;40(5):316-320. Published online May 30, 2010

Abstract PDF: Perforation of the esophagus is a deadly injury that requires careful management if the patient is to survive. Prompt recognition and proper treatment of esophageal perforation may avert death or minimize complications. Esophageal perforation might be followed by mediastinitis, broncho-esophageal fistula, pneumomediastinum, peritonitis and empyema. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. Endoscopic closure of an esophageal perforation with metallic clips and conservative therapy has recently been reported. We describe here two patients with esophageal perforation and pneumomediastinum that were caused by fish bones. One was completely closed by endoscopic clipping and the other was not. Non-surgical management that was made up of parenteral nutrition and antibiotic therapy produced the same successful outcomes in these two cases. (Korean J Gastrointest Endosc 2010;40:316-320)

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Endoscopic Removal of an Impacted Fishhook That Was in the Esophagus for Two Months: So Young Bae, M.D., Jun Haeng Lee, M.D., Hye Jeong Kim, M.D., Young Kyung Sung, M.D., Song Yi Song, M.D., Jae J. Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2009;39(2):85-87. Published online August 30, 2009

Abstract PDF: An esophageal foreign body has clinical significance because it may cause serious complications such as esophageal perforation, mediastinitis and/or aorto-esophageal fistula. A prompt attempt to remove an esophageal foreign body via flexible endoscopy should be made when the shape of the foreign body is especially sharp and long as it can easily lead to esophageal perforation. We report here on a case of endoscopic removal of an impacted esophageal foreign body, a fishhook, that hade been present in the esophagus for two months, and there were no serious complications from the procedure. (Korean J Gastrointest Endosc 2009;39:85-87)

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Risk Factors Predicting the Development of Complication after Foreign Body Ingestion: Sung Hoon Jung, M.D., Chang Nyol Paik, M.D., Kang Moon Lee, M.D., Woo Chul Chung, M.D., Jeong Rok Lee, M.D., U-Im Chang, M.D. and Jin Mo Yang, M.D.; Korean J Gastrointest Endosc 2009;38(4):199-204. Published online April 30, 2009

Abstract PDF: Background
/Aims: Complications related to foreign body ingestion are uncommon, and especially a food bolus, but some ingested foreign bodies are associated with severe and life threatening morbidity. The aim of this study is determine the predictive risk factors for complications resulting from foreign body ingestion in patients who are without gastrointestinal tract obstruction. Methods: We retrospectively analyzed the data of 147 patients who were diagnosed with a foreign body in the GI tract without obstruction between Jan. 2000 to Aug. 2008. Results: Animal bone fragment and coin were the most common type of foreign bodies in adults and children, respectively. Multivariate analysis showed age (p=0.019), the duration of impaction (p=0.013) and the location of the impacted foreign body (p=0.011) were significant independent risk factors associated with the development of complications. Especially, the most important risk factor for children was the location of the impacted foreign body and for adults it was the duration of impaction. Conclusions: Old age, a longer duration of impaction and impaction at the upper esophageal sphincter or upper esophagus are important predictive factors of complication after foreign body ingestion in patients without gastrointestinal tract obstruction. For cases with these factors, more intensive awareness by the physician should be adapted. (Korean J Gastrointest Endosc 2009;38:199-204)

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A Case of a Foreign Body in the Common Bile Duct Caused by Lipiodol: Kwan Woo Nam, M.D., Dae Soon Kwon, M.D., Hee Seok Moon, M.D., Seok Hyun Kim, M.D., Byung Seok Lee, M.D., Heon Young Lee, M.D., Jae Kyu Seong, M.D. and Hyun Yong Jeong, M.D.; Korean J Gastrointest Endosc 2008;37(2):156-158. Published online August 30, 2008

