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Reviews
True natural orifice transluminal endoscopic surgery-transgastric cholecystectomy and beyond
Pingting Gao, Jia Yu, Mingyan Cai, Lili Ma, Quanlin Li, Pinghong Zhou
Received December 26, 2024  Accepted January 30, 2025  Published online July 4, 2025  
DOI: https://doi.org/10.5946/ce.2024.352    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Natural orifice transluminal endoscopic surgery (NOTES) represents a revolutionary advancement in minimally invasive surgery, eliminating the need for external incisions and offering faster recovery and improved aesthetics. Endoscopic transgastric cholecystectomy (ETGC), a NOTES-based procedure, stands out for its potential to revolutionize gallbladder removal by offering a truly scarless alternative to traditional laparoscopic cholecystectomy (LC). This review explores the historical development of cholecystectomy, evolution of NOTES, and emergence of ETGC as a feasible alternative to LC. We highlight the technical refinements that have enabled ETGC, including innovations in full-thickness resection and suturing techniques, and discuss challenges such as visibility, orientation, and wound closure. Finally, we examine the role of robotic platforms in enhancing precision and expanding clinical applications by positioning ETGC as a transformative technique in the era of minimally invasive surgery.
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Natural orifice transluminal endoscopic surgery: history and current development
Zaheer Nabi, D. Nageshwar Reddy
Received January 6, 2025  Accepted March 25, 2025  Published online July 1, 2025  
DOI: https://doi.org/10.5946/ce.2025.009    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Natural orifice transluminal endoscopic surgery (NOTES) represents an innovative advancement in minimally invasive surgery, utilizing natural body orifices to access the peritoneal cavity to minimize surgical trauma, reduce postoperative pain, and avoid visible scars. Since its inception, NOTES has faced challenges such as technical complexity and securing safe access closure, which initially limited its widespread adoption. However, advancements in endoscopic techniques and technology, closure devices, and hybrid approaches may revitalize its clinical utility. Hybrid NOTES, particularly transvaginal techniques, has demonstrated significant benefits, including reduced postoperative pain, faster recovery, and improved cosmesis, without compromising safety or efficacy. Innovations such as flexible endoscopic platforms, robotic assistance, and novel suturing techniques address previous limitations and enable broader applications across various gastrointestinal indications. Comparative studies have shown comparable outcomes between NOTES and traditional laparoscopy, with specific advantages in terms of patient comfort and recovery time. As technology evolves, NOTES continues to expand its clinical indications, and its future holds promise with the integration of robotics and artificial intelligence. Further research and structured training programs are crucial to overcome existing barriers and ensure safe and effective implementation in diverse clinical settings.
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Original Article
Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan
Nozomi Okuno, Kazuo Hara, Seiji Natsume, Masataka Okuno, Shin Haba, Tomonari Asano, Takamichi Kuwahara, Hiroki Koda, Yasuhiro Shimizu
Received August 18, 2024  Accepted September 16, 2024  Published online February 11, 2025  
DOI: https://doi.org/10.5946/ce.2024.218    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Malignant lesions of the pancreatic head can cause obstructive jaundice requiring biliary drainage. However, the effect of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and metal stents on surgical resection remains controversial. This study aimed to investigate the efficacy of primary endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) performed prior to pancreatoduodenectomy, excluding patients with biliary duct cancer.
Methods
We retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between January 2019 and December 2022. The patients were divided into three groups: without biliary drainage (n=130), endoscopic biliary stenting (EBS) (n=57), and primary EUS-HGS (n=20).
Results
The positivity rate of the intraoperative bile juice culture was significantly higher in the EBS group (p<0.001). No significant difference was observed among the groups in terms of postoperative adverse events (Clavien-Dindo grade 3 or higher, p=0.784) or the positive rate of peritoneal lavage cytology (p=0.984). Seven patients in the EBS group (12.3%) experienced early adverse events related to biliary drainage (post-ERCP pancreatitis, n=3; acute cholecystitis, n=3; bile duct perforation, n=1), whereas none in the EUS-HGS group experienced adverse events.
Conclusions
Primary EUS-HGS is technically feasible as a preoperative procedure and has no short-term postoperative disadvantages.
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Systematic Review and Meta-analysis
Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis
Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari
Clin Endosc 2025;58(2):240-252.   Published online February 3, 2025
DOI: https://doi.org/10.5946/ce.2024.120
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.
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Reviews
Colon stenting as a bridge to surgery in obstructive colorectal cancer management
Dong Hyun Kim, Han Hee Lee
Clin Endosc 2024;57(4):424-433.   Published online March 8, 2024
DOI: https://doi.org/10.5946/ce.2023.138
AbstractAbstract PDFPubReaderePub
Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

