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A practical approach for small bowel bleeding
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Sung Eun Kim, Hyun Jin Kim, Myeongseok Koh, Min Cheol Kim, Joon Sung Kim, Ji Hyung Nam, Young Kwan Cho, A Reum Choe, The Research Group for Capsule Endoscopy and Enteroscopy of the Korean Society of Gastrointestinal Endoscopy
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Clin Endosc 2023;56(3):283-289. Published online May 11, 2023
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DOI: https://doi.org/10.5946/ce.2022.302
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 Abstract
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- Gastrointestinal (GI) bleeding is one of the most common conditions among patients visiting emergency departments in Korea. GI bleeding is divided into upper and lower GI bleeding, according to the bleeding site. GI bleeding is also divided into overt and occult GI bleeding based on bleeding characteristics. In addition, obscure GI bleeding refers to recurrent or persistent GI bleeding from a source that cannot be identified after esophagogastroduodenoscopy or colonoscopy. The small intestine is the largest part of the alimentary tract. It extends from the pylorus to the cecum. The small intestine is difficult to access owing to its long length. Moreover, it is not fixed to the abdominal cavity. When hemorrhage occurs in the small intestine, the source cannot be found in many cases because of the characteristics of the small intestine. In practice, small-intestinal bleeding accounts for most of the obscure GI bleeding. Therefore, in this review, we introduce and describe systemic approaches and examination methods, including video capsule endoscopy and balloon enteroscopy, that can be performed in patients with suspected small bowel bleeding in clinical practice.
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Citations
Citations to this article as recorded by  - Effect of Different Types of Antithrombotic Agents on Clinical Outcomes in Patients With Small Bowel Bleeding Who Underwent Balloon‐Assisted Enteroscopy: A KASID Multicenter Study
Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong‐Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
Journal of Gastroenterology and Hepatology.2025; 40(2): 456. CrossRef - Do all antithrombotic agents have a similar impact on small bowel bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clinical Endoscopy.2025; 58(1): 80. CrossRef - Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
Surgical Endoscopy.2025; 39(3): 2044. CrossRef - MultiResFF‐Net: Multilevel Residual Block‐Based Lightweight Feature Fused Network With Attention for Gastrointestinal Disease Diagnosis
Sohaib Asif, Yajun Ying, Tingting Qian, Jun Yao, Jinjie Qu, Vicky Yang Wang, Rongbiao Ying, Dong Xu, Mohamadreza (Mohammad) Khosravi
International Journal of Intelligent Systems.2025;[Epub] CrossRef - Manejo da hemorragia digestiva baixa na emergência: abordagem cirúrgica
Carla Azevedo Zaibak, Sara Monteiro Barbosa, Nathalia Machado De Lima, Jordane Lula Cruz, Angela Maria Pereira Costa, Maria Eduarda da Silva Borges, Mariana Vasconcellos De Oliveira, Danyelly Rodrigues Machado
Cuadernos de Educación y Desarrollo.2024;[Epub] CrossRef - Case 19: A 65-Year-Old Man With Melena and Hematochezia
Hajin Lee, Younghee Choe, Jung Heo, Gwkang Hui Park, Su Young Lee, Young Wook Cho, Hyo Suk Kim
Journal of Korean Medical Science.2024;[Epub] CrossRef - Aortoduodenal fistula bleeding caused by an aortic stent graft
Seunghyun Hong, Gwang Ha Kim
Clinical Endoscopy.2024; 57(3): 407. CrossRef - Diagnostic Yield and Outcomes of Small Bowel Capsule Endoscopy in Patients with Small Bowel Bleeding Receiving Antithrombotics
Nikos Viazis, Dimitris Christodoulou, Vasilis Papastergiou, Konstantinos Mousourakis, Dimitra Kozompoli, Giannis Stasinos, Konstantina Dimopoulou, Periklis Apostolopoulos, Fotios Fousekis, Christos Liatsos, Nikolaos Kyriakos, Theodoros Argyropoulos, Georg
Diagnostics.2024; 14(13): 1361. CrossRef - Difficult Small Bowel Bleeding in Surgical View
Jung Min Bae
Journal of Acute Care Surgery.2024; 14(2): 41. CrossRef - Jejunal Dieulafoy’s lesion resembling subepithelial mass resulting in profound gastrointestinal hemorrhage
Thanaboon Chaemsupaphan, Tanawat Geeratragool, Napat Angkathunyakul, Arissa Phothisirisakulwong, Monthira Maneerattanaporn
Clinical Endoscopy.2024; 57(4): 552. CrossRef
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Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam
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Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang, the Committees of Quality Management and Conscious Sedation of Korean Society of Gastrointestinal Endoscopy
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Clin Endosc 2022;55(2):234-239. Published online October 12, 2021
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DOI: https://doi.org/10.5946/ce.2021.126
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Abstract
PDFPubReaderePub
- Background
/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions.
