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Original Article
Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea
Yuri Kim, Ji Yong Ahn, Hwoon-Yong Jung, Seokin Kang, Ho June Song, Kee Don Choi, Do Hoon Kim, Jeong Hoon Lee, Hee Kyong Na, Young Soo Park
Clin Endosc 2024;57(3):350-363.   Published online February 15, 2024
DOI: https://doi.org/10.5946/ce.2023.144
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs.
Methods
Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed.
Results
Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group.
Conclusions
cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.
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Brief Reports
Effective hemostasis under gel immersion endoscopy using inflated balloons on the tip of double balloon endoscope for active bleeding in the small intestine
Shunsuke Horitani, Natsuko Saito, Koki Hosoda, Hironao Matsumoto, Toshiyuki Mitsuyama, Takeshi Yamashina, Masaaki Shimatani, Makoto Naganuma
Clin Endosc 2024;57(3):409-411.   Published online February 8, 2024
DOI: https://doi.org/10.5946/ce.2023.146
PDFSupplementary MaterialPubReaderePub
  • 1,647 View
  • 129 Download
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Use of an endoscopic powered debridement device for treatment of post-surgical fatty pancreatic necrosis
Judy Daboul, Shiab Mussad, Anna Cecilia Amaral, Waleed K. Hussain, Peter J. Lee, Samuel Han
Clin Endosc 2024;57(3):412-414.   Published online February 23, 2024
DOI: https://doi.org/10.5946/ce.2023.120
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  • 1,561 View
  • 106 Download
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Original Articles
Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent
Hakan Şentürk, İbrahim Hakkı Köker, Koray Koçhan, Sercan Kiremitçi, Gülseren Seven, Ali Tüzün İnce
Clin Endosc 2024;57(2):209-216.   Published online July 3, 2023
DOI: https://doi.org/10.5946/ce.2023.022
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose.
Methods
Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40–87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours.
Results
The median procedure time was 33 minutes (range, 23–55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41–194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired.
Conclusions
T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

Citations

Citations to this article as recorded by  
  • Tubular fully covered self-expandable metallic stents for endoscopic ultrasound-guided gastrojejunostomy: moving forward or taking a step back?
    Rami G. El Abiad, Mouen A. Khashab
    Clinical Endoscopy.2024; 57(2): 193.     CrossRef
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Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites
Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui
Clin Endosc 2024;57(2):246-252.   Published online September 7, 2023
DOI: https://doi.org/10.5946/ce.2023.075
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites.
Methods
Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention.
Results
Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed.
Conclusions
In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

Citations

Citations to this article as recorded by  
  • Management of iatrogenic perforations during endoscopic interventions in the hepato-pancreatico-biliary tract
    Kirsten Boonstra, Rogier P. Voermans, Roy L.J. van Wanrooij
    Best Practice & Research Clinical Gastroenterology.2024; : 101890.     CrossRef
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  • 1 Crossref
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Case Report
Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series
Koichi Soga
Clin Endosc 2024;57(2):263-267.   Published online April 4, 2023
DOI: https://doi.org/10.5946/ce.2022.213
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Technical failure of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is often attributed to device failure. To rectify this problem, we developed a single-pigtail plastic stent (SPPS) for EUS-GBD. We retrospectively reviewed the cases of four patients who underwent EUS-GBD for acute cholecystitis. To prepare the SPPS, a 7.5-Fr endoscopic nasobiliary drainage tube was cut to an appropriate length. The use of SPPS during EUS-GBD was successful from both technical and clinical standpoints. The SPPS spontaneously detached 57 days after the procedure in patient 4 and 412 days after the procedure in patient 1. Patient 1 developed cholecystitis after 426 days and was managed with antibiotics. The other three patients did not develop any complications after surgery. In conclusion, we designed a new SPPS dedicated to EUS-GBD and established its technical feasibility and clinical effectiveness.

