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대한소화기내시경학회> Clinical Endoscopy> Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases

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Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases

Luca Elli , Erica Centorrino , Andrea Costantino , Maurizio Vecchi , Stefania Orlando , Mirella Fraquelli
  • : 대한소화기내시경학회
  • : Clinical Endoscopy 55권4호
  • : 연속간행물
  • : 2022년 07월
  • : 532-539(8pages)
Clinical Endoscopy

DOI


목차

INTRODUCTION
METHODS
RESULTS
DISCUSSION
Conflicts of Interest
Funding
Acknowledgments
Author Contributions
ORCID
REFERENCES

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Background/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods: We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results: A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions: CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

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간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 2234-2400
  • : 2234-2443
  • : 학술지
  • : 연속간행물
  • : 2011-2022
  • : 1307


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55권5호(2022년 09월) 수록논문
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1New sedatives and analgesic drugs for gastrointestinal endoscopic procedures

저자 : Jae Min Lee , Yehyun Park , Jin Myung Park , Hong Jun Park , Jun Yong Bae , Seung Young Seo , Jee Hyun Lee , Hyung Ku Chon , Jun-won Chung , Hyun Ho Choi , Jun Kyu Lee , Byung-wook Kim

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 581-587 (7 pages)

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Procedural sedation has become increasingly common in endoscopy. Sedatives and analgesics induce anxiolysis and amnesia. In addition, an appropriate level of sedation is necessary for safe procedures including therapeutic endoscopy. Midazolam and propofol are the most commonly used drugs in sedative endoscopy. In recent years, the need to ascertain the safety and effectiveness of sedation has increased in practice. Therefore, new sedatives and analgesic drugs for optimal sedative endoscopy, have recently emerged. This article reviews the characteristics of sedatives and analgesics, and describes their clinical use in gastrointestinal endoscopy.

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2Management of aerosol generation during upper gastrointestinal endoscopy

저자 : Chawisa Nampoolsuksan , Vitoon Chinswangwatanakul , Asada Methasate , Jirawat Swangsri , Atthaphorn Trakarnsanga , Chainarong Phalanusitthepha , Thammawat Parakonthun , Voraboot Taweerutchana , Nicha Srisuworanan , Tha

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 588-593 (6 pages)

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In the highly contagious coronavirus disease 2019 pandemic, aerosol-generating procedures (AGPs) are associated with high-risk of transmission. Upper gastrointestinal endoscopy is a procedure with the potential to cause dissemination of bodily fluids. At present, there is no consensus that endoscopy is defined as an AGP. This review discusses the current evidence on this topic with additional management. Prevailing publications on coronavirus related to upper gastrointestinal endoscopy and aerosolization from the PubMed and Scopus databases were searched and reviewed. Comparative quantitative analyses showed a significant elevation of particle numbers, implying that aerosols were generated by upper gastrointestinal endoscopy. The associated source events have also been reported. To reduce the dispersion, certain protective measures have been developed. Endoscopic unit protocols are recommended for the concerned personnel. Therefore, upper gastrointestinal endoscopy should be classified as an AGP. Proper practices should be adopted by healthcare workers and patients.

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3Preparation of image databases for artificial intelligence algorithm development in gastrointestinal endoscopy

저자 : Chang Bong Yang , Sang Hoon Kim , Yun Jeong Lim

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 594-604 (11 pages)

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Over the past decade, technological advances in deep learning have led to the introduction of artificial intelligence (AI) in medical imaging. The most commonly used structure in image recognition is the convolutional neural network, which mimics the action of the human visual cortex. The applications of AI in gastrointestinal endoscopy are diverse. Computer-aided diagnosis has achieved remarkable outcomes with recent improvements in machine-learning techniques and advances in computer performance. Despite some hurdles, the implementation of AI-assisted clinical practice is expected to aid endoscopists in real-time decision-making. In this summary, we reviewed state-of-the-art AI in the field of gastrointestinal endoscopy and offered a practical guide for building a learning image dataset for algorithm development.

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4Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases

저자 : Mamoru Takenaka , Masatoshi Kudo

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 605-614 (10 pages)

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The double-guidewire method has been increasingly used in endoscopic procedures for biliary and pancreatic diseases in recent years, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-related procedures. In addition, double-lumen catheters with uneven distal and proximal lumen openings have been introduced, making it possible to easily create a double-guidewire situation, and the usefulness of the double-guidewire technique using uneven double-lumen cannulas has been widely reported. Although the advantages of using two guidewires depend on the particular situation and the appropriate use of the two guidewires, deepening the knowledge of the double-guidewire method will contribute greatly to troubleshooting in daily practice. In this review, the usefulness of the double-guidewire technique is discussed with respect to two main areas: selective insertion of guidewires and devices and biliary cannulation.