Citations

Citations to this article as recorded by  
  • Chitosan Approaches in Colon Cancer Therapy: Understanding its Macromolecular Interactions and Structure-Property Relationships
    Sankha Bhattacharya, Dilpreet Singh
    Journal of Macromolecular Science, Part B.2025; : 1.     CrossRef
  • A rare case of massive colonic distention secondary to undiagnosed colon adenocarcinoma
    Chloe Lahoud, Toni Habib, Michel Al Achkar, Tyler Grantham, Nissar Ahmed
    Medical Reports.2025; 12: 100207.     CrossRef
  • Optimal Timing of Surgery After Insertion of Self‐Expandable Metallic Stent to Obstructive Colorectal Neoplasm as a Bridge to Surgery
    Dong Hyun Kim, Hyun Lim, Jung‐Wook Kim, Yunho Jung, Hyun‐Soo Kim, Ki‐Hyun Kim, Jin Won Kim, Young‐Eun Joo, Bo‐In Lee, Han Hee Lee
    Journal of Gastroenterology and Hepatology.2025; 40(7): 1809.     CrossRef
  • Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea
    Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee
    Clinical Endoscopy.2024; 57(6): 790.     CrossRef
  • Self-Expandable Metal Stents for Obstructing Colon Cancer and Extracolonic Cancer: A Review of Latest Evidence
    Pedro Marílio Cardoso, Eduardo Rodrigues-Pinto
    Cancers.2024; 17(1): 87.     CrossRef
  • 14,463 View
  • 765 Download
  • 5 Web of Science
  • 5 Crossref
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Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
Clin Endosc 2024;57(3):309-316.   Published online February 15, 2024
DOI: https://doi.org/10.5946/ce.2023.217
AbstractAbstract PDFPubReaderePub
The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariat­ric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article compre­hensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern ex­ists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongo­ing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to sup­port its routine use in clinical practice.

Citations

Citations to this article as recorded by  
  • Bacteroides and NAFLD: pathophysiology and therapy
    Jun Zhang, Jing Zhou, Zheyun He, Hongshan Li
    Frontiers in Microbiology.2024;[Epub]     CrossRef
  • 5,221 View
  • 172 Download
  • 2 Web of Science
  • 1 Crossref
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Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review
Renato Medas, Eduardo Rodrigues-Pinto
Clin Endosc 2023;56(6):693-705.   Published online July 3, 2023
DOI: https://doi.org/10.5946/ce.2023.043
AbstractAbstract PDFPubReaderePub
Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.

Citations

Citations to this article as recorded by  
  • Intravaginal endoscopic vacuum therapy of a rectovaginal fistula: expanding boundaries
    Renato Medas, Guilherme Macedo, Eduardo Rodrigues-Pinto
    Endoscopy.2025; 57(S 01): E30.     CrossRef
  • Post-Surgical Leaks of the Upper Digestive Tract – The Importance of an Early Endoscopic Approach
    I Tarrio, A Andrade, A R Ribeiro, M Moreira, T Araújo, L Lopes
    Endoscopy.2025; 57(S 02): S298.     CrossRef
  • Endoscopic vacuum therapy for gastrointestinal transmural defects: a literature review
    Tan Minh Le, Van Huy Tran, Kyu Sung Chung, Seong Woo Jeon
    Clinical Endoscopy.2025; 58(2): 181.     CrossRef
  • RESULTS OF THE APPLICATION OF ENDOSURGICAL TECHNOLOGIES IN THE DIAGNOSIS AND TREATMENT OF EARLY INTRAABDOMINAL COMPLICATIONS IN POSTOPERATIVE PERIOD
    I. A. Yusubov, E. Y. Sharifov
    World of Medicine and Biology.2024; 20(89): 184.     CrossRef
  • 4,437 View
  • 378 Download
  • 3 Web of Science
  • 4 Crossref
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Original Articles
Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States
Dushyant Singh Dahiya, Abhilash Perisetti, Hemant Goyal, Sumant Inamdar, Amandeep Singh, Rajat Garg, Chin-I Cheng, Mohammad Al-Haddad, Madhusudhan R. Sanaka, Neil Sharma
Clin Endosc 2023;56(3):340-352.   Published online April 17, 2023
DOI: https://doi.org/10.5946/ce.2022.166
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States.
Methods
We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared.
Results
From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management.
Conclusions
Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

Citations

Citations to this article as recorded by  
  • Medical disputes involving lower gastrointestinal endoscopies: cases from the Korean Medical Dispute Mediation and Arbitration Agency
    Eun Hye Oh, Jeong Eun Shin, Jun Yong Bae, Yoon Suk Lee, Yehyun Park, Yong Hwan Kwon, Chang Nyol Paik, Jun Kyu Lee, Tae Hee Lee
    The Korean Journal of Internal Medicine.2025; 40(3): 404.     CrossRef
  • Colonic Volvulus
    Samantha L. Savitch, Calista M. Harbaugh
    Clinics in Colon and Rectal Surgery.2024; 37(06): 398.     CrossRef
  • Navigating Abdominal Volvulus: A Comprehensive Review of Management Strategies
    Simran Chauhan, Raju K Shinde, Yashraj Jain
    Cureus.2024;[Epub]     CrossRef
  • Clinicopathological Features of Elderly Patients with Colonic Volvulus
    Mehmet Onur Gul, Selda Oğuz Aşlayan, Kadir Çorbacı, Aytaç Selman, Emre Berat Akçay, Oğuzhan Sunamak, Cebrail Akyüz
    European Journal of Therapeutics.2024; 30(3): 303.     CrossRef
  • Hospitalizaciones por vólvulo en Chile: caracterización de la tasa de egreso hospitalario durante el período 2019-2022.
    Ignacio González Soto, Vicente Villegas Rivera, Monserrat Ruiz Ruiz, Osvaldo Herrera Riffo, Javiera Yanccoli Torres, B Mena
    Revista ANACEM.2024; 18(1): 64.     CrossRef
  • Incidental Sigmoid Volvulus after a Ground-level Fall: An Unusual Case Report
    Ziya Karimov, Elchin Shirinov, Gunay Huseynova, Mirhuseyn Mammadov, Meltem Songür Kodik
    Caucasian Medical Journal.2023; 1(3): 36.     CrossRef
  • 3,224 View
  • 176 Download
  • 5 Web of Science
  • 6 Crossref
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Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer
Yoichiro Ono, Kenshi Yao, Yasuhiro Takaki, Satoshi Ishikawa, Kentaro Imamura, Akihiro Koga, Kensei Ohtsu, Takao Kanemitsu, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Atsuko Ota, Hiroshi Tanabe, Seiji Haraoka, Satoshi Nimura, Akinori Iwashita, Susumu Sato, Rumie Wakasaki
Clin Endosc 2023;56(3):315-324.   Published online January 5, 2023
DOI: https://doi.org/10.5946/ce.2022.072
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma.
Methods
This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia.
Results
Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness.
Conclusions
Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