Methods
This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction.
Results
A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups.
Conclusions
Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.
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Citations
Citations to this article as recorded by - Insights into anesthesia administration for elderly individuals undergoing painless gastroenteroscopy: A bibliometric study
Gang Wang, Biao Zhen, Jia-Jun Li, Chun-Nv Jin, Jun Jia, Bo-Hai Liu, Yan-Hui Bai
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef - Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea
Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee
Clinical Endoscopy.2024; 57(4): 476. CrossRef - The effective dose of butorphanol tartrate in patients of different ages undergoing painless gastroscopy
Yaorui Sun, Shujiao Liu, Wenli Si, Quanyi Zhang, Fei Yu, Ming Su, Chao Sun
Journal of International Medical Research.2024;[Epub] CrossRef - Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy: a cohort study
Yuan-rui Zhao, Ke-sheng Huang, Guo Hou, Lan Yao, Li-ping Lu, Song Xu, Ying-tao Lian, Zhun Yao, Zhui Yu
World Journal of Emergency Medicine.2023; 14(1): 31. CrossRef - Effective dose of propofol combined with a low-dose esketamine for gastroscopy in elderly patients: A dose finding study using dixon’s up-and-down method
Yuling Zheng, Yafei Xu, Bixin Huang, Ying Mai, Yiwen Zhang, Zhongqi Zhang
Frontiers in Pharmacology.2022;[Epub] CrossRef - Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef
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5,987
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Comparison of Oral Sulfate Solution and Polyethylene Glycol Plus Ascorbic Acid on the Efficacy of Bowel Preparation
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Ji Hyung Nam, Seok Bo Hong, Yun Jeong Lim, Seongju Lee, Hyoun Woo Kang, Jae Hak Kim, Jin Ho Lee
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Clin Endosc 2020;53(5):568-574. Published online April 24, 2020
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DOI: https://doi.org/10.5946/ce.2019.209
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Abstract
PDFPubReaderePub
- Background
/Aims: The quality of bowel preparation is one of the quality indicators for colonoscopy. The aim of this study was to compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol plus ascorbic acid (PEG-AA) for bowel preparation.
Methods
The study involved 167 patients who underwent diagnostic colonoscopies. Inadequate bowel preparation was defined as any score of ≤1 in each colon section based on the Boston Bowel Preparation Scale. Multivariate logistic regression was used to compare the efficacy of OSS and PEG-AA. Subgroup analyses were performed based on patient characteristics.
Results
Overall, 106 (63.5%) patients received OSS, and 61 (36.5%) patients received PEG-AA. The rate of inadequate bowel preparation was 12.3% in patients receiving OSS and 32.8% in patients receiving PEG-AA (p=0.001). OSS (odds ratio [OR] = 0.26; p=0.003) and morning examination (OR=0.11; p=0.038) were significantly associated with efficient bowel preparation. The efficacy of OSS compared with PEG-AA was only significant in patients ≥50 years of age vs. <50 years of age (OR=0.13; p=0.001 vs. OR=0.96; p=0.959) and female vs. male patients (OR=0.06; p=0.002 vs. OR=0.58; p=0.339).