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5Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis

저자 : Suprabhat Giri , Shivaraj Afzalpurkar , Sumaswi Angadi , Sridhar Sundaram

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 615-625 (11 pages)

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Background/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.
Methods: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
Results: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events.
Conclusions: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

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6Combination of endoscopic submucosal dissection techniques, a practical solution for difficult cases

저자 : Dong-hoon Yang

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 626-627 (2 pages)

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7Tacrolimus for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: a potential new target of old drug?

저자 : Seok Jeong

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 628-629 (2 pages)

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8Safe implementation of transoral incisionless fundoplication as a new technique in a tertiary care center

저자 : Shivanand Bomman , Sofya Malashanka , Adil Ghafoor , David J. Sanders , Shayan Irani , Richard A. Kozarek , Andrew Ross , Michal Hubka , Rajesh Krishnamoorthi

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 630-636 (7 pages)

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Background/Aims: Transoral incisionless fundoplication (TIF) is an accepted anatomic treatment for gastroesophageal reflux disease in selected patients. In this report, we analyze our institution's programmatic allocation of resources during the safe implementation of TIF as a new procedure.
Methods: A retrospective analysis of all patients who underwent TIF from January 2020 to February 2021 at our institution was performed. The process of initially allocating the operating room (OR) with overnight admission and postoperative esophagram for added safety, and subsequently transitioning TIF to the endoscopy suite (ES) as an outpatient procedure was described. Patient safety and outcomes were evaluated during transition.
Results: Thirty patients who underwent TIF were identified. The mean age was 51.2±16.0 years. TIF was performed in an OR in nine patients (30%) and 21 (70%) in the ES. All the OR patients were admitted overnight and had routine esophagogram. In contrast, four (19%) from the ES group required clinically-indicated admission and three (14.2%) required esophagram. The mean procedure duration was significantly lower in the ES group (65.7 min vs. 84 min, p=0.02).
Conclusions: A stepwise, resource-efficient process was described that allowed safe initiation of TIF as a new technique and its effective transition to a fully outpatient procedure.

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9Comparison of diagnostic performances of slow-pull suction and standard suction in endoscopic ultrasound-guided fine needle biopsy for gastrointestinal subepithelial tumors

저자 : Joon Seop Lee , Chang Min Cho , Yong Hwan Kwon , An Na Seo , Han Ik Bae , Man-hoon Han

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 637-644 (8 pages)

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Background/Aims: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs.
Methods: In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques.
Results: The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis.
Conclusions: SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.

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10Optical diagnosis by near-focus versus normal-focus narrow band imaging colonoscopy in colorectal polyps based on combined NICE and WASP classification: a randomized controlled trial

저자 : Nisa Netinatsunton , Natcha Cheewasereechon , Tanawat Pattarapuntakul , Jaksin Sottisuporn , Kanet Kanjanapradit , Bancha Ovartlarnporn

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 5호 발행 연도 : 2022 페이지 : pp. 645-654 (10 pages)

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Background/Aims: Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Workgroup Serrated Polyps and Polyposis (WASP) classifications were developed for optical diagnosis of neoplastic and sessile serrated polyps, respectively. Near-focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not yet been evaluated. We aimed to compare the accuracy of near-focus NBI (group A) with normal-focus NBI (group B) in real-time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.
Methods: Among 362 patients, 118 with 227 polyps were recruited. Groups A and B included 62 patients with 130 polyps (three lost polyps) and 56 patients with 106 polyps (six lost polyps), respectively. Optical diagnoses were compared with pathological reports.
Results: The accuracy of optical diagnosis of neoplastic polyps in groups A and B was not significantly different (76% vs. 71%, p=0.52). WASP criteria provided all false positive diagnoses of sessile polyps as serrated polyps in 31 (16.2%) patients.
Conclusions: Near-focus NBI was not superior to normal-focus NBI in optical diagnostics of neoplastic polyps using NICE criteria. In our study, WASP classification yielded all false positives in the diagnosis of sessile serrated adenomas/polyps. Routine real-life optical diagnosis of polyps is still unadvisable.