Citations

Citations to this article as recorded by  
  • Usefulness of inserting a modified single‐pigtail plastic stent into a metallic stent in endoscopic ultrasound-guided gallbladder drainage
    Koichi Soga
    Endoscopy.2023; 55(S 01): E1081.     CrossRef
  • 2,288 View
  • 171 Download
  • 1 Crossref
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Video of Issue
A remnant cystic duct presenting as a duodenal subepithelial tumor
Gwang Ha Kim, Dong Chan Joo
Clin Endosc 2024;57(2):268-269.   Published online February 2, 2024
DOI: https://doi.org/10.5946/ce.2023.275
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  • 203 Download
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Boost Your Learning with Quiz
Nightmare of straight-type plastic stent migration into the peripheral bile duct: what is my savior?
Yun Chae Lee, Shayan Irani, Hyung Ku Chon
Clin Endosc 2024;57(1):134-136.   Published online August 3, 2023
DOI: https://doi.org/10.5946/ce.2023.132
PDFSupplementary MaterialPubReaderePub
  • 1,486 View
  • 107 Download
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Review
Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a technical review
Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Rie Shiomi, Takahiro Shin, Kei Sugimoto, Shomei Ryozawa
Clin Endosc 2023;56(6):716-725.   Published online April 17, 2023
DOI: https://doi.org/10.5946/ce.2023.023
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically challenging. For example, scope insertion, selective cannulation, and intended procedures, such as stone extraction or stent placement, can be difficult. Single-balloon enteroscopy (SBE)-assisted ERCP has been used to effectively and safely address these technical issues in clinical practice. However, the small working channel limits its therapeutic potential. To address this shortcoming, a short-type SBE (short SBE) with a working length of 152 cm and a channel of 3.2 mm diameter has recently been introduced. Short SBE facilitates the use of larger accessories to complete certain procedures, such as stone extraction or self-expandable metallic stent placement. Despite the development in the SBE endoscope, various steps have to be overcome to successfully perform such procedure. To improve success, the challenging factors of each procedure must be identified. At the same time, endoscopists need to be mindful of adverse events, such as perforation, which can arise due to adhesions specific to the surgically altered anatomy. This review discussed technical tips regarding SBE-assisted ERCP in patients with surgically altered anatomy to increase success and reduce the risk of adverse events associated with ERCP.

Citations

Citations to this article as recorded by  
  • Advanced technical tips and recent insights in ERCP using balloon‐assisted endoscopy
    Masaaki Shimatani, Toshiyuki Mitsuyama, Takeshi Yamashina, Masahiro Takeo, Shunsuke Horitani, Natsuko Saito, Hironao Matsumoto, Masahiro Orino, Masataka Kano, Takafumi Yuba, Takuya Takayama, Tatsuya Nakagawa, Shoji Takayama
    DEN Open.2024;[Epub]     CrossRef
  • Efficacy of texture and color enhancement imaging for short‐type single‐balloon enteroscopy‐assisted biliary cannulation in patients with Roux‐en‐Y gastrectomy: Multicenter study (with video)
    Yuki Tanisaka, Mamoru Takenaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Takahiro Shin, Kei Sugimoto, Ken Kamata, Kosuke Minaga, Shunsuke Omoto, Tomohiro Yamazaki, Shomei Ryozawa
    Digestive Endoscopy.2024;[Epub]     CrossRef
  • Development and evaluation of artificial organ models for ERCP training in patients with surgically altered anatomies
    Kai Koch, Benedikt Duckworth-Mothes, Ulrich Schweizer, Karl-Ernst Grund, Tom G. Moreels, Alfred Königsrainer, Dörte Wichmann
    Scientific Reports.2023;[Epub]     CrossRef
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Original Articles
Usefulness of the S-O clip for duodenal endoscopic submucosal dissection: a propensity score-matched study
Ippei Tanaka, Dai Hirasawa, Hiroaki Saito, Junichi Akahira, Tomoki Matsuda
Clin Endosc 2023;56(6):769-777.   Published online May 24, 2023
DOI: https://doi.org/10.5946/ce.2022.195
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal tumors (SNADETs) is associated with a high rate of en bloc resection. However, the technique for ESD remains challenging. Recent studies have demonstrated the effectiveness of S-O clips in colonic and gastric ESD. We evaluated the efficacy and safety of duodenal ESD using an S-O clip for SNADETs.
Methods
Consecutive patients who underwent ESD for SNADETs between January 2011 and December 2021 were retrospectively enrolled. Propensity score matching analysis was used to compare patients who underwent duodenal ESD with the S-O clip (S-O group) and those who underwent conventional ESD (control group). Intraoperative perforation rate was the primary outcome, while procedure time and R0 resection rate were the secondary outcomes.
Results
After propensity score matching, 16 pairs were created: 43 and 17 in the S-O and control groups, respectively. The intraoperative perforation rate in the S-O group was significantly lower than that in the control group (p=0.033). A significant difference was observed in the procedure time between the S-O and control groups (39±9 vs. 82±30 minutes, respectively; p=0.003).
Conclusions
The S-O clip reduced the intraoperative perforation rate and procedure time, which may be useful and effective in duodenal ESD.
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Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases
Hayato Yamaguchi, Masakatsu Fukuzawa, Takashi Kawai, Takahiro Muramatsu, Taisuke Matsumoto, Kumiko Uchida, Yohei Koyama, Akira Madarame, Takashi Morise, Shin Kono, Sakiko Naito, Naoyoshi Nagata, Mitsushige Sugimoto, Takao Itoi
Clin Endosc 2023;56(6):778-789.   Published online July 26, 2023
DOI: https://doi.org/10.5946/ce.2022.268
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD).
Methods
We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes.
Results
Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]).
Conclusions
RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