Abstract PDF: Finding a foreign body in the common bile duct (CBD) is very rare. Transcatheter arterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma and metastatic liver tumors, and especially when the tumors are not surgically resectable. We experienced a patient with a CBD foreign body 47 days after performing TACE for single hepatic metastasis of adrenal cortical carcinoma. The foreign body in the common bile duct was high attenuated on the pre-enhanced computed tomography (CT) and it was not observed on the previous CT. We successfully extracted it via a basket after performing endoscopic sphincterotomy; this foreign body was dark black color, flexible and smooth. It was not observed on the follow-up CT scan after one month. The foreign body in the common bile duct was tumor tissue that contained lipiodol and it was near the bile duct. We report here on a rare case of a foreign body in the common bile duct, and it was caused by lipiodol after performing TACE. (Korean J Gastrointest Endosc 2008;37:156-159)

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Endoscopic Removal of a Pork Bone from the Sigmoid Colon in a Patient with Ulcerative Colitis: Si Hyung Lee, M.D., Byung Ik Jang, M.D. and Tae Nyeun Kim, M.D.; Korean J Gastrointest Endosc 2008;37(1):51-54. Published online July 30, 2008

Abstract PDF: Inflammatory bowel disease is a risk factor for low gastrointestinal foreign body impaction, but such cases are very rare. Impaction of a foreign body in the lower gastrointestinal tract can result in perforation, bleeding, abscess formation and fistula. A risk factor for perforation is inflammatory bowel disease, a sharp foreign body and a long-standing foreign body in the gastrointestinal tract. Thus, a foreign body in the lower gastrointestinal tract should be promptly removed by surgery or endoscopy. Most of these cases can currently be managed by endoscopy because of the development of endoscopic devices and the accumulation of experience. Here we report on a case of successful removal of a pork bone from the sigmoid colon in a patient with ulcerative colitis. (Korean J Gastrointest Endosc 2008;37:51-54)

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A Case of a Sharp Denture-Induced Esophageal Perforation Managed by Medical Treatment: Jae Myung Cha, M.D., Joung Il Lee, M.D., Jae Won Choe, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D. and Hyun Phil Shin, M.D.; Korean J Gastrointest Endosc 2008;37(1):35-39. Published online July 30, 2008

Abstract PDF: Foreign bodies in the esophagus are regarded as clinically important as they cause symptoms such as pain and dysphagia and can cause complications such as perforation. Recent progress in therapeutic endoscopy has made it possible to extract most foreign bodies in the esophagus. However, endoscopic extraction of sharp foreign bodies impacted in the esophagus may be a difficult and complicated procedure. Although rapid surgical intervention is the main treatment for esophageal perforation, medical treatment can be successful for a minor perforation after early diagnosis if the perforation size is small and symptoms or signs associated with the perforation are mild. We report a case of a sharp denture- induced esophageal perforation managed by medical treatment that consisted of parenteral nutrition and antibiotics. This case highlights the necessity for an early diagnosis and treatment for an esophageal perforation, which can occur even after removal of a foreign body. (Korean J Gastrointest Endosc 2008;37:35-39)

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Two Cases of Gastrointestinal Perforation by Foreign Bodies: Hyeong-Cheon Park, M.D., Chang-Hwan Park, M.D., Sung-Bum Cho, M.D., So-Young Joo, M.D., Seon-Young Park, M.D., Suck Cho, M.D., Seung-Hwan Lee, M.D., Kyoung-Won Yoon, M.D., Wan-Sik Lee, M.D., Hyun-Soo Kim, M.D., Sung-Kyu Choi, M.D. and Jong-Sun Rew, M.D.; Korean J Gastrointest Endosc 2007;35(1):46-50. Published online July 30, 2007

Abstract PDF: About 80∼90% of ingested foreign bodies usually pass through the gastrointestinal tract spontaneously without any specific symptoms or gastrointestinal injury. Most of the foreign bodies in the stomach are passed along by gastrointestinal movement, and they are usually evacuated once they pass over the pylorus, Treitz ligament, the ileocecal valve and the rectosigmoid junction. Yet those foreign bodies that are sharp and/or pointed have a high risk of perforation, bleeding and abscess formation. We report here on two cases of a nail in the stomach and toothpicks in the sigmoid colon, and both cases were complicated by perforation. Both patients didn't know that they swallowed the foreign bodies. These patients were treated by surgery and antibiotics. As seen in our cases, we should keep in mind that a sharp, pointed foreign body in the gastrointestinal tract could induce severe complications such as perforation or abscess formation.

