Clinical Endoscopy

Aerosol protection using modified N95 respirator during upper gastrointestinal endoscopy: a randomized controlled trial: Chawisa Nampoolsuksan, Thawatchai Akaraviputh, Asada Methasate, Jirawat Swangsri, Atthaphorn Trakarnsanga, Chainarong Phalanusitthepha, Thammawat Parakonthun, Voraboot Taweerutchana, Nicha Srisuworanan, Tharathorn Suwatthanarak, Thikhamporn Tawantanakorn, Varut Lohsiriwat, Vitoon Chinswangwatanakul; Clin Endosc 2024;57(3):335-341. Published online June 21, 2023; DOI: https://doi.org/10.5946/ce.2023.018

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: The coronavirus disease 2019 pandemic has affected the worldwide practice of upper gastrointestinal endoscopy. Here we designed a modified N95 respirator with a channel for endoscope insertion and evaluated its efficacy in upper gastrointestinal endoscopy.
Methods
Thirty patients scheduled for upper gastrointestinal endoscopy were randomized into the modified N95 (n=15) or control (n=15) group. The mask was placed on the patient after anesthesia administration and particles were counted every minute before (baseline) and during the procedure by a TSI AeroTrak particle counter (9306-04; TSI Inc.) and categorized by size (0.3, 0.5, 1, 3, 5, and 10 µm). Differences in particle counts between time points were recorded.
Results
During the procedure, the modified N95 group displayed significantly smaller overall particle sizes than the control group (median [interquartile range], 231 [54–385] vs. 579 [213–1,379]×103/m3; p=0.056). However, the intervention group had a significant decrease in 0.3-µm particles (68 [–25–185] vs. 242 [72–588]×103/m3; p=0.045). No adverse events occurred in either group. The device did not cause any inconvenience to the endoscopists or patients.
Conclusions
This modified N95 respirator reduced the number of particles, especially 0.3-µm particles, generated during upper gastrointestinal endoscopy.

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Changes in Policy and Endoscopic Procedures during the 2019 Coronavirus Disease Outbreak: A Single Center Experience: Adi Lahat, Avidan Benjamin; Clin Endosc 2021;54(1):48-54. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.132

Background
/Aims: The coronavirus disease-19 (COVID-19) pandemic forced endoscopy units to enact major changes on daily practice and policy. The Chaim Sheba Medical Center is a tertiary referral center located in the center of Israel, and serves cities with high infection rates. Our aim was to review the policies enacted during this outbreak and study their influence on the performance of endoscopic procedures.
Methods
Following the revision of work protocols, personnel were divided into two permanent and physically separate working groups and screening procedures were rescheduled. Relevant data including the number of endoscopic examinations, type of procedure performed, and patient referrals and indications were taken from a computerized database and evaluated. The study included data for January–March 2018–2020, and a comparison among the data from each year was performed.
Results
As of March 2020, the total number of endoscopic examinations performed reduced by 44% (p<0.0001) as compared to previous years, gastroscopy examinations reduced by 39% (p=0.02), and lower endoscopy procedures reduced by 57% (p<0.0001). Meanwhile, the number of advanced endoscopic procedures performed remained consistent with previous years. The indications for performance of gastroscopy and lower endoscopy were different in March 2020, while these remained unchanged for advanced endoscopic procedures.
Conclusions
The current policy appears to serve both our initial goals: protecting personnel and patients’ safety and minimizing potential damage from delayed endoscopic procedures. A longer term follow-up study is needed in order to fully analyze our results.