Citations

Citations to this article as recorded by  
  • Planned Hybrid Endoscopic Submucosal Dissection as Alternative for Colorectal Neoplasms: A Propensity Score-Matched Study
    Yu-xin Zhang, Xun Liu, Fang Gu, Shi-gang Ding
    Digestive Diseases and Sciences.2024; 69(3): 949.     CrossRef
  • Understanding hybrid endoscopic submucosal dissection subtleties
    João Paulo de Souza Pontual, Alexandre Moraes Bestetti, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2023; 56(6): 738.     CrossRef
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The efficacy of a novel integrated outside biliary stent and nasobiliary drainage catheter system for acute cholangitis: a single center pilot study
Naosuke Kuraoka, Tetsuro Ujihara, Hiromi Kasahara, Yuto Suzuki, Shun Sakai, Satoru Hashimoto
Clin Endosc 2023;56(6):795-801.   Published online April 11, 2023
DOI: https://doi.org/10.5946/ce.2022.289
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures.
Methods
We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022.
Results
Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient.
Conclusions
The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.
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Evaluation of a new method, “non-injection resection using bipolar soft coagulation mode (NIRBS)”, for colonic adenomatous lesions
Mitsuo Tokuhara, Masaaki Shimatani, Kazunari Tominaga, Hiroko Nakahira, Takuya Ohtsu, Katsuyasu Kouda, Makoto Naganuma
Clin Endosc 2023;56(5):623-632.   Published online May 18, 2023
DOI: https://doi.org/10.5946/ce.2022.200
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic resection of all colorectal adenomatous lesions with a low complication rate, simplicity, and negative residuals is challenging. Hence, we developed a new method called “non-injection resection using bipolar soft coagulation mode (NIRBS)” method, adapted for colorectal lesions. In addition, we evaluated the effectiveness of this method.
Methods
We performed NIRBS throughout a 12-month period for all colorectal lesions which snare resection was acceptable without cancerous lesions infiltrating deeper than the submucosal layer.
Results
A total of 746 resected lesions were included in the study, with a 4.5 mm mean size (range, 1–35 mm). The major pathological breakdowns were as follows: 64.3% (480/746) were adenomas, and 5.0% (37/746) were intraepithelial adenocarcinomas (Tis lesions). No residuals were observed in any of the 37 Tis lesions (mean size, 15.3 mm). Adverse events included bleeding (0.4%) but no perforation.
Conclusions
NIRBS allowed the resection of multiple lesions with simplicity because of the non-injection and without perforating due to the minimal burn effect of the bipolar snare set in the soft coagulation mode. Therefore, NIRBS can be used to resect adenomatous lesions easily, including Tis lesions, from small to large lesions without leaving residuals.

