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대한소화기내시경학회> Clinical Endoscopy> Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis

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Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis

Moon Won Lee , Gwang Ha Kim
  • : 대한소화기내시경학회
  • : Clinical Endoscopy 54권3호
  • : 연속간행물
  • : 2021년 05월
  • : 324-328(5pages)
Clinical Endoscopy

DOI


목차

INTRODUCTION
ENDOSCOPIC ULTRASONOGRAPHY FEATURES OF GASTRIC MESENCHYMAL TUMORS
DIGITAL ENDOSCOPIC ULTRASONOGRAPHY IMAGE ANALYSIS FOR GASTRIC MESENCHYMAL TUMORS
CONCLUSIONS
REFERENCES

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Gastric mesenchymal tumors (GMTs) are incidentally discovered in national gastric screening programs in Korea. Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. The differentiation of gastrointestinal stromal tumors from benign mesenchymal tumors, such as schwannomas or leiomyomas, is important to ensure appropriate clinical management. However, this is difficult and operator dependent because of the subjective interpretation of EUS images. Digital image analysis computes the distribution and spatial variation of pixels using texture analysis to extract useful data, enabling the objective analysis of EUS images and decreasing interobserver and intraobserver agreement in EUS image interpretation. This review aimed to summarize the usefulness and future of digital EUS image analysis for GMTs based on published reports and our experience. Clin Endosc 2021;54:324-328

UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 2234-2400
  • : 2234-2443
  • : 학술지
  • : 연속간행물
  • : 2011-2021
  • : 1143


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발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 4호 발행 연도 : 2021 페이지 : pp. 455-463 (9 pages)

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Endocytoscopy (EC) is a contact-type optical endoscope that allows in vivo cellular observation during gastrointestinal endoscopy and is now commercially available not only in Japan but also in Asian, European Union, and Middle Eastern countries. EC helps conduct a highly accurate pathological prediction without biopsy. Initially, EC was reported to be effective for esophageal diseases. Subsequently, its efficacy for stomach and colorectal diseases has been reported. In this narrative review, we searched for clinical studies that investigated the efficacy of EC. EC seems to accurately diagnose gastrointestinal diseases without biopsy. Most of the studies aimed to clarify the relationship between endocytoscopic findings of gastrointestinal neoplasia and pathological diagnosis. Some studies have investigated non-epithelial lesions or diseases, such as inflammatory bowel disease or infectious diseases. However, there are few high-level pieces of evidence, such as randomized trials; thus, further studies are needed. Clin Endosc 2021;54:455-463

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5Current Status of Image-Enhanced Endoscopy for Early Identification of Esophageal Neoplasms

저자 : Shin Hee Kim , Su Jin Hong

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 4호 발행 연도 : 2021 페이지 : pp. 464-476 (13 pages)

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Advanced esophageal cancer is known to have a poor prognosis. The early detection of esophageal neoplasms, including esophageal dysplasia and early esophageal cancer, is highly important for the accurate treatment of the disease. However, esophageal dysplasia and early esophageal cancer are usually subtle and can be easily missed. In addition to the early detection, proper pretreatment evaluation of the depth of invasion of esophageal cancer is very important for curative treatment. The progression of non-invasive diagnosis via image-enhanced endoscopy techniques has been shown to aid the early detection and estimate the depth of invasion of early esophageal cancer and, as a result, may provide additional opportunities for curative treatment. Here, we review the advancement of image-enhanced endoscopy-related technologies and their role in the early identification of esophageal neoplasms. Clin Endosc 2021;54:464-476

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6Application of Current Image-Enhanced Endoscopy in Gastric Diseases

저자 : Wansik Lee

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 4호 발행 연도 : 2021 페이지 : pp. 477-487 (11 pages)