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Association of COVID-19 Pandemic with Colorectal Cancer Screening: Impact of Race/Ethnicity and Social Vulnerability
Muhammad Muntazir Mehdi Khan, Muhammad Musaab Munir, Selamawit Woldesenbet, Yutaka Endo, Mujtaba Khalil, Diamantis Tsilimigras, Alan Harzman, Emily Huang, Matthew Kalady, Timothy M. Pawlik
Annals of Surgical Oncology.2024; 31(5): 3222. CrossRef
Setting up a three‐stage pre‐endoscopy triage during the coronavirus disease 2019 pandemic: A multicenter observational study
Tao‐Chieh Liu, Chen‐Ling Peng, Fang‐Yu Hsu, Li‐Chun Chang, Hsiu‐Po Wang, Wei‐Kuo Chang
DEN Open.2023;[Epub] CrossRef
Impact of the COVID-19 Pandemic on Colorectal Cancer Screening: a Systematic Review
Afrooz Mazidimoradi, Azita Tiznobaik, Hamid Salehiniya
Journal of Gastrointestinal Cancer.2022; 53(3): 730. CrossRef
The impact of the COVID-19 pandemic on colorectal and gastric cancer diagnosis, disease stage and mortality
Naim Abu-Freha, Reut Hizkiya, Muhammad Abu-Abed, Tal Michael, Binil Mathew Jacob, Keren Rouvinov, Doron Schwartz, Avraham Reshef, Uri Netz, Ilia Pinsk, Ohad Etzion
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The Dramatic Change in Endoscopic Activities Following the Coronavirus Disease 2019 Outbreak. Is It Evolution?
Kook Hyun Kim
Clinical Endoscopy.2021; 54(3): 445. CrossRef
Protecting Your Endoscopy Unit during the COVID-19 Pandemic
Hyeong Ho Jo, Eun Young Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(3): 239. CrossRef
Capsule Endoscopy in Crohn’s Disease—From a Relative Contraindication to Habitual Monitoring Tool
Adi Lahat, Ido Veisman
Diagnostics.2021; 11(10): 1737. CrossRef

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Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea: Jun Ki Min, Jae Myung Cha, Yu Kyung Cho, Jie-Hyun Kim, Soon Man Yoon, Jong Pil Im, Yunho Jung, Jeong Seop Moon, Jin-Oh Kim, Yoon Tae Jeen; Clin Endosc 2018;51(3):239-252. Published online May 31, 2018; DOI: https://doi.org/10.5946/ce.2018.075

Abstract PDF PubReader ePub

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

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Young-Il Kim
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Association between Endoscopist Volume and Interval Cancers after Colonoscopy: Results from the National Colorectal Cancer Screening Program in Korea
Dong Jun Kim, Nan-He Yoon, Jae Kwan Jun, Mina Suh, Sunhwa Lee, Seongju Kim, Ji Eun Kim, Hooyeon Lee
Cancer Research and Treatment.2024; 56(4): 1164. CrossRef
Interval Advanced Gastric Cancer After Negative Endoscopy
Tae Jun Kim, Jeung Hui Pyo, Young Hye Byun, Sung Chul Choi, Jin Pyo Hong, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Poong-Lyul Rhee, Jae J. Kim, Jun Haeng Lee
Clinical Gastroenterology and Hepatology.2023; 21(5): 1205. CrossRef
Simulator-based training method in gastrointestinal endoscopy training and currently available simulators
Yuri Kim, Jeong Hoon Lee, Gin Hyug Lee, Ga Hee Kim, Gunn Huh, Seung Wook Hong, Hwoon-Yong Jung
Clinical Endoscopy.2023; 56(1): 1. CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
Intestinal Research.2023; 21(1): 20. CrossRef
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Vikneswaran Namasivayam, Noriya Uedo
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Lei Xin, Ye Gao, Zhiyuan Cheng, Tianjiao Wang, Han Lin, Yanan Pang, Chang Sun, Zengjun Fu, Zhaoshen Li, Xudong Ma, Luowei Wang
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Reduced detection rate of artificial intelligence in images obtained from untrained endoscope models and improvement using domain adaptation algorithm
Junseok Park, Youngbae Hwang, Hyun Gun Kim, Joon Seong Lee, Jin-Oh Kim, Tae Hee Lee, Seong Ran Jeon, Su Jin Hong, Bong Min Ko, Seokmin Kim
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Vasuki Rajaguru, Jieun Jang, Jeoung A. Kwon, Jae Hyun Kim, Jaeyong Shin, Mison Chun
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Antispasmodic Agent Administration Improves Gastric Neoplasm Detection Rates during Esophagogastroduodenoscopy
Sang Yoon Kim, Jae Myung Park
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Young-Eun Joo
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Mucosal Incision and Forceps Biopsy for Reliable Tissue Sampling of Gastric Subepithelial Tumors: Sa Young Shin, Sang Jin Lee, Jae Hyuck Jun, Jong Kyu Park, Hyun Il Seo, Koon Hee Han, Young Don Kim, Woo Jin Jeong, Gab Jin Cheon; Clin Endosc 2017;50(1):64-68. Published online March 4, 2016; DOI: https://doi.org/10.5946/ce.2015.094