Conclusions
OSS was significantly more efficient for bowel preparation than PEG-AA, especially in patients ≥50 years of age and female patients. Morning examination led to a good quality of bowel preparation, irrespective of the preparation regimen.
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Citations
Citations to this article as recorded by - A randomized, controlled trial of oral sulfate solution versus polyethylene glycol for bowel preparation for colonoscopy
Dong-Ling Xie, Jin-Hui Fan, Chan-Juan Fan, Ying-Hui Gao, Jian-Ping Cheng
BMC Gastroenterology.2025;[Epub] CrossRef - Efficacy, Safety, and Tolerance of Split Dose Oral Sulfate Solution Versus Split-Dose Polyethylene Glycol Versus Single Dose Polyethylene Glycol for Colonoscopy Preparation: A Prospective Randomized Study
George Sarin Zacharia, Varghese Thomas
Middle East Journal of Digestive Diseases.2025; 17(1): 12. CrossRef - Efficacy of Oral Sulfate Tablet and 2 L-Polyethylene Glycol With Ascorbic Acid for Bowel Preparation: A Prospective Randomized KASID Multicenter Trial
Yunho Jung, Hyun Gun Kim, Dong-Hoon Yang, Hyoun Woo Kang, Jae Jun Park, Dong Hoon Baek, Jaeyoung Chun, Tae-Geun Gweon, Hyeon Jeong Goong, Min Seob Kwak, Hyun Jung Lee, Soo-Kyung Park, Jong Hoon Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef - Observation of the application effect of low-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) combined with ascorbic acid tablets in bowel preparation for colonoscopy in hospitalized patients
Le-Can Wu, En-Dian Zheng, Hao-Yue Sun, Xi-Zhou Lin, Ju-Yi Pan, Xiao-Xiao Lin
Frontiers in Oncology.2023;[Epub] CrossRef - Comparison of the efficacy and safety of an oral sulfate solution and 3-L polyethylene glycol on bowel preparation before colonoscopy: a phase III multicenter randomized controlled trial
Peng Pan, Shengbing Zhao, Shuling Wang, Yihang Song, Lun Gu, Youxiang Chen, Jiangrong Zhao, Lungen Lu, Xiuling Li, Hongzhi Xu, Gaifang Liu, Yanqing Li, Le Xu, Jiangbin Wang, Zhaoshen Li, Yu Bai
Gastrointestinal Endoscopy.2023; 98(6): 977. CrossRef - Randomized trial of oral sulfate solution versus polyethylene glycol–ascorbic acid for bowel cleansing in elderly people
Seung‐Joo Nam, Sung Chul Park, Sung Joon Lee, Sang Hoon Lee, Ji Hyun Kim, Chang Seok Bang, Hyun Il Seo
Journal of Gastroenterology and Hepatology.2022; 37(2): 319. CrossRef - Comparison of 2 L Polyethylene Glycol Plus Ascorbic Acid and 4 L Polyethylene Glycol in Elderly Patients Aged 60–79: A Prospective Randomized Study
Sung Hoon Jung, Chul-Hyun Lim, Tae-Geun Gweon, Jinsu Kim, Jung Hwan Oh, Kyu-Tae Yoon, Jee Young An, Jeong‑Seon Ji, Hwang Choi
Digestive Diseases and Sciences.2022; 67(10): 4841. CrossRef - Oral sulfate solution benefits polyp and adenoma detection during colonoscopy: Meta‐analysis of randomized controlled trials
Cheng Chen, Mengyang Shi, Zhongli Liao, Weiqing Chen, Yongzhong Wu, Xu Tian
Digestive Endoscopy.2022; 34(6): 1121. CrossRef - Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study
Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
Journal of Crohn's and Colitis.2022; 16(11): 1706. CrossRef - How to Choose the Optimal Bowel Preparation Regimen for Colonoscopy
Ji Eun Na, Eun Ran Kim
The Ewha Medical Journal.2021; 44(4): 122. CrossRef - Oral Sulfate Solution is as Effective as 2 L Polyethylene Glycol Plus Ascorbic Acid
Sung Hyun Shin, Kwang An Kwon
Clinical Endoscopy.2020; 53(5): 503. CrossRef