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Image-enhanced endoscopy (IEE) plays an integral role in endoscopic diagnosis and treatment. IEE enables an early and accurate detection of cancer and characterization of lesions prior to therapeutic decisions. Ideal IEE can serve as an optical or digital chromoscopic endoscopy, as well as an optical biopsy that predicts exact histopathology. Several IEE modalities have recently been developed and are used in the clinical field. The stomach is a challenging organ for imaging because of its complex secretion function and status of Helicobacter pylori infection. Therefore, understanding the current IEE modalities for their clinical applicability in an evidence-based approach is warranted. Along with technology refinements, the new paradigm will be available for the diagnosis of gastric cancer or other conditions in the stomach in the near future. Clin Endosc 2021;54:477-487

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7Clinical Applications of Linked Color Imaging and Blue Laser/Light Imaging in the Screening, Diagnosis, and Treatment of Superficial Colorectal Tumors

저자 : Taku Sakamoto , Hourin Cho , Yutaka Saito

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 4호 발행 연도 : 2021 페이지 : pp. 488-493 (6 pages)

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Considering its contribution to reducing colorectal cancer morbidity and mortality, the most important task of colonoscopy is to find all existing polyps. Moreover, the accurate detection of existing polyps determines the risk of colorectal cancer morbidity and is an important factor in deciding the appropriate surveillance program for patients. Image-enhanced endoscopy is an easy-to-use modality with improved lesion detection. Linked color imaging (LCI) and blue laser/light imaging (BLI) are useful modalities for improving colonoscopy quality. Each mode has unique optical features; therefore, their intended use differs. LCI contributes to improved polyp detection due to its brightness and high color contrast between the lesion and normal mucosa, while BLI contributes to the characterization of detected polyps by evaluating the vessel and surface patterns of detected lesions. The proper use of these observation modes allows for more efficient endoscopic diagnosis. Moreover, recent developments in artificial intelligence will soon change the clinical practice of colonoscopy and this system will provide an efficient education modality for novice endoscopists. Clin Endosc 2021;54:488-493

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8Photodynamic Therapy for Esophageal Cancer

저자 : Takahiro Inoue , Ryu Ishihara

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 4호 발행 연도 : 2021 페이지 : pp. 494-498 (5 pages)

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Photodynamic therapy, a curative local treatment for esophageal squamous cell carcinoma, involves a photosensitizing drug (photosensitizer) with affinity for tumors and a photodynamic reaction triggered by laser light. Previously, photodynamic therapy was used to treat superficial esophageal squamous cell carcinoma judged to be difficult to undergo endoscopic resection. Recently, photodynamic therapy has mainly been performed for local failure after chemoradiotherapy. Although surgery is the most promising treatment for local failure after chemoradiotherapy, its morbidity and mortality rates are high. Endoscopic resection is feasible for local failure after chemoradiotherapy but requires advanced skills, and its indication is limited to within the submucosal layer by depth. Photodynamic therapy is less invasive than surgery and has a wider indication than endoscopic resection. Porfimer sodium (a first-generation photosensitizer) causes a high frequency of side effects related to photosensitivity and requires the long-term sun-shade period. Talaporfin (a second-generation photosensitizer) requires a much shorter sun-shade period than porfimer sodium. Photodynamic therapy will profoundly change treatment strategies for local failure after chemoradiotherapy. Clin Endosc 2021;54:494-498

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저자 : Kasenee Tiankanon , Satimai Aniwan , Rungsun Rerknimitr

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 4호 발행 연도 : 2021 페이지 : pp. 499-504 (6 pages)

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Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalent cancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program as a response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, while there are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage of endoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel, reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemical test (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FIT cutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify the priority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies and the current status of the Thailand CRC screening program. Clin Endosc 2021;54:499-504

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10Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections

저자 : Chi Hyuk Oh , Jun Kyu Lee , Tae Jun Song , Jin-seok Park , Jae Min Lee , Jun Hyuk Son , Dong Kee Jang , Miyoung Choi , Jeong-Sik Byeon , In Seok Lee , Soo Teik Lee , Ho Soon Choi , Ho Gak Kim , Hoon Jai

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 4호 발행 연도 : 2021 페이지 : pp. 505-521 (17 pages)