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A Case of Foreign Body Induced Esophageal Perforation Repaired by Endoscopic Clipping: Woo Sik Han, M.D., Jong-Jae Park, M.D., Beom Jae Lee, M.D., Joo Yeon Oh, M.D., Youn Ho Kim, M.D., Sung Woo Jung, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2007;35(1):28-32. Published online July 30, 2007

Abstract PDF: An esophageal perforation is a potentially life threatening condition with a high mortality rate. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. The successful endoscopic closure of an esophageal perforation with metallic clips was recently reported. We report a case of an esophageal perforation caused by a dog bone and mediastinitis treated by non-surgical management consisting of parenteral nutrition, antibiotics therapy and endoscopic clipping.

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Esophageal Perforation and Empyema after Fish Bone Swallowing: Yeon Soo Kim, M.D., Seung Woo Lee, M.D., Sang Bum Kang, M.D., Soon Woo Nam, M.D., Dong Soo Lee, M.D. and Kun Park, M.D.*; Korean J Gastrointest Endosc 2007;34(6):320-323. Published online June 30, 2007

Abstract PDF: Most foreign bodies accidentally ingested are eliminated naturally but 10∼20% of cases require endoscopic treatment. Esophageal perforation due to the indigestion of a foreign body is rare and might be followed by mediastinitis, broncho-esophageal fistula, pneumomediastinum, peritonitis, and empyema. Rapid surgery is important because the morbidity and mortality depend on the duration from perforation to treatment. A 64 year-old woman sustained odynophagea after swallowing a fish bone. Empyema due to an esophageal perforation developed, and she died despite aggressive treatment. This case highlights the need for an early diagnosis and treatment to reduce the morbidity and mortality.

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A Case of Esophageal Obstruction Caused by an Ingested Canine Gallbladder: Jong In Yang, M.D., Ji Won Kim, M.D.*, Kook Lae Lee, M.D.*, Jung Mook Kang, M.D., Yong Jin Jung, M.D.*, Ji Bong Jeong, M.D.* and Byung Kwan Kim, M.D.*; Korean J Gastrointest Endosc 2007;34(3):143-145. Published online March 30, 2007

Abstract PDF: Endoscopic intervention is a very important and effective tool for evaluating and treating an esophageal foreign body. The size of a cystic foreign body filled with liquid can be reduced by needle puncture and fluid spillage. We report a rare case of an acute total obstruction of the esophagus by an ingested canine gallbladder that was removed by endoscopic intervention. (Korean J Gastrointest Endosc 2007;34:143⁣145)

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A Case of Liver Abscess Caused by Toothpick Penetrating Gastric Wall: Hyun Cheol Koo, M.D., Jae Pil Han, M.D., Ick Keun Kim, M.D., In Il Park, M.D., Jue Yong Lee, M.D., Kyung Min Sohn, M.D., Kwang Ho Baik, M.D., Jin Bong Kim, M.D. and Dong Jun Kim, M.D.; Korean J Gastrointest Endosc 2006;33(2):94-99. Published online August 30, 2006

Abstract PDF: The ingestion of foreign bodies into the gastrointestinal tract is common, and most are passed out spontaneously without causing any problems. However, a perforation can cause a variety of complications involving considerable morbidity and mortality. Moreover, clinical presentation of a perforation can vary and patients are often unaware of the episode. Hence, a pre-operative diagnosis is difficult under these circumstances. We report an unusual case of a liver abscess that developed secondary to a toothpick that had penetrated the gastric wall and migrated to the liver. The liver abscess was treated successfully with internal drainage by inserting an endoscopic pigtail catheter through the hepato-gastric fistula. The toothpick was removed using an endoscopic snare. (Korean J Gastrointest Endosc 2006;33:94⁣99)