Citations

Citations to this article as recorded by  
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
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  • 94 Download
  • 1 Web of Science
  • 1 Crossref
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Review
Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management
Clement Chun Ho Wu, Samuel Jun Ming Lim, Christopher Jen Lock Khor
Clin Endosc 2023;56(4):433-445.   Published online July 17, 2023
DOI: https://doi.org/10.5946/ce.2023.013
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

Citations

Citations to this article as recorded by  
  • Prevention of post-ERCP complications
    Lotfi Triki, Andrea Tringali, Marianna Arvanitakis, Tommaso Schepis
    Best Practice & Research Clinical Gastroenterology.2024; 69: 101906.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
    Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
    Clinical Endoscopy.2024; 57(2): 226.     CrossRef
  • Could assessment of genetic susceptibility be an effective solution to prevent pancreatitis from occurring after endoscopic retrograde cholangiopancreatography?
    Jae Min Lee
    The Korean Journal of Internal Medicine.2023; 38(6): 783.     CrossRef
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Original Articles
Utility of narrow-band imaging with or without dual focus magnification in neoplastic prediction of small colorectal polyps: a Vietnamese experience
Tien Manh Huynh, Quang Dinh Le, Nhan Quang Le, Huy Minh Le, Duc Trong Quach
Clin Endosc 2023;56(4):479-489.   Published online May 24, 2023
DOI: https://doi.org/10.5946/ce.2022.212
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Accurate neoplastic prediction can significantly decrease costs associated with pathology and unnecessary colorectal polypectomies. Narrow band imaging (NBI) and dual-focus (DF) mode are promising emerging optical technologies for recognizing neoplastic features of colorectal polyps digitally. This study aimed to clarify the clinical usefulness of NBI with and without DF assistance in the neoplastic prediction of small colorectal polyps (<10 mm).
Methods
This cross-sectional study included 530 small colorectal polyps from 343 consecutive patients who underwent colonoscopy at the University Medical Center from September 2020 to May 2021. Each polyp was endoscopically diagnosed in three successive steps using white-light endoscopy (WLE), NBI, and NBI-DF and retrieved for histopathological assessment. The diagnostic accuracy of each modality was evaluated with reference to histopathology.
Results
There were 295 neoplastic polyps and 235 non-neoplastic polyps. The overall accuracies of WLE, WLE+NBI, and WLE+NBI+NBI-DF in the neoplastic prediction of colorectal polyps were 70.8%, 87.4%, and 90.8%, respectively (p<0.001). The accuracy of WLE+NBI+NBI-DF was significantly higher than that of WLE+NBI in the polyp size ≤5 mm subgroup (87.3% vs. 90.1%, p<0.001).
Conclusions
NBI improved the real-time neoplastic prediction of small colorectal polyps. The DF mode was especially useful in polyps ≤5 mm in size.

Citations

Citations to this article as recorded by  
  • Effectiveness of Dual-Focus Magnification on Confidence Levels in Optical Diagnosis of Small Colorectal Polyps
    Tien M Huynh, Quang D Le, Nhan Q Le , Huy M Le , Duc T Quach
    Cureus.2024;[Epub]     CrossRef
  • The role of narrow-band imaging with or without dual focus in the detection of polyps smaller than 10 mm, especially diminutive polyps
    Jin Hwa Park
    Clinical Endoscopy.2023; 56(4): 455.     CrossRef
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
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  • 4 Web of Science
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Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography
Yasuhiro Kuraishi, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Masanori Yamada, Nobumasa Mizuno
Clin Endosc 2023;56(4):490-498.   Published online April 27, 2023
DOI: https://doi.org/10.5946/ce.2022.130
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique.
Methods
One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated.
Results
The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes).
Conclusions
Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.