Citations

Citations to this article as recorded by  
  • Nasopharyngeal examination during transoral upper gastrointestinal endoscopy
    Vui Heng Chong
    Clinical Endoscopy.2024; 57(1): 137.     CrossRef
  • Endoscopy under general anesthesia for detecting synchronous lesions of head and neck squamous cell carcinoma
    Jin Hee Noh, Do Hoon Kim
    Clinical Endoscopy.2023; 56(3): 308.     CrossRef
  • 3,338 View
  • 205 Download
  • 2 Web of Science
  • 2 Crossref
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Endoscopic Submucosal Dissection versus Surgery for Undifferentiated-Type Early Gastric Cancer: A Systematic Review and Meta-Analysis
Cheal-Wung Huh, Dae Won Ma, Byung-Wook Kim, Joon Sung Kim, Seung Jae Lee
Clin Endosc 2021;54(2):202-210.   Published online February 17, 2021
DOI: https://doi.org/10.5946/ce.2020.121
AbstractAbstract PDFPubReaderePub
Background
/Aims: The use of endoscopic submucosal dissection (ESD) for treating undifferentiated-type early gastric cancer is controversial. The objective of this study was to perform a meta-analysis to compare the long-term outcomes of ESD and surgery for undifferentiated-type early gastric cancer.
Methods
The PubMed, Cochrane Library, and EMBASE databases were used to search for relevant studies comparing ESD and surgery for undifferentiated-type early gastric cancer. The methodological quality of the included publications was evaluated using the Risk of Bias Assessment tool for Nonrandomized Studies. The rates of overall survival, recurrence, adverse event, and complete resection were determined. Odds ratios (ORs) and 95% confidence intervals (CIs) were also evaluated.
Results
This meta-analysis enrolled five studies with 429 and 1,236 participants undergoing ESD and surgery, respectively. No significant difference was found in the overall survival rate between the ESD and surgery groups (OR, 2.29; 95% CI, 0.98–5.36; p=0.06). However, ESD was associated with a higher recurrence rate and a lower complete resection rate. The adverse event rate was similar between the two groups.
Conclusions
ESD with meticulous surveillance esophagogastroduodenoscopy may be as effective and safe as surgery in patients with undifferentiated-type early gastric cancer. Further large-scale, randomized, controlled studies from additional regions are required to confirm these findings.