Abstract PDF PubReader ePub

Background
/Aims: The diagnostic efficacy of current tissue sampling techniques for gastric subepithelial tumors (SETs) is limited. Better tissue sampling techniques are needed to improve pathological diagnosis. The aim of this study was to evaluate the safety and efficacy of a new technique, mucosal incision and forceps biopsy, for reliable tissue sampling of gastric SETs.
Methods
This study enrolled 12 consecutive patients who underwent mucosal incision and forceps biopsy of gastric SETs between November 2011 and September 2014 at Gangneung Asan Hospital. The medical records of patients were reviewed retrospectively. The safety and diagnostic yield of this method were evaluated.
Results
By performing mucosal incision and forceps biopsy, we were able to provide a definitive histological diagnosis for 11 out of 12 cases. The pathological diagnoses were leiomyoma (3/11), gastrointestinal stromal tumor (GIST; 2/11), lipoma (2/11), schwannoma (1/11), and ectopic pancreas (3/11). In cases of leiomyoma (n=3) and GIST (n=2), tissue samples were of sufficient size to allow immunohistochemical staining. In addition, the mitotic index was evaluated in two cases of GIST. There were no procedure-related complications.
Conclusions
Mucosal incision and forceps biopsy can be used as one of several methods to obtain adequate tissue samples from gastric SETs.

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Natural history of gastric leiomyoma
Kwangbeom Park, Ji Yong Ahn, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwwon-Yong Jung
Surgical Endoscopy.2024; 38(5): 2726. CrossRef
Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
Gastrointestinal Endoscopy.2024; 99(6): 895. CrossRef
Diagnostic ability and adverse events of mucosal incision‐assisted biopsy for gastric subepithelial tumors: Systematic review and meta‐analysis
Eriko Koizumi, Osamu Goto, Akihisa Matsuda, Toshiaki Otsuka, Yumiko Ishikawa, Shun Nakagome, Masahiro Niikawa, Tsugumi Habu, Keiichiro Yoshikata, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Jun Omori, Naohiko Akimoto, Hiroshi Yoshida, Kat
Digestive Endoscopy.2024;[Epub] CrossRef
Advancements in the Diagnosis of Gastric Subepithelial Tumors
Osamu Goto, Mitsuru Kaise, Katsuhiko Iwakiri
Gut and Liver.2022; 16(3): 321. CrossRef
Endoscopic full-thickness resection of gastric subepithelial tumors with the gFTRD-system: a prospective pilot study (RESET trial)
Benjamin Meier, Arthur Schmidt, Nicolas Glaser, Alexander Meining, Benjamin Walter, Andreas Wannhoff, Bettina Riecken, Karel Caca
Surgical Endoscopy.2020; 34(2): 853. CrossRef
Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors
Sang Yoon Kim, Ki-Nam Shim, Joo-Ho Lee, Ji Young Lim, Tae Oh Kim, A. Reum Choe, Chung Hyun Tae, Hye-Kyung Jung, Chang Mo Moon, Seong-Eun Kim, Sung-Ae Jung
Clinical Endoscopy.2019; 52(6): 565. CrossRef
Diagnosis of Gastric Subepithelial Tumors Using Endoscopic Ultrasonography or Abdominopelvic Computed Tomography: Which is Better?
Eun Young Park, Gwang Ha Kim
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Eun Young Kim
Clinical Endoscopy.2017; 50(1): 6. CrossRef

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A Case of Retrograde Jejunogastric Intussusception Following Subtotal Gastrectomy: Ji Hoon Yoon, M.D., Hyuk Yong Kwon, M.D., Myoung Joon Kim, M.D., Min Gu Chon, M.D., Seol Jung Ak, M.D., Seung Keun Park, M.D. and Hee Ug Park, M.D.; Korean J Gastrointest Endosc 2011;42(2):94-97. Published online February 28, 2011

Abstract PDF: Retrograde jejunogastric intussusception is a rare complication following Billroth ll gastric surgery. It is a segmental invagination of a jejunal loop into the stomach through stoma. Clinical manifestations are epigastric pain, vomiting with bile or blood, and a palpable mass in the epigastrium. Gastroscopy and a upper GI (UGI) series are very helpful in the diagnosis of this disease. Although the management of this disease is usually surgical, when endoscopic reduction has failed, surgery should be immediately done because of the high mortality. We present here a case of jejunogastric intussusception that was diagnosed by gastroscopy in a patient with a history of Billroth ll surgery that had been done 6 years prior due to gastric cancer. (Korean J Gastrointest Endosc 2011;42:94-97)

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The Effect of Peppermint Oil on Peristalsis during Gastroscopy: Sanghoon Park, M.D., Hoon Jai Chun, M.D., Eun Sun Kim, M.D., Sung Chul Park, M.D., Eun Suk Jung, M.D., Bora Keum, M.D., Yeon Seok Seo, M.D., Yoon Tae Jeen, M.D., Soon Ho Um, M.D., Chang Duck Kim, M.D. and Ho Sang Ryu, M.D.; Korean J Gastrointest Endosc 2009;39(4):199-204. Published online October 30, 2009