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A Case of Ingested Two Magnets Attracted Each Other that were Holding Gastric Mucosa: Min-Ji Goo, M.D., Ji-Sook Park, M.D., Seok-Jin Kang, M.D.*, Hyun-Jin Kim, M.D.*, Ji-Hyun Seo, M.D., Hyang-Ok Woo, M.D. and Hee-Shang Youn, M.D.; Korean J Gastrointest Endosc 2006;32(4):275-277. Published online April 30, 2006

Abstract PDF: Foreign body ingestion is common in children. About 80% of ingested foreign bodies spontaneously pass through gastrointestinal tract. The management of an ingested magnet depends on its size, the same as for other foreign bodies. However, it has been reported that magnetic foreign body ingestion can lead to gastrointestinal fistula. We report here on the case of a 13-month-old boy who ingested two magnet bars that attracted to each other, and they were holding the gastric mucosa. A simple abdomen X-ray revealed that the location of two magnet bars was not changed according to the patient's positional change. The magnet bars were removed with an alligator forcep under gastroduodenal endoscopy. (Korean J Gastrointest Endosc 2006;32:275⁣277)

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A Case of Foreign Body Removal Using Latex Glove and Two Endoscopes: In Hwan Kim, M.D., Jeong Soon Kim, M.D., Sang Soon Park, M.D., Yeun Jung Lim, M.D., Sang Jong Park, M.D., Eun Jeong Jang, M.D., Ju Sang Park, M.D. and Hyun Wook Baik, M.D.; Korean J Gastrointest Endosc 2005;31(5):334-338. Published online November 30, 2005

Abstract PDF: Foreign body ingestion is a common clinical problem. Foreign bodies are generally swallowed accidentally and most pass out spontaneously. However, if a sharp object is not eliminated early, it can penetrate the bowel wall and cause severe complications. Endoscopic techniques for removing sharp foreign bodies safely include methods using a protector hood and overtube. An overtube is uncomfortable and has limitations in its diameter. We introduced a method using a latex glove, which is easily available, comfortable, and has no limitations in diameter. In addition, two endoscopes were used to reduce the risk of complications, and the large sharp object was easily wrapped with the latex glove. We report a case of a sharp and large foreign body being removed endoscopically using a latex glove and two endoscopes without any complications. (Korean J Gastrointest Endosc 2005;31:334⁣338)

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Endoscopic Treatment of Foreign Bodies in the Upper Gastrointestinal Tract: Yoon Sae Kang, M.D., Jae Hoon Jung, M.D., Kyung Hoon Chae, M.D., Won Seok Heo, M.D., Yeon Soo Kim, M.D., Seok Hyun Kim, M.D., Jae Kyu Sung, M.D.,Byung Seok Lee, M.D. and Hyun Yong Jeong, M.D.; Korean J Gastrointest Endosc 2005;31(3):135-139. Published online September 30, 2005

Abstract PDF: Background
/Aims: The ingestion of foreign bodies in the upper gastrointestinal tract usually happens as a result of accidental swallowing, and rarely produces symptoms. Although most foreign bodies are eliminated spontaneously, 10∼20% of cases need treatment with endoscopy. We evaluated the role of endoscopy for removing foreign bodies from the upper gastrointestinal tract. Methods: We analyzed one hundred and thirty-nine cases of foreign bodies in the upper gastrointestinal tract which were endoscopically treated at Chungnam National University Hospital from January 2001 to July 2004. Results: Patients' age ranged from 6 months to 96 years old (mean 36.0 years old). The ratio of males to females was 1.2：1. The common foreign bodies included coins (29 cases) and fish bones (23 cases), animal bones (19 cases), and stones (15 cases) follows in order. The most common location was the esophagus (79.9%). In most cases (73.4%), the foreign body was removed using an alligator tooth and a grasping forceps. Twenty-eight among one hundred and thirty-nine patients had a co-morbid condition, such as esophageal disease, diabetes mellitus, hypertension, stomach cancer, or a psychiatric disorder. Conclusions: Endoscopic removal is a very powerful and useful method for removing foreign bodies from the upper gastrointestinal tract. Nevertheless, a simpler and more efficient endoscopic equipment is required. (Korean J Gastrointest Endosc 2005;31:135⁣139)