Citations

Citations to this article as recorded by  
  • Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline)
    In-Ho Kim, Seung Joo Kang, Wonyoung Choi, An Na Seo, Bang Wool Eom, Beodeul Kang, Bum Jun Kim, Byung-Hoon Min, Chung Hyun Tae, Chang In Choi, Choong-kun Lee, Ho Jung An, Hwa Kyung Byun, Hyeon-Su Im, Hyung-Don Kim, Jang Ho Cho, Kyoungjune Pak, Jae-Joon Kim
    Journal of Gastric Cancer.2025; 25(1): 5.     CrossRef
  • A Comprehensive and Comparative Review of Global Gastric Cancer Treatment Guidelines: 2024 Update
    Sang Soo Eom, Keun Won Ryu, Hye Sook Han, Seong-Ho Kong
    Journal of Gastric Cancer.2025; 25(1): 153.     CrossRef
  • Artificial intelligence-assisted diagnosis of early gastric cancer: present practice and future prospects
    Changda Lei, Wenqiang Sun, Kun Wang, Ruixia Weng, Xiuji Kan, Rui Li
    Annals of Medicine.2025;[Epub]     CrossRef
  • Curative criteria for endoscopic treatment of gastric cancer
    João A. Cunha Neves, Pedro G. Delgado-Guillena, Patrícia Queirós, Diogo Libânio, Enrique Rodríguez de Santiago
    Best Practice & Research Clinical Gastroenterology.2024; 68: 101884.     CrossRef
  • Optimal Surveillance of Metachronous Gastric Lesion after Endoscopic Resection of Early Gastric Cancer
    Dong Chan Joo, Gwang Ha Kim
    Gut and Liver.2024; 18(5): 781.     CrossRef
  • Chinese national clinical practice guidelines on the prevention, diagnosis, and treatment of early gastric cancer
    Peng Li, Ziyu Li, Enqiang Linghu, Jiafu Ji
    Chinese Medical Journal.2024; 137(8): 887.     CrossRef
  • Endoscopic Submucosal Dissection for Early Gastric Cancer Exceeding Expanded Criteria—Long-Term Outcomes from the German ESD Registry
    Kathrin Riedl, Andreas Probst, Alanna Ebigbo, Ingo Steinbrück, Hans-Peter Allgaier, David Albers, Matthias Mende, Michael Anzinger, Joerg Schirra, Viktor Rempel, Albrecht Lorenz, Siegbert Faiss, Ingo Wallstabe, Ulrike Denzer, Andreas Wannhoff, Franz Ludwi
    Journal of Clinical Medicine.2024; 13(18): 5538.     CrossRef
  • Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach
    Tae-Han Kim, In-Ho Kim, Seung Joo Kang, Miyoung Choi, Baek-Hui Kim, Bang Wool Eom, Bum Jun Kim, Byung-Hoon Min, Chang In Choi, Cheol Min Shin, Chung Hyun Tae, Chung sik Gong, Dong Jin Kim, Arthur Eung-Hyuck Cho, Eun Jeong Gong, Geum Jong Song, Hyeon-Su Im
    Journal of Gastric Cancer.2023; 23(1): 3.     CrossRef
  • Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions
    Ana Clara Vasconcelos, Mário Dinis-Ribeiro, Diogo Libânio
    Cancers.2023; 15(12): 3084.     CrossRef
  • Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort
    Apostolis Papaefthymiou, Michel Kahaleh, Arnaud Lemmers, Sandro Sferrazza, Maximilien Barret, Katsumi Yamamoto, Pierre Deprez, José C. Marín-Gabriel, George Tribonias, Hong Ouyang, Federico Barbaro, Oleksandr Kiosov, Stefan Seewald, Gaurav Patil, Shaimaa
    Endoscopy International Open.2023; 11(07): E673.     CrossRef
  • A meta-analysis of the impact on gastrectomy versus endoscopic submucosal dissection for early stomach cancer
    Rajesh K. Singh
    International Journal of Clinical Medical Research.2023; 1(3): 88.     CrossRef
  • A meta-analysis of the impact on gastrectomy versus endoscopic submucosal dissection for early stomach cancer
    Rajesh K. Singh
    International Journal of Clinical Medical Research.2023;[Epub]     CrossRef
  • Long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated intramucosal gastric cancer regardless of size
    Gil Ho Lee, Eunyoung Lee, Bumhee Park, Jin Roh, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee, Choong-Kyun Noh
    World Journal of Gastroenterology.2022; 28(8): 840.     CrossRef
  • Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated-type early gastric cancer meeting the expanded criteria: a systematic review and meta-analysis
    Hyo-Joon Yang, Jie-Hyun Kim, Na Won Kim, Il Ju Choi
    Surgical Endoscopy.2022; 36(6): 3686.     CrossRef
  • Endoscopic submucosal dissection versus surgery for patients with undifferentiated early gastric cancer
    Harold Benites-Goñi, Fernando Palacios-Salas, Andrea Carlin-Ronquillo, Carlos Díaz-Arocutipa, Alejandro Piscoya, Adrián Hernández
    Revista Española de Enfermedades Digestivas.2022;[Epub]     CrossRef
  • The future of endoscopic resection for early gastric cancer
    Raquel Ortigão, Diogo Libânio, Mário Dinis‐Ribeiro
    Journal of Surgical Oncology.2022; 125(7): 1110.     CrossRef
  • Endoscopic treatment for early gastric cancer
    Ji Yong Ahn
    Journal of the Korean Medical Association.2022; 65(5): 276.     CrossRef
  • Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
    Eun Jeong Gong, Chang Seok Bang
    Journal of the Korean Medical Association.2022; 65(5): 284.     CrossRef
  • Long-Term Outcomes of Endoscopic Submucosal Dissection of Undifferentiated-Type Early Gastric Cancer
    Chang Seok Bang
    Clinical Endoscopy.2021; 54(2): 143.     CrossRef
  • 6,415 View
  • 224 Download
  • 18 Web of Science
  • 19 Crossref
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Focused Review Series: Cutting Edge of Advanced Therapeutic Endoscopy
Peroral Endoscopic Myotomy for Esophageal Motility Disorders
Jun Young Kim, Yang Won Min
Clin Endosc 2020;53(6):638-645.   Published online November 20, 2020
DOI: https://doi.org/10.5946/ce.2020.223
AbstractAbstract PDFPubReaderePub
Peroral endoscopic myotomy (POEM) is one of the most clinically successful tunnel-based minimally invasive endoscopic treatments. The classic indications of POEM include achalasia of all types, including failed prior treatments, and expanded indications include the non-achalasia esophageal motility disorders, such as esophagogastric junction outflow obstruction, diffuse esophageal spasm, and jackhammer esophagus. For achalasia treatment, POEM has achieved a comparable surgical efficacy and a safety outcome and, therefore, has emerged as a first-line treatment. For non-achalasia esophageal motility disorders, POEM has also shown high clinical response rates. The complication rate of POEM for esophageal motility disorders is low and most complications are managed with conservative treatment. Currently, POEM is a representative procedure of natural orifice transluminal endoscopic surgery, which has shown a good clinical efficacy with low complication rates for esophageal motility disorders including achalasia. However, further studies are needed to treat non-achalasia motility disorder via POEM.