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Comparison of Fentanyl versus Meperidine in Combination with Midazolam for Sedative Colonoscopy in Korea
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Gwan Woo Hong, Jun Kyu Lee, Jung Hyeon Lee, Ji Hun Bong, Sung Hun Choi, Hyeki Cho, Ji Hyung Nam, Dong Kee Jang, Hyoun Woo Kang, Jae Hak Kim, Yun Jeong Lim, Moon Soo Koh, Jin Ho Lee
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Clin Endosc 2020;53(5):562-567. Published online July 3, 2020
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DOI: https://doi.org/10.5946/ce.2020.022
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Abstract
PDFPubReaderePub
- Background
/Aims: Combination of midazolam and opioids is used widely for endoscopic sedation. Compared with meperidine, fentanyl is reportedly associated with rapid recovery, turnover rate of endoscopy room, and quality of endoscopy. We compared fentanyl with meperidine when combined with midazolam for sedative colonoscopy.
Methods
A retrospective, cross-sectional, 1:2 matching study was conducted. Induction and recovery time were compared as the primary outcomes. Moreover, cecal intubation time, withdrawal time, total procedure time of colonoscopy, paradoxical reaction, adenoma detection rate, and adverse effect of midazolam or opioids were assessed as the secondary outcomes.
Results
A total of 129 subjects (43 fentanyl vs. 86 meperidine) were included in the analysis. The fentanyl group showed significantly more rapid induction time (4.5±2.7 min vs. 7.5±4.7 min, p<0.001), but longer recovery time (59.5±25.6 min vs. 50.3±10.9 min, p=0.030) than the meperidine group. In multivariate analysis, the induction time of the fentanyl group was 3.40 min faster (p<0.001), but the recovery time was 6.38 min longer (p=0.046) than that of the meperidine group. There was no difference in withdrawal time and adenoma detection rate between the two groups.
Conclusions
The fentanyl group had more rapid sedation induction time but longer recovery time than the meperidine group.
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Citations
Citations to this article as recorded by - Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam
Roberto Piro, Eleonora Casalini, Matteo Fontana, Carla Galeone, Patrizia Ruggiero, Sofia Taddei, Giulia Ghidoni, Giulia Patricelli, Nicola Facciolongo
Thoracic Cancer.2022; 13(4): 533. CrossRef - Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam
Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang
Clinical Endoscopy.2022; 55(2): 234. CrossRef - [Retracted] Efficacy of Analgesic Propofol/Esketamine and Propofol/Fentanyl for Painless Induced Abortion: A Randomized Clinical Trial
Naixing Xin, Wei Yan, Shuangfen Jin, Min Tang
BioMed Research International.2022;[Epub] CrossRef - Endoscopist-Driven Sedation Practices in South Korea: Re-evaluation Considering the Nationwide Survey in 2019
Seon-Young Park, Jun Kyu Lee, Chang-Hwan Park, Byung-Wook Kim, Chang Kyun Lee, Hong Jun Park, Byung Ik Jang, Dong Uk Kim, Jin Myung Park, Jae Min Lee, Young Sin Cho, Hyung Ku Chon, Seung Young Seo, Woo Hyun Paik
Gut and Liver.2022; 16(6): 899. CrossRef - Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef - Risk Factors for Prolonged Hospital Stay after Endoscopy
Toshihiro Nishizawa, Shuntaro Yoshida, Osamu Toyoshima, Tatsuya Matsuno, Masataka Irokawa, Toru Arano, Hirotoshi Ebinuma, Hidekazu Suzuki, Takanori Kanai, Kazuhiko Koike
Clinical Endoscopy.2021; 54(6): 851. CrossRef
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