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Endoscopic Treatment of Foreign Bodies in the Upper Gastrointestinal Tract: Yoon Sae Kang, M.D., Jae Hoon Jung, M.D., Kyung Hoon Chae, M.D., Won Seok Heo, M.D., Yeon Soo Kim, M.D., Seok Hyun Kim, M.D., Jae Kyu Sung, M.D.,Byung Seok Lee, M.D. and Hyun Yong Jeong, M.D.; Korean J Gastrointest Endosc 2005;31(3):135-139. Published online September 30, 2005

Abstract PDF: Background
/Aims: The ingestion of foreign bodies in the upper gastrointestinal tract usually happens as a result of accidental swallowing, and rarely produces symptoms. Although most foreign bodies are eliminated spontaneously, 10∼20% of cases need treatment with endoscopy. We evaluated the role of endoscopy for removing foreign bodies from the upper gastrointestinal tract. Methods: We analyzed one hundred and thirty-nine cases of foreign bodies in the upper gastrointestinal tract which were endoscopically treated at Chungnam National University Hospital from January 2001 to July 2004. Results: Patients' age ranged from 6 months to 96 years old (mean 36.0 years old). The ratio of males to females was 1.2：1. The common foreign bodies included coins (29 cases) and fish bones (23 cases), animal bones (19 cases), and stones (15 cases) follows in order. The most common location was the esophagus (79.9%). In most cases (73.4%), the foreign body was removed using an alligator tooth and a grasping forceps. Twenty-eight among one hundred and thirty-nine patients had a co-morbid condition, such as esophageal disease, diabetes mellitus, hypertension, stomach cancer, or a psychiatric disorder. Conclusions: Endoscopic removal is a very powerful and useful method for removing foreign bodies from the upper gastrointestinal tract. Nevertheless, a simpler and more efficient endoscopic equipment is required. (Korean J Gastrointest Endosc 2005;31:135⁣139)

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A Case of Common Bile Duct Stone Caused by Foreign Body in Patient with Adenoma of the Ampulla of Vater: Ju Hyun Park, M.D., Sun Mi Lee, M.D., Jun Hyok Oh, M.D., Sang Youn Hwang, M.D., Seong Hun Lee, M.D., Tae Oh Kim, M.D., Seong Ook Lee, M.D., Won Il Park, M.D., Suk Kim, M.D.*, Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and; Korean J Gastrointest Endosc 2005;30(2):114-117. Published online February 27, 2005

Abstract PDF: Choledocholithiasis caused by a foreign body is rare. The most common type of foreign body in the common bile duct is a residual object from previous surgery such as a metal clip or suture material. Foreign body may enter the biliary system after choledochointestinal anastomosis or endoscopic sphincterotomy. Rarely, penetrating missile fragment or gunshot shrapnel account for another type of foreign body. We experienced a case of common bile duct (CBD) stone caused by foreign meterial in 75-years-old women who had a plant foreign body in the common bile duct. She had no past history of abdominal surgery or penetrating trauma. The foreign body and stone were successfully extracted with Dormia basket after the endoscopic sphincterotomy. (Korean J Gastrointest Endosc 2005;30: 114⁣117)

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A Case of Esophageal Foreign Body Induced by Glue Ingestion: Hwang Rae Chun, M.D., Hoon Jai Chun, M.D., Bora Keum, M.D., Sung Woo Jung, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Soon Ho Um, M.D., Chang Duck Kim, M.D. and Jin Hai Hyun, M.D.; Korean J Gastrointest Endosc 2005;30(1):24-27. Published online January 30, 2005