Citations

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  • Intraoperative Complications During Benign Esophageal Surgery
    Katelyn R. Ward, Jenny Bui, Rishindra M. Reddy
    Thoracic Surgery Clinics.2025;[Epub]     CrossRef
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    McKenzie K Allen , Wayne Frei
    Cureus.2024;[Epub]     CrossRef
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    Kristina T. Flicek, Laura R. Carucci, Mary Ann Turner
    Abdominal Radiology.2024; 50(5): 1942.     CrossRef
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    V. T. Ivashkin, A. S. Trukhmanov, I. V. Maev, O. M. Drapkina, A. I. Martynov, O. A. Storonova, E. A. Godgello, M. P. Korolev, T. L. Lapina, P. V. Pavlov, A. V. Paraskevova, I. A. Tarasova, E. D. Fedorov, A. T. Tskhovrebov, M. P. Shapka, A. L. Shestakov, A
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    Min Ji Kim, Yang Won Min
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Focused Review Series: Endoscopic Ultrasound-Guided Therapeutic Intervention: Focus on Technique and Practical Tips
Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: Techniques and Literature Review of Transmural Stenting
Akira Imoto, Takeshi Ogura, Kazuhide Higuchi
Clin Endosc 2020;53(5):525-534.   Published online September 24, 2020
DOI: https://doi.org/10.5946/ce.2020.173
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has emerged as an option in patients with failure of retrograde access to the pancreatic duct (PD) because of difficulty in cannulation or surgically altered anatomy. This article provides a comprehensive review of the techniques and outcomes of EUS-PD, especially EUS-guided pancreatic transmural stenting. The clinical data derived from a total of 401 patients were reviewed in which the overall technical and clinical success rates were 339/401 (85%, range 63%–100%) and 328/372 (88%, range 76%–100%), respectively. Short-term adverse events occurred in 25% (102/401) of the cases, which included abdominal pain (n=45), acute pancreatitis (n=17), bleeding (n=10), and issues associated with pancreatic juice leakage such as perigastric or peripancreatic fluid collection (n=9). In conclusion, although EUS-PD remains a challenging procedure with a high risk of adverse events such as pancreatic juice leakage, perforation, and severe acute pancreatitis, the procedure seems to be a promising alternative for PD drainage in patients with altered anatomy or unsuccessful endoscopic retrograde pancreatography.

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Focused Review Series: Cutting Edge of Advanced Therapeutic Endoscopy
Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors
Naomi Kakushima, Masao Yoshida, Yohei Yabuuchi, Noboru Kawata, Kohei Takizawa, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono
Clin Endosc 2020;53(6):652-658.   Published online January 15, 2020
DOI: https://doi.org/10.5946/ce.2019.184
AbstractAbstract PDFPubReaderePub
Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses.

Citations

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    Naomi Kakushima, Masao Yoshida, Kohei Takizawa, Yohei Yabuuchi, Noboru Kawata, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono
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Original Article
Effectiveness of Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid as a Non-Surgical Treatment for Internal Hemorrhoids
Yuichi Tomiki, Jun Aoki, Shunsuke Motegi, Rina Takahashi, Toshiaki Hagiwara, Yu Okazawa, Kosuke Mizukoshi, Masaya Kawai, Shinya Munakata, Shun Ishiyama, Kiichi Sugimoto, Kazuhiro Sakamoto
Clin Endosc 2019;52(6):581-587.   Published online July 24, 2019
DOI: https://doi.org/10.5946/ce.2019.017
AbstractAbstract PDFPubReaderePub
Background
/Aims: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy.
Methods
We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups.
Results
There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group.
Conclusions
Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.

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    Sung Il Kang
    Journal of the Anus, Rectum and Colon.2025; 9(2): 179.     CrossRef
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    G. Gallo, A. Picciariello, C. Armellin, E. Lori, G. Tomasicchio, G. L. Di Tanna, G. A. Santoro, M. Alharbi, S. Sorrenti, U. Grossi
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    Vasiliki Manaki, Vangelis Bontinis, Alkis Bontinis, Argirios Giannopoulos, Ioannis Kontes, Angeliki Chorti, Kiriakos Ktenidis
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    Xianglu Wang, Xia Wu, Quan Wen, Bota Cui, Faming Zhang
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    Anling He, Mingkai Chen
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    Hiroka Kondo, Ryosuke Nakagawa, Tomoko Yamamoto, Shigeki Yamaguchi
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    Masanori Yoshimitsu, Hiroyuki Egi, Shogo Nagamatsu, Manabu Shimomura, Keishi Hakoda, Masashi Miguchi, Toshihiko Kohashi, Masazumi Okajima, Hideki Ohdan
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    Naoki Muguruma, Tetsuji Takayama
    Clinical Endoscopy.2019; 52(6): 521.     CrossRef
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Focused Review Series: Endoscopic Submucosal Dissection for Undifferentiated-Type Early Gastric Cancer
Is Radical Surgery Necessary for All Patients Diagnosed as Having Non-Curative Endoscopic Submucosal Dissection?
Si Hyung Lee, Byung Sam Park
Clin Endosc 2019;52(1):21-29.   Published online January 30, 2019
DOI: https://doi.org/10.5946/ce.2019.014
AbstractAbstract PDFPubReaderePub
If a lesion does not meet the expanded indication criteria for treatment with endoscopic therapy for early gastric cancer or does not have a positive resection margin, it is regarded as suitable for non-curative resection. Non-curative resection is closely related to the risk of local recurrence, lymph node metastasis, and poor prognosis. If the result is confirmed as non-curative resection, additional treatment should be considered depending on the risks of residual tumor, local recurrence, and lymph node metastasis. As lymphatic invasion is the most important risk factor of recurrence and poor prognosis, surgical treatment should be considered if lymphatic invasion is present. If patients are not suitable for additional surgery owing to old age or coexisting severe disease, close surveillance can be an alternative treatment option.