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Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies. Clin Endosc 2021;54:505-521

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Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS. Clin Endosc 2021;54:301-308

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5Contrast Harmonic Endoscopic Ultrasound in Pancreatic Diseases

저자 : Rafael Mejuto-fernandez , Julio Iglesias-garcia

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 3호 발행 연도 : 2021 페이지 : pp. 309-313 (5 pages)

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Endoscopic ultrasound (EUS) was first described in 1986, with the aim of overcoming the problems affecting transabdominal ultrasound imaging, mainly problems related to the interposition of gas, and artifacts produced by bone or fat. Now, EUS can be considered as the best method for the analysis of pancreatic diseases, overtaking the diagnostic accuracy of computed tomography and magnetic resonance imaging. However, fundamental B-mode imaging is limited for the diagnosis of solid pancreatic lesions, because most of them are depicted as heterogeneous and hypo-echoic, and it is difficult to differentiate between benign and malignant lesions. Similar to how perfusion patterns obtained by computed tomography or magnetic resonance imaging after injection of contrast agents allow for the characterization of focal lesions, EUS has also recently been introduced to the use of contrast agents for performing contrast-enhanced harmonic EUS (CEH-EUS), which has the capability to distinguish the type of perfusion between lesions and surrounding tissue. CEH-EUS has shown its usefulness for the diagnosis and characterization of solid pancreatic lesions. Moreover, CEH-EUS is also highly accurate for distinguishing non-neoplastic from neoplastic cysts in pancreatic lesions. Another potential role of CEH-EUS is its ability to direct EUS-guided tissue acquisition. Clin Endosc 2021;54:309-313

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6Endoscopic Ultrasound-Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Pancreatic Malignancy

저자 : Seong-hun Kim , Eun Ji Shin

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 3호 발행 연도 : 2021 페이지 : pp. 314-323 (10 pages)

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Stereotactic body radiation therapy (SBRT) is an important treatment option for pancreatic cancer, which is known to be one of the malignancies with the worst prognosis. However, the high radiation doses delivered during SBRT may cause damage to adjacent radiosensitive organs. To minimize such damage, fiducial markers are used for localization during SBRT for pancreatic cancer. The development of endoscopic ultrasound (EUS) has enabled fiducial markers to be inserted into the pancreas using an EUS fine-needle aspiration (FNA) needle, unlike in the past when percutaneous placement was generally performed. For successful EUS-guided fiducial marker placement, it is necessary for the fiducial markers to be loaded within the EUS-FNA needles to have a low probability of complications and a low migration risk, and to be stably observed in SBRT imaging. A systematic review has shown that the technical success rate of EUS-guided fiducial marker placement is 96.27%, whereas the fiducial marker migration and adverse event rates are 4.33% and 4.85%, respectively. Nonetheless, standardized techniques for fiducial marker placement and the characteristics of optimal fiducial markers have not yet been established. This review will introduce the characteristics (e.g., materials and shapes) of fiducial markers used in fiducial marker placement for pancreatic cancer and will discuss conventional techniques along with their success rates, difficulties, and adverse events. Clin Endosc 2021;54:314-323

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7Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis

저자 : Moon Won Lee , Gwang Ha Kim

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 3호 발행 연도 : 2021 페이지 : pp. 324-328 (5 pages)

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Gastric mesenchymal tumors (GMTs) are incidentally discovered in national gastric screening programs in Korea. Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. The differentiation of gastrointestinal stromal tumors from benign mesenchymal tumors, such as schwannomas or leiomyomas, is important to ensure appropriate clinical management. However, this is difficult and operator dependent because of the subjective interpretation of EUS images. Digital image analysis computes the distribution and spatial variation of pixels using texture analysis to extract useful data, enabling the objective analysis of EUS images and decreasing interobserver and intraobserver agreement in EUS image interpretation. This review aimed to summarize the usefulness and future of digital EUS image analysis for GMTs based on published reports and our experience. Clin Endosc 2021;54:324-328