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1Recent developments in small bowel endoscopy: the “black box” is now open!

저자 : Luigina Vanessa Alemanni , Stefano Fabbri , Emanuele Rondonotti , Alessandro Mussetto

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 473-479 (7 pages)

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Over the last few years, capsule endoscopy has been established as a fundamental device in the practicing gastroenterologist's toolbox. Its utilization in diagnostic algorithms for suspected small bowel bleeding, Crohn's disease, and small bowel tumors has been approved by several guidelines. The advent of double-balloon enteroscopy has significantly increased the therapeutic possibilities and release of multiple devices (single-balloon enteroscopy and spiral enteroscopy) aimed at improving the performance of small bowel enteroscopy. Recently, some important innovations have appeared in the small bowel endoscopy scene, providing further improvement to its evolution. Artificial intelligence in capsule endoscopy should increase diagnostic accuracy and reading efficiency, and the introduction of motorized spiral enteroscopy into clinical practice could also improve the therapeutic yield. This review focuses on the most recent studies on artificial-intelligence-assisted capsule endoscopy and motorized spiral enteroscopy.

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2Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice

저자 : Kyeong Ok Kim

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 480-488 (9 pages)

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Endoscopy is vital for diagnosis, assessing treatment response, monitoring and surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

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3Post-polypectomy surveillance: the present and the future

저자 : Masau Sekiguchi , Takahisa Matsuda , Kinichi Hotta , Yutaka Saito

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 489-495 (7 pages)

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An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

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4Endoscopic treatment for rectal neuroendocrine tumor: which method is better?

저자 : Seung Min Hong , Dong Hoon Baek

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 496-506 (11 pages)

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Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mm without atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probability of patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resection of rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations for technique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopic characteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover, the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resection is the most suitable resection method for rectal NETs of < 10 mm, because it is an effective and safe technique that is relatively simple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be considered when the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopic mucosal resection does not work well.

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5Endoscopic diagnosis of gastric metastases from malignant melanoma: systematic review

저자 : Helena Campoli Reggiani , Ana Clara Aguiar Pongeluppi , Vitória Froes Miraglia Martins Ferreira , Isadora Pinheiro Felix , Paulo Moacir De Oliveira Campoli

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 507-515 (9 pages)

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Background/Aims: Metastases of malignant melanoma (MM) are rare and associated with poor prognosis. The objective of this study was to analyze the clinical and endoscopic characteristics of gastric metastases of MM by systematically reviewing cases and case series involving patients diagnosed using upper gastrointestinal endoscopy.
Methods: The PubMed and LILACS databases were searched. Reports containing individual patient data were included. Outcomes such as clinical data, endoscopic findings, treatments, and survival were analyzed.
Results: A total of 88 studies with individual data from 113 patients with gastric metastases of MM were included. The primary sites of MM were the skin (62%), eyes (10%), and mucous membranes (6%). Most patients (56%) had multiple metastases in the stomach, located predominantly in the gastric body (approximately 80%). The overall survival rate at 2 years was 4%. There was a significant reduction in the survival of patients with multiple gastric metastases compared to that of patients with single metastasis (hazard ratio, 0.459; 95% confidence interval, 0.235-0.895; p=0.022).
Conclusions: Gastric metastases of MM have a poor prognosis, especially in patients with multiple implants in the stomach. Additional studies are needed to verify whether ocular and mucosal melanomas are associated with a higher risk of gastric metastases than that of cutaneous melanomas.

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6Prevention of stricture after endoscopic submucosal dissection for esophageal cancer: intralesional steroid infusion using a spray tube

저자 : Jong Yeul Lee

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 516-517 (2 pages)

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7Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation

저자 : Se Woo Park

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 518-519 (2 pages)

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8Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer

저자 : Atsushi Goto , Takeshi Okamoto , Ryo Ogawa , Kouichi Hamabe , Shinichi Hashimoto , Jun Nishikawa , Taro Takami

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 520-524 (5 pages)

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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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9Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection

저자 : Wang Fangjun , Leng Xia , Gao Yi , Shen Xiuyun , Wang Wenping , Liu Huamin , Liu Pengfei

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 525-531 (7 pages)

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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=0.331).
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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10Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases

저자 : Luca Elli , Erica Centorrino , Andrea Costantino , Maurizio Vecchi , Stefania Orlando , Mirella Fraquelli

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 532-539 (8 pages)

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Background/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods: We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results: A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions: CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

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