Abstract PDF: Background
/Aims: Gastrointestinal peristalsis may hinder inspection of the gastrointestinal track or its treatment during endoscopy. Antispasmodic agents such as hyoscine-N-butylbromide are commonly administered before endoscopy for alleviating peristalsis, although it causes unwanted complications. Peppermint oil (PMO) has a spasmolytic effect on viscera and it has been used as an adjunctive remedy for some disorders. We evaluated the antispasmodic effect of PMO solution during gastroscopy, and we determined if there are any adverse effects.
Methods
1.6% PMO solution was sprayed on the antrum of the examinees (n=40) during gastroscopy. Observation was performed 5 cm ahead of the pyloric ring to count the peristaltic waves for 3 minutes before and after spraying PMO. The intensity of peristalsis was graded from 0 (none) to 4 (severe), and the pulse rate of all the examinees was recorded every minute.
Results
The number of peristaltic contractions decreased after PMO spraying from 7.02±2.25 to 3.17±2.57 times/3 minutes (p＜0.01). The peristaltic intensity also decreased from 3.15±1.18 to 1.34±0.95 (p＜0.01) with a difference of 1.80± 1.29. On observing the examinees' pulse rates, using PMO did not induce tachycardia. No adverse effect during and after the investigation with PMO solution was reported.
Conclusions
PMO showed a significant antispasmodic effect, and it reduced the number of peristaltic contractions and the intensity of gastric peristalsis. It also did not have any significant side effects. PMO solution may be used as an effective antispasmodic agent during gastroscopy. (Korean J Gastrointest Endosc 2009; 39:199-204)

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A Case of Retrograde Jejunogastric Intussusception Diagnosed by Gastroscopy: Hyeug Lee, M.D., Eun Ok Kim, M.D., Juyoung Shin, M.D., Seung Hyun Oh, M.D., Hong Seok Song, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Jeong Jo Jeong, M.D., Sang Wook Choi, M.D., Sung Geun Kim, M.D.*, Sang Seob Yun, M.D.* and Seong Lee, M.D.*; Korean J Gastrointest Endosc 2008;37(2):112-115. Published online August 30, 2008

Abstract PDF: Retrograde intussusception of the jejunum into the stomach through the stroma of a gastroenterostomy is a very rare, but potentially fatal complication after gastrectomy. Once symptoms develop, the mortality rate is high if this is not treated within 48 hours, so making an early diagnosis with a high index of suspicion and administering prompt treatment are mandatory. Gastroscopy could be a useful diagnostic tool for patients with a history of gastrectomy and who present with abdominal pain and hematemesis, and with considering the possibility of intussusception. A 65-year-old man with a history of Billroth II gastrectomy that was done 35 years ago due to gastric ulcer perforation was admitted with abdominal pain and hematemesis. A necrotic mucosa that was suspicious of an intussuscepted small bowel tissue was detected on gastroscopy. Subsequent open reduction and small bowel resection was performed with successful results. We report here on a case of postoperative retrograde jejunogastric intussusception that occurred 35 years after Billroth II gastrectomy, and it was first diagnosed by performing gastroscopy. (Korean J Gastrointest Endosc 2008;37:112-115)

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A Case of Jejunogastric Intussusception that was Diagnosed by Gastroscopy in a Patient who had Undergone Subtotal Gastrectomy: Kang Kim, M.D., Gun Young Hong, M.D., Sang Chul Choi, M.D., Jun Ho Cho, M.D., Kyung Rok Lee, M.D., Sang Uk Park, M.D., Kang Suk Seo, M.D. and Yun Ken Lym, M.D.; Korean J Gastrointest Endosc 2008;37(1):25-29. Published online July 30, 2008

Abstract PDF: Jejunogastric intussusception is a rare, but potentially lethal complication after gastrectomy or gastrojejunostomy. In the acute condition, early diagnosis and prompt surgical treatment are mandatory to reduce the incidence of mortality. We present here a case of jejunogastric intussusception that was diagnosed by gastroscopy in a patient with a history of subtotal gastrectomy, and she had experienced increasing epigastric pain and vomiting for 1 day. (Korean J Gastrointest Endosc 2008;37:25-29)