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8Artificial Intelligence in Lower Gastrointestinal Endoscopy: The Current Status and Future Perspective

저자 : Sebastian Manuel Milluzzo , Paola Cesaro , Leonardo Minelli Grazioli , Nicola Olivari , Cristiano Spada

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 3호 발행 연도 : 2021 페이지 : pp. 329-339 (11 pages)

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The present manuscript aims to review the history, recent advances, evidence, and challenges of artificial intelligence (AI) in colonoscopy. Although it is mainly focused on polyp detection and characterization, it also considers other potential applications (i.e., inflammatory bowel disease) and future perspectives. Some of the most recent algorithms show promising results that are similar to human expert performance. The integration of AI in routine clinical practice will be challenging, with significant issues to overcome (i.e., regulatory, reimbursement). Medico-legal issues will also need to be addressed. With the exception of an AI system that is already available in selected countries (GI Genius; Medtronic, Minneapolis, MN, USA), the majority of the technology is still in its infancy and has not yet been proven to reach a sufficient diagnostic performance to be adopted in the clinical practice. However, larger players will enter the arena of AI in the next few months. Clin Endosc 2021;54:329-339

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9Safety and Recipient Satisfaction of Propofol Sedation in Outpatient Endoscopy: A 24-Hour Prospective Investigation Using a Questionnaire Survey

저자 : Yoshihide Kanno , Tetsuya Ohira , Yoshihiro Harada , Shinsuke Koshita , Takahisa Ogawa , Hiroaki Kusunose , Yoshiki Koike , Taku Yamagata , Toshitaka Sakai , Kaori Masu , Keisuke Yonamine , Kazuaki Miyamoto ,

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 3호 발행 연도 : 2021 페이지 : pp. 340-347 (8 pages)

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Background/Aims: The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy.
Methods: In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a next-day questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated.
Results: Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20-200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations.
Conclusions: Propofol sedation was found to be safe-without severe adverse events or accidents-for outpatient endoscopy on the basis of the patients' next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening. Clin Endosc 2021;54:340-347

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10Clinical Gastroenterology and Gastrointestinal Endoscopy Practices during the Coronavirus Disease 2019 Pandemic in Indonesia: An Online Nationwide Survey

저자 : Ahmad Fariz Malvi Zamzam Zein , Rabbinu Rangga Pribadi , Uswatun Khasanah , Muhammad Begawan Bestari , Ari Fahrial Syam

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 54권 3호 발행 연도 : 2021 페이지 : pp. 348-355 (8 pages)

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Background/Aims: The coronavirus disease 2019 (COVID-19) pandemic has necessitated modifications to allow the safe practice of clinical gastroenterology and gastrointestinal endoscopy. This study aimed to investigate the characteristics of clinical gastroenterology and gastrointestinal endoscopy practices during the COVID-19 pandemic in Indonesia.
Methods: This cross-sectional study enrolled physician members of the Indonesian Society for Digestive Endoscopy. We used an online self-administered questionnaire disseminated via social media. The 32-item survey determined the baseline characteristics of the participants, characteristics of clinical gastroenterology and gastrointestinal endoscopy practices, involvement of the physicians in the management of COVID-19, and overall impact of the pandemic on practice. All collected data were analyzed using descriptive statistics.
Results: The 200 participants in this study had a median age of 50 (34-76) years. Modifications in clinical gastroenterology practice were frequently reported in the outpatient (95.5%) and inpatient (100%) settings. All participants reported changes in the gastrointestinal endoscopy practice patterns. Of the participants, 86.0% were working in high-risk zones, and several of them reported inadequate protective personal equipment (34.0%). The median overall impact score of the pandemic on practice was 9 (2-10).
Conclusions: Physicians practicing clinical gastroenterology and gastrointestinal endoscopy in Indonesia work in high-risk settings. Modifications in clinical gastroenterology and gastrointestinal endoscopy practices are prevalent during the COVID-19 pandemic. Clin Endosc 2021;54:348-355

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