Citations

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  • Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea
    Si Hyung Lee, Min Cheol Kim, Seong Woo Jeon, Kang Nyeong Lee, Jong Jae Park, Su Jin Hong
    Clinical Endoscopy.2020; 53(2): 196.     CrossRef
  • 6,984 View
  • 108 Download
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Case Report
Laparoscopic Resection of a Jejunal Inflammatory Fibroid Polyp that Caused Occult Gastrointestinal Bleeding, Diagnosed via Capsule Endoscopy and Double-Balloon Enteroscopy: A Case Report
Chizu Kameda, Hideaki Miwa, Ryohei Kawabata, Daiki Marukawa, Masahiro Murakami, Shingo Noura, Junzo Shimizu, Junichi Hasegawa
Clin Endosc 2018;51(4):384-387.   Published online March 20, 2018
DOI: https://doi.org/10.5946/ce.2017.162
AbstractAbstract PDFPubReaderePub
An inflammatory fibroid polyp (IFP) is a mesenchymal tumor of the gastrointestinal tract. IFPs in the small intestine are the most frequently detected with symptoms, such as abdominal pain and tarry stool due to intussusception. Accordingly, few studies have reported jejunal IFP as a cause of occult gastrointestinal bleeding (OGIB) diagnosed via both of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). A 68-year-old woman presented with a progression of anemia and a positive fecal occult blood test result. Esophagogastroduodenoscopy and total colonoscopy findings were unremarkable. CE revealed a tumor with bleeding in the jejunum. DBE also revealed a jejunal polypoid tumor. Bleeding from the tumor seemed to have caused anemia. The patient underwent partial laparoscopic resection of the jejunum, including resection of the tumor. The tumor was histopathologically diagnosed as IFP. To our knowledge, this is the first reported case of laparoscopic resection of jejunal IFP with OGIB diagnosed via CE and DBE preoperatively.

Citations

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  • Minimally invasive colonoscopy treatment of inflammatory fibroid polyps in the terminal ileum
    Yin-Si Tang, Lu Liu, Ying Gao, Qiao-Chu He, Hai-Mei Guo, Zhi-Feng Zhao
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Focused Review Series: The New Eras of Therapeutic Endoscopy - Endoscopic Submucosal Surgery
Current Status of Peroral Endoscopic Myotomy
Young Kwan Cho, Seong Hwan Kim
Clin Endosc 2018;51(1):13-18.   Published online January 31, 2018
DOI: https://doi.org/10.5946/ce.2017.165
AbstractAbstract PDFPubReaderePub
Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

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    Mentore Ribolsi, Matteo Ghisa, Edoardo Savarino
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    E.A. Gallyamov, S.A. Erin, G.Yu. Gololobov, A.I. Burmistrov, M.A. Chicherina, A.A. Rikunova
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Introduction to Endoscopic Submucosal Surgery
Weon Jin Ko, Joo Young Cho
Clin Endosc 2018;51(1):8-12.   Published online January 23, 2018
DOI: https://doi.org/10.5946/ce.2017.154
AbstractAbstract PDFPubReaderePub
The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.

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  • Strategies for Resection of Esophageal and Gastroesophageal Junction Submucosal Tumors
    Mohammad Alomari, Daniel Knewitz, Rocio Castillo Larios, Jamii St Julien, Mathew Thomas, Enrique F. Elli, Steven P. Bowers
    Journal of Laparoendoscopic & Advanced Surgical Techniques.2025;[Epub]     CrossRef
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    Jia Liu, Panxianzhi Ni, Yi Wang, Zhengkui Zhou, Junlin Li, Tianxu Chen, Tun Yuan, Jie Liang, Yujiang Fan, Jing Shan, Xiaobin Sun, Xingdong Zhang
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    Abdullah Ozgur Yeniova, In kyung Yoo, Eunju Jeong, Joo Young Cho
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    E. A. Drobyazgin, Yu. V. Chikinev, D. A. Arkhipov, N. I. Mit’ko, M. N. Chekanov, E. I. Vereshchagin, I. V. Peshkova, A. S. Polyakevich
    Experimental and Clinical Gastroenterology.2021; 1(6): 75.     CrossRef
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  • 171 Download
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  • 4 Crossref
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Endoscopic Full-Thickness Resection Combined with Laparoscopic Surgery
Chan Gyoo Kim
Clin Endosc 2018;51(1):33-36.   Published online January 12, 2018
DOI: https://doi.org/10.5946/ce.2017.153
AbstractAbstract PDFPubReaderePub
Endoscopic full-thickness resection combined with laparoscopic surgery was recently developed. These procedures could be categorized as “Cut first and then suture” and “Suture first and then cut”. “Cut first and then suture” includes laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR). Recent studies have demonstrated the safety and efficacy of LECS and LAEFR. However, these techniques are limited by the related exposure of the tumor and gastric mucosa to the peritoneal cavity and manipulation of these organs, which could lead to viable cancer cell seeding and the spillage of gastric juice into the peritoneal cavity. In the “Suture first and then cut” technique, the serosal side of the stomach is sutured to invert the stomach and subsequently endoscopic resection is performed. In this article, details of these techniques, including their advantages and limitations, are described.