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A Case of Mesenteroaxial Gastric Volvulus Diagnosed Using Endoscopic Procedure: Yang Ho Kim, M.D., Yong Ung Lee, M.D., Chin Woong Cho, M.D., In Seok Seo, M.D., Seung Min Park, M.D., Yong Keun Cho, M.D., Eun Yong Go, M.D. and Jong Myeoung Lee, M.D.*; Korean J Gastrointest Endosc 2006;33(1):46-49. Published online July 30, 2006

Abstract PDF: Gastric volvulus is characterized by an abnormal rotation of the stomach typically 180^oleft to right around a line joining the relatively fixed pylorus and the esophagus. Gastric volvulus can be classified anatomically as organoaxial, mesenteroaxial or combined, and symptomatically as acute or chronic. Acute gastric volvulus is an extremely rare emergency surgical condition. The classical triad of gastric volvulus are severe nausea with a paradoxical inability to vomit, localized epigastric pain and an inability to pass a nasogastric tube. Gastric volvulus may be suspected on a plain radiological examination of the abdomen as well as by its symptoms. It is confirmed by the specific findings on the esophagogastroduodenoscopy. We report a case of acute mesenteroaxial gastric volvulus, that was treated using laparoscopic reduction and anterior gastropexy. (Korean J Gastrointest Endosc 2006;33:46⁣49)

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Propofol 과 Fentanyl 로 상부 위장관 내시경시 산소 공급에 따른 산소 포화도에 관한 연구 ( Study on the Degree of Oxygen Saturation during Upper Gastrointestinal Endoscopy Using Propofol / Fentanyl With Oxygenation ): Korean J Gastrointest Endosc 2001;22(6):399-405. Published online November 30, 2000

Abstract PDF: Background
/Aims: Propofol is usually used for anesthesia in the case of day surgery. We studied the effects of propofol plus fentanyl for sedation and the effect of oxygenation during gastroscopy, Methods: 154 patients who asked conscious sedation during gastroscopy were randomly divided into three groups. The first group (PF-0 group, 50 patients) and the second group (PF group, 48 patients) were received an initial bolus dose of propofol (40 mg) plus fentanyl (50 ㎍) intravenously, followed by additional doses of propofol at one minute interval until conscious sedation. PF-0 group was received preoxygenation (3 L/min) via nasal canula, and PF group was not, The third group (56 patients) received an initial bolus dose of midazolam (3 mg) intravenously, followed by additional doses of midazolam at two minutes interval (M group). Results: In PF-0 group, time to achieve sedation, regain orientation, and recover walking ability were 118.0±85.2 sec, 67.5±91.2 sec and 11.1±5.3 min. Gag reflex during the procedure was absent or nearly absent in 96% of patients. Despite the changes of blood pressure and heart rate compared to the values taken prior to the procedures were observed, all values were not clinically significant, In PF-0 group, transient oxygen desaturation (SaO2<90%) was observed in four (8.0%) patients. Conclusions: Propofol plus fentanyl with oxygenation seems to be more acceptable and suitable method for sedation during outpatient gastroscopic examination. (Korean J Gastrointest Endosc 2001;22:399-405)

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증례 : 식도 위장관 ; 식도에 발생한 점막교 4예 ( Case Reports : Esophagus , Stomach & Intestine ; 4 Cases of Mucosal Bridges in the Esophagus ): Korean J Gastrointest Endosc 1996;16(6):969-975. Published online November 30, 1995

Abstract PDF: Mucosal bridge, endoscopically observed, is a cord-like mucosal connection across the lumen. The bridge is very elastic and stretches easily, unlike granulation tissue. Mucosal bridges of the esophagus have been occasionally described in various circumstances, particularly in congenital or acquired origin as the inflammatory diseases. The occurrence of mucosal bridges due to inflammatory process may arise anywhere from the esophagus to the colon. It has been more frequently reported in the colon than in the esophagus, stomach, and duodenum. We experienced four cases of esophageal mucosal bridges and three of them were accompanied by esophageal diverticulum. We report these cases with a review of relevant literatures. (Korean J Gastrointest Endose 16: 969-974, 1996)

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위 림프종의 내시경적 소견 ( The Endoscopic Findings of Gastric Lymphoma ): Korean J Gastrointest Endosc 1992;12(1):45-51. Published online November 30, 1991

Abstract PDF: Gastric lymphoma occupies about 1-7% of gastric cancer and is the most common type of extranodal lymphoma. To evaluate the endoscopic morphologic characteristics of gastric lymphoma, we analysed the endoscopic findings in 45 patients with pathologically-proven gastric lymphoma. (continue...)

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