Abstract PDF: Foreign bodies of the upper gastrointestinal tract are usually discovered in children, persons with esophageal disease, prisoners with a purpose of secondary gain, and mentally disturbed or disabled individuals. In adults, accidentally or intentionally ingested foreign bodies such as dentures, coins, corks, toothbrush, needles, and nails are reported. To our knowledge, there has been one case of gastric bezoar caused by glue ingestion that was removed by surgical operation in Korea. However, there has been no case report of esophageal foreign body caused by glue ingestion neither in Korea nor elsewhere. We report a case of a man with a history of chronic glue inhalation, who ingested glue with suicidal intent, that was solidified from the upper esophagus to the stomach. It was successfully removed by therapeutic endoscopy. (Korean J Gastrointest Endosc 2005;30:24⁣27)

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Endoscopic Treatment of Esophageal Foreign Bodies in Adult: Management of 257 Cases: Hyun Jin Kim, M.D., Ok Jae Lee, M.D., Hyun Ju Min, M.D., Do Hyun Kang, M.D., Eun Jeong Lee, M.D., Ji Hun Lee, M.D., Tae Hyo Kim, M.D., Woon Tae Jung, M.D. and Joong Hyun Cho, M.D.; Korean J Gastrointest Endosc 2004;29(2):51-57. Published online August 30, 2004

Abstract PDF: Background
/Aims: The majority of foreign body ingestions occur in pediatric population. We assessed the characteristics and endoscopic treatment outcome of esophageal foreign bodies in adults. Methods: Medical records of consecutive 257 patients who received trial of endoscopic treatment for esophageal foreign bodies, from January 1998 through November 2003 in Gyeongsang National University Hospital, were analyzed retrospectively. Results: Among 257 cases, 132 were male. The incidence was highest in 5th decade, and mean age was 54.6 years. Most common location was upper esophagus (84.6%). Accidental ingestion accounted for 92.2%. Twenty cases (7.8%) of voluntary ingestion were all prisoners or in psychiatric problems. Fish bone was the most common type. Endoscopic treatment was successful in 253 cases (98.4%) and 4 were managed with rigid esophagoscopy. Four cases who complicated by acute mediastinitis or pneumomediastinum at presentation had sharp-pointed or long objects lodged in upper esophagus, and almost presented at 48 hours after the ingestion. Full esophagogastroduodenoscopy could find 37 organic lesions in 35 cases. Conclusions: Majority of esophageal foreign bodies in adults developed accidentally during meals. Voluntary ingestion of foreign bodies was not related to meals, and developed by prisoners or psychiatric patients. The sharp-pointed or long objects lodged in upper esophagus with delayed presentation may cause complication. Endoscopic treatment is safe and beneficial, and a full endoscopic evaluation should be recommended for the evaluation of a synchronous organic disease. (Korean J Gastrointest Endosc 2004;29:51⁣57)

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Endoscopic Removal of a Spoon from the Stomach Using Guidewire: Byung Wook Lim, M.D., Young Soo Moon, M.D., Sang Eun Lee, M.D., Tae Nyun Kim, M.D., Kyung Ah Kim, M.D., Hyun Bae Son, M.D., Jeon Ho Yang, M.D., Jeong Rak Lee, M.D.* and Kyung Tae Kim, M.D.*; Korean J Gastrointest Endosc 2004;29(1):17-21. Published online July 30, 2004

Abstract PDF: Foreign body ingestion is a relatively uncommon, but potentially serious condition. Most of gastrointestinal foreign bodies pass spontaneously. But, large objectives are usually lodged in the stomach and cause perforation, bleeding, and obstruction. Therefore, prompt retrieval of lodged foreign bodies are necessary before complications develop. Particularly, in the case of long metallic spoon, there have been no cases of spontaneous passage reported. Therefore, prompt retrieval of a metallic spoon are necessary. A 28- year-old woman with schizophrenia who ingested a long spoon for suicidal attempt was referred to our hospital. Simple abdomen showed a 18 cm sized long, metallic spoon with saw-toothed end placed in the stomach. We removed a spoon by an endoscopic technique and an extraction maneuver using a guidewire and a Magill forceps. (Korean J Gastrointest Endosc 2004;29:17⁣21)

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