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    Noriaki Kashu, Noriyuki Nishiwaki, Tetsuya Kagawa, Tomokazu Kakishita, Shinji Hato
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    Yuki Aisu, Daiki Yasukawa, Yusuke Kimura, Tomohide Hori
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  • 209 Download
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  • 6 Crossref
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Case Report
Long -Term Survival in Stage IV Esophageal Adenocarcinoma with Chemoradiation and Serial Endoscopic Cryoablation
Zachary Spiritos, Parit Mekaroonkamol, Bassel F. El- Rayes, Seth D. Force, Steven A. Keilin, Qiang Cai, Field F. Willingham
Clin Endosc 2017;50(5):491-494.   Published online April 24, 2017
DOI: https://doi.org/10.5946/ce.2017.006
AbstractAbstract PDFPubReaderePub
Esophageal cancer has a poor overall prognosis and is frequently diagnosed at a late stage. Conventional treatment for metastatic esophageal cancer involves chemotherapy and radiation. Local disease control plays a significant role in improving survival. Endoscopic spray cryotherapy is a novel modality that involves freezing and thawing to produce local ablation of malignant tissue via ischemic mechanisms. Spray cryotherapy has been shown to be effective, particularly for early T-stage, superficial esophageal adenocarcinomas. We present the case of a 72-year-old-male with locally recurrent stage IV esophageal adenocarcinoma and long-term survival of 7 years to date, with concurrent chemoradiation and serial cryoablation. He remains asymptomatic and continues to undergo chemotherapy and sequential cryoablation. The findings highlight the long-term safety and efficacy of cryotherapy in combination with chemoradiation, and suggest that cryoablation may have an additive role in the treatment of advanced stage esophageal adenocarcinoma.

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    Youssef Y. Soliman, Madappa Kundranda, Toufic Kachaamy
    Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 91.     CrossRef
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    Benjamin Charles Norton, Apostolis Papaefthymiou, Andrea Telese, Margaret Duku, Imran Chaudhry, Alberto Murino, Gavin Johnson, Charles Murray, Rehan Haidry
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    Charlotte N. Frederiks, Jolanda M.W. van de Water, Gati Ebrahimi, Bas L.A.M. Weusten
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    Rui Zhang, Jiahua Zou, Ping Li, Qin Li, Yunfeng Qiao, Jianglong Han, Kejie Huang, Peng Ruan, Huiqing Lin, Qibin Song, Zhenming Fu
    Diseases of the Esophagus.2019;[Epub]     CrossRef
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  • 141 Download
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Focused Review Series: Roleses of Bariatric Endoscopy in Obesity Treatment
Role of Endoscopic Gastroplasty Techniques in the Management of Obesity
Yunho Jung
Clin Endosc 2017;50(1):21-25.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2016.147
AbstractAbstract PDFPubReaderePub
Health and wellness represent a major global concern. Trends such as a lack of exercise and excessive consumption of calories are major causes of the rapid increase in obesity worldwide. Obesity should be controlled because it can result in other illnesses, such as diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, breathing disorders, or cancer. However, many people have difficulty in managing obesity through exercise, dietary control, behavioral modifications, and drug therapy. Bariatric surgery is not commonly used due to a variety of complications, even though it has been demonstrated to produce reliable results with respect to adequate weight loss when performed using an open or a laparoscopic approach. Endoscopic bariatric procedures are emerging techniques that are less invasive and safer compared with current surgical approaches. However, the evaluation of endoluminal procedures is limited by the small number of studies and their short-term follow-up.

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    International Journal of Surgery.2018; 57: 22.     CrossRef
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  • 230 Download
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Endoscopic Approach for Major Complications of Bariatric Surgery
Moon Kyung Joo
Clin Endosc 2017;50(1):31-41.   Published online December 23, 2016
DOI: https://doi.org/10.5946/ce.2016.140
AbstractAbstract PDFPubReaderePub
As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.

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Review
Endoscopic Management of Gastroesophageal Reflux Disease: Revisited
Zaheer Nabi, D. Nageshwar Reddy
Clin Endosc 2016;49(5):408-416.   Published online September 30, 2016
DOI: https://doi.org/10.5946/ce.2016.133
AbstractAbstract PDFPubReaderePub
Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD.

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Focused Review Series: Advances in the management of upper GI SET
Current Techniques for Treating Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract
Weon Jin Ko, Joo Young Cho
Clin Endosc 2016;49(3):226-228.   Published online May 23, 2016
DOI: https://doi.org/10.5946/ce.2016.061
AbstractAbstract PDFPubReaderePub
Most gastrointestinal stromal tumors (GISTs) arise from the proper muscle layer of the upper gastrointestinal (GI) tract and have a low malignant potential. They are sometimes accompanied by symptoms, but in most cases are detected by chance. Endoscopic surgery of subepithelial tumors in the upper GI tract has been actively performed, and its merits include the need for fewer medical devices compared with other surgical procedures and post-resection organ preservation. However, because endoscopic procedures are still limited to small or pilot studies, a multidisciplinary approach combining laparoscopy and endoscopy is needed for more effective and pathologically acceptable management of GISTs. Many new endoscopic surgeries have been developed, and this review describes the current status of and the new approaches for endoscopic surgery of GISTs in the upper GI tract.