Citations

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  • Comments on ‘Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography’
    Masood Muhammad Karim, Adeel Ur Rehman, Faisal Wasim Ismail, Om Parkash
    Clinical Endoscopy.2024; 57(2): 280.     CrossRef
  • 2,676 View
  • 125 Download
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Brief Reports
Is simply covering the patient's mouth with a surgical mask during transnasal endoscopy sufficient as an anti-COVID-19 measure?
Yohei Nose, Tomo Ishida, Tomoki Makino, Tsuyoshi Takahashi, Yukinori Kurokawa, Hidetoshi Eguchi, Yuichiro Doki, Kiyokazu Nakajima
Clin Endosc 2023;56(3):381-383.   Published online April 21, 2023
DOI: https://doi.org/10.5946/ce.2022.199
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  • 2,123 View
  • 99 Download
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Side-viewing scope insertion using a large-diameter overtube designed for colonoscopy in a patient with a cascade stomach
Hirokazu Saito, Yoshitaka Kadowaki, Atsushi Fujimoto, Kana Ohmoto, Shuji Tada
Clin Endosc 2023;56(2):256-257.   Published online January 5, 2023
DOI: https://doi.org/10.5946/ce.2022.089
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  • 2,025 View
  • 125 Download
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Original Article
Endoscopic ultrasound-guided coiling and glue is safe and superior to endoscopic glue injection in gastric varices with severe liver disease: a retrospective case control study
Kapil D. Jamwal, Rajesh K. Padhan, Atul Sharma, Manoj K. Sharma
Clin Endosc 2023;56(1):65-74.   Published online January 3, 2023
DOI: https://doi.org/10.5946/ce.2021.119
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Gastric varices (GV) are present in 25% of cirrhotic patients with high rates of rebleeding and mortality. Data on endoscopic ultrasound (EUS)-guided treatment in severe liver disease (model for end stage liver disease sodium [MELD-Na] >18 and Child-Turcotte-Pugh [CTP] C with GV) are scarce. Thus, we performed a retrospective comparison of endoscopic glue injection with EUS-guided therapy in cirrhotic patients with large GV.
Methods
A retrospective study was performed in the tertiary hospitals of India. A total of 80 patients were recruited. The inclusion criteria were gastroesophageal varices type 2, isolated gastric varices type 1, bleeding within 6 weeks, size of GV >10 mm, and a MELD-Na >18. Treatment outcomes and complications of endoscopic glue injection and EUS-guided GV therapy were compared.
Results
In this study, the patients’ age, sex, liver disease severity (CTP, MELD-Na) and clinical parameters were comparable. The median number of procedures, injected glue volume, complications, and GV obturation were better in the EUS group, respectively. On subgroup analysis of the EUS method (e.g., direct gastric fundus vs. paragastric collateral [PGC] coil placement), PGC coil placement showed decreased coil requirement, less injected glue volume, decreased luminal coil extrusion, and increased successful GV obturation.
Conclusions
EUS-guided treatment is more efficient and safer, and requires a smaller number of treatment sessions, as compared to endoscopic treatment in severe liver disease patients with large GV. Furthermore, PGC coil placement increases the complete obliteration of GV.

Citations

Citations to this article as recorded by  
  • Efficacy of clip-assisted endoscopic cyanoacrylate injection therapy for gastric varices: A Meta-analysis
    Yong-Cai Lv, Yan-Hua Yao, Jing-Jing Lei
    World Chinese Journal of Digestology.2024; 32(2): 158.     CrossRef
  • Advances in the endoscopic management of gastric varices
    Xin‐Tong Chi, Ting‐Ting Lian, Ze‐Hao Zhuang
    Digestive Endoscopy.2024;[Epub]     CrossRef
  • Trends in endovascular treatment and prevention of portal bleeding
    S.V. Mikhin, P.V. Mozgovoy, A.V. Kitaeva, D.E. Gorbunov, I.V. Mikhin
    Khirurgiya. Zhurnal im. N.I. Pirogova.2024; (3): 38.     CrossRef
  • Role of endoscopic ultrasound in the secondary prevention of gastric varices
    Joung-Ho Han
    Clinical Endoscopy.2023; 56(1): 50.     CrossRef
  • Management of Gastric Varices: GI Perspective
    Catherine Vozzo, Vibhu Chittajallu, Brooke Glessing, Ashley Faulx, Amitabh Chak, Richard C.K. Wong
    Digestive Disease Interventions.2023; 07(04): 266.     CrossRef
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  • 202 Download
  • 2 Web of Science
  • 5 Crossref
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Brief Reports
Trans-cavity lumen-apposing metal stent removal: an alternative safe modality
Giacomo Emanuele Maria Rizzo, Ilaria Tarantino
Clin Endosc 2023;56(1):129-131.   Published online January 18, 2023
DOI: https://doi.org/10.5946/ce.2022.105
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  • 1,588 View
  • 95 Download
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Aerosol extractor for COVID-2019 prevention during endoscopic procedure
Takuto Hikichi, Tsunetaka Kato, Ryoichiro Kobashi, Minami Hashimoto, Jun Nakamura
Clin Endosc 2022;55(6):815-818.   Published online August 29, 2022
DOI: https://doi.org/10.5946/ce.2022.025
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Citations