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Case Report
Hybrid Natural Orifice Transluminal Endoscopic Surgery with Sentinel Lymph Node Navigation for Deep Early Gastric Cancer in the Fundic Region
Yoon Suk Park, Seong Hwan Kim, Hee Yun Ryu, Young Kwan Cho, Yun Ju Jo, Tae il Son, Young Ok Hong
Clin Endosc 2016;49(3):298-302.   Published online March 29, 2016
DOI: https://doi.org/10.5946/ce.2015.114
AbstractAbstract PDFPubReaderePub
For patients refusing surgical treatment for deep early gastric cancer, hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation is a potential treatment option, particularly when the anatomic location of the cancer has low probability of lymph node metastasis. We report a case of deep early gastric cancer of the fundus beyond the endoscopic submucosal dissection indication that was treated by hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation. In a conventional approach, a total gastrectomy would have been needed; however, the patient refused surgical intervention. In this case, since the patient showed no positivity of the sentinel lymph node on intraoperative navigation, laparoscopic basin lymph node dissection was not performed. Hybrid natural orifice transluminal endoscopic surgery might be considered for specific regions such as the safety zone where lymph node metastases are less likely to occur.

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Original Article
Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation
Dae Kyu Shin, Sun Young Shin, Chi Young Park, Sun Mi Jin, Yang Hyun Cho, Won Hee Kim, Chang-Il Kwon, Kwang Hyun Ko, Ki Baik Hahm, Pil Won Park, Jong Woo Kim, Sung Pyo Hong
Clin Endosc 2016;49(3):282-288.   Published online February 18, 2016
DOI: https://doi.org/10.5946/ce.2015.046
AbstractAbstract PDFPubReaderePub
Background
/Aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations.
Methods
We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea.
Results
A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively.
Conclusions
Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

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Case Report
Asymptomatic Gastric Band Erosion Detected during Routine Gastroduodenoscopy
Gee Young Yun, Woo Sub Kim, Hye Jin Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
Clin Endosc 2016;49(3):294-297.   Published online February 11, 2016
DOI: https://doi.org/10.5946/ce.2016.001
AbstractAbstract PDFPubReaderePub
The incidence of gastric band erosion has decreased to 1%. Gastric band erosion can manifest with various clinical symptoms, although some patients remain asymptomatic. We present a case of a mostly asymptomatic patient who was diagnosed with gastric band erosion during a routine health check-up. A 32-year-old man without any underlying diseases except for non-alcoholic fatty liver underwent laparoscopic adjustable gastric band surgery in 2010. He had no significant complications postoperatively. He underwent routine health check-ups with near-normal gastroduodenoscopic findings through 2014. However, in 2015, routine gastroduodenoscopy showed that the gastric band had eroded into the stomach. His gastric band was removed laparoscopically, and the remaining gastric ulcer perforation was repaired using an omental patch. Due to the early diagnosis, the infection was not serious. The patient was discharged on postoperative day 3 with oral antibiotics. This patient was fortunately diagnosed early by virtue of a routine health check-up, thus eliminating the possibility of serious complications.

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Original Article
Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices
Myong Ki Baeg, Sang-Woo Kim, Sun-Hye Ko, Yoon Bum Lee, Seawon Hwang, Bong-Woo Lee, Hye Jin Choi, Jae Myung Park, In-Seok Lee, Yong-Seog Oh, Myung-Gyu Choi
Clin Endosc 2016;49(2):176-181.   Published online February 11, 2016
DOI: https://doi.org/10.5946/ce.2015.023
AbstractAbstract PDFPubReaderePub
Background
/Aims: Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients.
Methods
Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram.
Results
Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events.
Conclusions
Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed.

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Review
Novel Endoscopic Management of Obesity
Jerome Dargent
Clin Endosc 2016;49(1):30-36.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.30
AbstractAbstract PDFPubReaderePub
Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory.

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Case Report
Delayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer
Soo Hoon Kang, Kyungho Lee, Hyun Woo Lee, Ga Eun Park, Yun Soo Hong, Byung-Hoon Min
Clin Endosc 2015;48(3):251-255.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.251
AbstractAbstract PDFPubReaderePub

Delayed perforation is a very rare complication of endoscopic submucosal dissection (ESD), with a reported incidence of 0.1% to 0.45%. Few reports exist on the clinical features and outcomes of delayed perforation after ESD, and it is unclear whether the optimal management strategy is emergency surgery or endoscopic closure with conservative treatment. Here, we report two cases of delayed perforation occurring after ESD for early gastric cancer. In both cases, lesions were located in the antrum, and tumor depths were confined to the mucosal layer. Total procedure times for ESD were 25 and 45 minutes, respectively. Because delayed perforation may be associated with excessive thermal damage and necrosis of the muscle layer, treatment with emergency surgery should be used instead of conservative management in cases of delayed perforation after ESD.

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