Citations to this article as recorded by  
  • Retrospective study about clinical severity and epidemiological analysis of the COVID-19 Omicron subvariant lineage-infected patients in Hohhot, China
    Yanhai Wang, Guohui Yu, Jingru Shi, Xiaqing Zhang, Jianxin Huo, Meng Li, Jiaxi Chen, Liyuan Yu, Yan Li, Zhiliang Han, Jianwen Zhang, Xuna Ren, Yujie Wang, Wu Yuntana
    BMC Infectious Diseases.2024;[Epub]     CrossRef
  • 2,316 View
  • 119 Download
  • 1 Web of Science
  • 1 Crossref
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Percutaneous endoscopy (peritoneoscopy) and lithotripsy for retrieval of dropped gallstones post-cholecystectomy
Nariman Nezami, Keywan Behbahani, David R. Elwood, Wendy R. Greene, Bill S. Majdalany, Jamil Shaikh
Clin Endosc 2022;55(6):819-823.   Published online October 19, 2022
DOI: https://doi.org/10.5946/ce.2021.278
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Citations

Citations to this article as recorded by  
  • Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones – A Case Series
    Ali Husnain, Allison Reiland, Albert A. Nemcek, Riad Salem, Alexander P. Nagle, Ezra Teitelbaum, Ahsun Riaz
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024;[Epub]     CrossRef
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  • 1 Crossref
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Original Articles
Efficacy of the pocket-creation method with a traction device in endoscopic submucosal dissection for residual or recurrent colorectal lesions
Daisuke Ide, Tomohiko Richard Ohya, Mitsuaki Ishioka, Yuri Enomoto, Eisuke Nakao, Yuki Mitsuyoshi, Junki Tokura, Keigo Suzuki, Seiichi Yakabi, Chihiro Yasue, Akiko Chino, Masahiro Igarashi, Akio Nakashima, Masayuki Saruta, Shoichi Saito, Junko Fujisaki
Clin Endosc 2022;55(5):655-664.   Published online May 31, 2022
DOI: https://doi.org/10.5946/ce.2022.009
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions.
Methods
We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events.
Results
En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group.
Conclusions
PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.

Citations

Citations to this article as recorded by  
  • Novel adjustable traction “noose knot” method for colorectal endoscopic submucosal dissection
    Junki Tokura, Daisuke Ide, Keigo Suzuki, Chihiro Yasue, Akiko Chino, Masahiro Igarashi, Shoichi Saito
    Endoscopy.2024; 56(S 01): E55.     CrossRef
  • Difficult colorectal polypectomy: Technical tips and recent advances
    Sukit Pattarajierapan, Hiroyuki Takamaru, Supakij Khomvilai
    World Journal of Gastroenterology.2023; 29(17): 2600.     CrossRef
  • Endoscopic full-thickness resection versus endoscopic submucosal dissection for challenging colorectal lesions: a randomized trial
    Gianluca Andrisani, Cesare Hassan, Margherita Pizzicannella, Francesco Pugliese, Massimiliano Mutignani, Chiara Campanale, Giorgio Valerii, Carmelo Barbera, Giulio Antonelli, Francesco Maria Di Matteo
    Gastrointestinal Endoscopy.2023; 98(6): 987.     CrossRef
  • Combination of endoscopic submucosal dissection techniques, a practical solution for difficult cases
    Dong-Hoon Yang
    Clinical Endoscopy.2022; 55(5): 626.     CrossRef
  • 4,386 View
  • 302 Download
  • 4 Web of Science
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Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer
Atsushi Goto, Takeshi Okamoto, Ryo Ogawa, Kouichi Hamabe, Shinichi Hashimoto, Jun Nishikawa, Taro Takami
Clin Endosc 2022;55(4):520-524.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2021.262
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety.
Methods
Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment.
Results
Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed.
Conclusions
Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis Clinical trial number (UMIN000037567).
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Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection
Wang Fangjun, Leng Xia, Gao Yi, Shen Xiuyun, Wang Wenping, Liu Huamin, Liu Pengfei
Clin Endosc 2022;55(4):525-531.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2021.241
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods
From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results
The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p>0.05).
Conclusions
The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.
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Real-time semantic segmentation of gastric intestinal metaplasia using a deep learning approach
Vitchaya Siripoppohn, Rapat Pittayanon, Kasenee Tiankanon, Natee Faknak, Anapat Sanpavat, Naruemon Klaikaew, Peerapon Vateekul, Rungsun Rerknimitr
Clin Endosc 2022;55(3):390-400.   Published online May 9, 2022
DOI: https://doi.org/10.5946/ce.2022.005
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Previous artificial intelligence (AI) models attempting to segment gastric intestinal metaplasia (GIM) areas have failed to be deployed in real-time endoscopy due to their slow inference speeds. Here, we propose a new GIM segmentation AI model with inference speeds faster than 25 frames per second that maintains a high level of accuracy.
Methods
Investigators from Chulalongkorn University obtained 802 histological-proven GIM images for AI model training. Four strategies were proposed to improve the model accuracy. First, transfer learning was employed to the public colon datasets. Second, an image preprocessing technique contrast-limited adaptive histogram equalization was employed to produce clearer GIM areas. Third, data augmentation was applied for a more robust model. Lastly, the bilateral segmentation network model was applied to segment GIM areas in real time. The results were analyzed using different validity values.
Results
From the internal test, our AI model achieved an inference speed of 31.53 frames per second. GIM detection showed sensitivity, specificity, positive predictive, negative predictive, accuracy, and mean intersection over union in GIM segmentation values of 93%, 80%, 82%, 92%, 87%, and 57%, respectively.
Conclusions
The bilateral segmentation network combined with transfer learning, contrast-limited adaptive histogram equalization, and data augmentation can provide high sensitivity and good accuracy for GIM detection and segmentation.

Citations

Citations to this article as recorded by  
  • Applications of artificial intelligence in gastroscopy: a narrative review
    Hu Chen, Shi-yu Liu, Si-hui Huang, Min Liu, Guang-xia Chen
    Journal of International Medical Research.2024;[Epub]     CrossRef
  • Computer‐aided diagnosis in real‐time endoscopy for all stages of gastric carcinogenesis: Development and validation study
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
    United European Gastroenterology Journal.2024;[Epub]     CrossRef
  • A Benchmark Dataset of Endoscopic Images and Novel Deep Learning Method to Detect Intestinal Metaplasia and Gastritis Atrophy
    Jie Yang, Yan Ou, Zhiqian Chen, Juan Liao, Wenjian Sun, Yang Luo, Chunbo Luo
    IEEE Journal of Biomedical and Health Informatics.2023; 27(1): 7.     CrossRef
  • Real-time gastric intestinal metaplasia diagnosis tailored for bias and noisy-labeled data with multiple endoscopic imaging
    Passin Pornvoraphat, Kasenee Tiankanon, Rapat Pittayanon, Phanukorn Sunthornwetchapong, Peerapon Vateekul, Rungsun Rerknimitr
    Computers in Biology and Medicine.2023; 154: 106582.     CrossRef
  • Diagnostic value of artificial intelligence-assisted endoscopy for chronic atrophic gastritis: a systematic review and meta-analysis
    Yanting Shi, Ning Wei, Kunhong Wang, Tao Tao, Feng Yu, Bing Lv
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Recent Advances in Applying Machine Learning and Deep Learning to Detect Upper Gastrointestinal Tract Lesions
    Malinda Vania, Bayu Adhi Tama, Hasan Maulahela, Sunghoon Lim
    IEEE Access.2023; 11: 66544.     CrossRef
  • Colon histology slide classification with deep-learning framework using individual and fused features
    Venkatesan Rajinikanth, Seifedine Kadry, Ramya Mohan, Arunmozhi Rama, Muhammad Attique Khan, Jungeun Kim
    Mathematical Biosciences and Engineering.2023; 20(11): 19454.     CrossRef
  • Clinical Decision Support System for All Stages of Gastric Carcinogenesis in Real-Time Endoscopy: Model Establishment and Validation Study
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee, Hae Min Jeong, Gwang Ho Baik, Jae Hoon Jeong, Sigmund Dick, Gi Hun Lee
    Journal of Medical Internet Research.2023; 25: e50448.     CrossRef
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Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum
Nobuaki Ikezawa, Takashi Toyonaga, Shinwa Tanaka, Tetsuya Yoshizaki, Toshitatsu Takao, Hirofumi Abe, Hiroya Sakaguchi, Kazunori Tsuda, Satoshi Urakami, Tatsuya Nakai, Taku Harada, Kou Miura, Takahisa Yamasaki, Stuart Kostalas, Yoshinori Morita, Yuzo Kodama
Clin Endosc 2022;55(3):417-425.   Published online May 12, 2022
DOI: https://doi.org/10.5946/ce.2021.245
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD.
Methods
D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed.
Results
The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively.
Conclusions
D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.

Citations

Citations to this article as recorded by  
  • Endoscopic submucosal dissection for diverticulum using combination of countertraction and circumferential-inversion method
    Hiroshi Takayama, Yoshinori Morita, Toshitatsu Takao, Douglas Motomura, Madoka Takao, Takashi Toyonaga, Yuzo Kodama
    Endoscopy.2024; 56(S 01): E91.     CrossRef
  • Successful planned piecemeal endoscopic resection using gel immersion and an over-the-scope clip for a lesion extensively extended into the colonic diverticulum
    Tomoaki Tashima, Takahiro Muramatsu, Tomonori Kawasaki, Tsubasa Ishikawa, Shomei Ryozawa
    VideoGIE.2023; 8(4): 167.     CrossRef
  • Future therapeutic implications of new molecular mechanism of colorectal cancer
    Sen Lu, Cheng-You Jia, Jian-She Yang
    World Journal of Gastroenterology.2023; 29(16): 2359.     CrossRef
  • Iatrogenic colorectal perforation caused by a clip
    Hirotaka Oura, Yasuki Hatayama, Erika Nomura, Harutoshi Sugiyama, Daisuke Murakami, Makoto Arai, Takayoshi Nishino
    Endoscopy.2023; 55(S 01): E1091.     CrossRef
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Case Reports
Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis
Pornpayom Numpraphrut, Sorachat Niltwat, Thammawat Parakonthun, Nonthalee Pausawasdi
Clin Endosc 2022;55(3):447-451.   Published online June 22, 2021
DOI: https://doi.org/10.5946/ce.2021.073
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Patients with symptomatic gastrointestinal stromal tumor (GIST) typically present with gastrointestinal bleeding and abdominal pain. This report presents an unusual case of fundic GIST complicated by gastroduodenal intussusception, manifesting as acute pancreatitis. The patient presented with epigastric pain and pancreatic enzyme elevation; thus, he was diagnosed with acute pancreatitis. Computed tomography showed evidence of pancreatitis and a 4×4.7 cm well-defined hyperdense lesion in the 2nd part of the duodenum, compressing the pancreatic head and pancreatic duct. Esophagogastroduodenoscopy revealed invagination of the gastric folds into the duodenum, causing pyloric canal blockage consistent with gastroduodenal intussusception. Spontaneous reduction of the lesion during endoscopy revealed a 4 cm pedunculated subepithelial mass with central ulceration originating from the gastric fundus. Endoscopic ultrasound demonstrated a heterogeneous hypoechoic lesion originating from the 4th layer of the gastric wall. Laparoscopic-endoscopic intragastric wedge resection of the fundic lesion was subsequently performed, and surgical histology confirmed GIST.

Citations

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  • Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review
    Wenbing Zhang, Haifeng Chen, Lulu Zhu, Zhiyuan Kong, Tingting Wang, Weiping Li
    Journal of International Medical Research.2022; 50(5): 030006052211007.     CrossRef
  • 4,633 View
  • 131 Download
  • 2 Web of Science
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Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography
Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair
Clin Endosc 2022;55(3):458-462.   Published online November 30, 2021
DOI: https://doi.org/10.5946/ce.2021.114
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.
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Brief Report
Underwater cold forceps polypectomy for an adenoma within a cecal diverticulum
Sho Sasaki, Jun Nishikawa, Isao Sakaida
Clin Endosc 2022;55(3):465-466.   Published online May 26, 2021
DOI: https://doi.org/10.5946/ce.2021.038
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  • 116 Download
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