Clinical Endoscopy

Volume 50(3); May 2017

Commentarys

Characteristics of Missed Synchronous Gastric Epithelial Neoplasms: Bong Eun Lee; Clin Endosc 2017;50(3):211-212. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.058

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Clinicopathological features and risk factors analysis of lymph node metastasis and long-term prognosis in patients with synchronous multiple gastric cancer
Liang Chen, Chao Yue, Gang Li, Xuezhi Ming, Rongmin Gu, Xu Wen, Bin Zhou, Rui Peng, Wei Wei, Huanqiu Chen
World Journal of Surgical Oncology.2021;[Epub] CrossRef

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Outcomes and Safety Issues Related to Percutaneous Endoscopic Gastrostomy in Neurodegenerative Diseases: Yun Jeong Lim; Clin Endosc 2017;50(3):213-214. Published online April 25, 2017; DOI: https://doi.org/10.5946/ce.2017.051

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Sessile Serrated Adenoma; the Hard-to-Catch Culprit of Interval Cancer: Suk Pyo Shin; Clin Endosc 2017;50(3):215-216. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.052

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Risk factors of traditional serrated adenoma and clinicopathologic characteristics of synchronous conventional adenoma
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Yuki Nakanishi, Maria T. Diaz-Meco, Jorge Moscat
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Prediction and Prevention of Postpolypectomy Bleeding: Necessity of a Different Approach for Patients Using Antithrombotic Agents: Duk Hwan Kim; Clin Endosc 2017;50(3):217-218. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.056

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Current strategies for malignant pedunculated colorectal polyps
Adriana Ciocalteu, Dan Ionut Gheonea, Adrian Saftoiu, Liliana Streba, Nicoleta Alice Dragoescu, Tiberiu Stefanita Tenea-Cojan
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Focused Review Series: Endoscopic Accessories Used for ESDs

History and Development of Accessories for Endoscopic Submucosal Dissection: Bong Min Ko; Clin Endosc 2017;50(3):219-223. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.078

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Endoscopic submucosal dissection (ESD) procedure is composed of circumferential mucosal incision and submucosal dissection. A variety of endoscopic accessories are required to perform mucosal incision and submucosal dissection safely. As a result of the improvements in ESD devices and peripheral equipment and development of the ESD technique, ESD procedures have been performed extensively worldwide. Here I review the history of the development of accessories used in performing ESD procedures.

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Lactobionic acid-modified chitosan thermosensitive hydrogels that lift lesions and promote repair in endoscopic submucosal dissection
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Accessory Devices Frequently Used for Endoscopic Submucosal Dissection: Hyuk Soon Choi, Hoon Jai Chun; Clin Endosc 2017;50(3):224-233. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.070

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) is increasingly being considered an essential component of treatment for early gastrointestinal cancers and subepithelial tumors. The ESD technique owes its popularity to the development of sophisticated instruments used for ESD. With an increase in the number of ESD procedures performed, there is rapid development in the number and types of endoscopic accessory devices used for such procedures. Despite the large numbers of new devices developed and marketed, the use of ESD instruments and accessory devices is largely determined by individual preferences and experiences. Accessory devices frequently used during ESD are important tools for ESD techniques. Each instrument possesses characteristic advantages and disadvantages associated with its use, and no one instrument is superior in all respects to others. In this article, we review the characteristics of endoscopic electrical knives, cap and hood, and hemostatic devices commonly used in ESD.

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Endoscopic submucosal dissection: an update on tools and accessories
Christopher Harlow, Arun Sivananthan, Lakshmana Ayaru, Kinesh Patel, Ara Darzi, Nisha Patel
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Hang Lak Lee
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Endoscopic Accessories Used for More Advanced Endoluminal Therapeutic Procedures: Hyunsoo Chung; Clin Endosc 2017;50(3):234-241. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.079

Abstract PDF PubReader ePub: Endoscopic accessories describe an extensive variety of auxiliary instruments used for diagnostic and therapeutic endoscopy. Various endoscopic accessories have been developed over the previous few decades and are mostly used for treating neoplastic lesions, such as early gastrointestinal (GI) carcinomas and premalignant lesions. Because of extensive research on natural orifice endoluminal surgery (NOTES) in the early 2000s and recent technological developments, new devices have been developed for various advanced endoluminal therapeutic procedures. In particular, a remarkable development of endoscopic management was achieved in the field of gastroesophageal reflux disease (GERD) and obesity. In both conditions, there is treatment gap between medical and surgical therapy. A large proportion of the patients who do not respond to medical treatment and lifestyle modification, still hesitate to directly undergo surgical treatment. To bridge this gap, endoscopic management has been receiving increasing attention. In this article, I review endoscopic and/or endoluminal devices used for the treatment of GERD and obesity with proposed mechanisms of their function.

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Future Development of Endoscopic Accessories for Endoscopic Submucosal Dissection: Jae-Young Jang; Clin Endosc 2017;50(3):242-249. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2017.073

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) has recently been accepted as a standard treatment for patients with early gastric cancer (EGC), without lymph node metastases. Given the rise in the number of ESDs being performed, new endoscopic accessories are being developed and existing accessories modified to facilitate the execution of ESD and reduce complication rates. This paper examines the history underlying the development of these new endoscopic accessories and indicates future directions for the development of these accessories.

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Reviews

Evaluation and Endoscopic Management of Esophageal Submucosal Tumor: Weon Jin Ko, Ga Won Song, Joo Young Cho; Clin Endosc 2017;50(3):250-253. Published online November 7, 2016; DOI: https://doi.org/10.5946/ce.2016.109

Abstract PDF PubReader ePub

Submucosal tumors (SMTs) originate from tissues that constitute the submucosal layer and muscularis propria, and are covered by normal mucosa. Esophageal SMTs are rare, accounting for <1% of all esophageal tumors. However, the recent widespread use of endoscopy has led to a rapid increase in incidental detection of SMTs in Korea. Esophageal SMTs are benign in ≥90% of cases, but the possibility of malignancies such as gastrointestinal stromal tumor and malignant leiomyosarcoma still exists. Therefore, patients undergo resection in the presence of symptoms or the possibility of a malignant tumor. For resection of esophageal SMTs, surgical resection was the only option available in case of possible malignancy, but minimally invasive surgery by endoscopic resection is becoming more preferable to surgical resection with the development of endoscopic ultrasonography, endoscopic techniques, and other devices.

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Clinical and Biological Features of Interval Colorectal Cancer: Yu Mi Lee, Kyu Chan Huh; Clin Endosc 2017;50(3):254-260. Published online March 21, 2017; DOI: https://doi.org/10.5946/ce.2016.115

Abstract PDF PubReader ePub

Interval colorectal cancer (I-CRC) is defined as a CRC diagnosed within 60 months after a negative colonoscopy, taking into account that 5 years is the “mean sojourn time.” It is important to prevent the development of interval cancer. The development of interval colon cancer is associated with female sex, old age, family history of CRC, comorbidities, diverticulosis, and the skill of the endoscopist. During carcinogenesis, sessile serrated adenomas/polyps (SSA/Ps) share many genomic and colonic site characteristics with I-CRCs. The clinical and biological features of I-CRC should be elucidated to prevent the development of interval colon cancer.

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Original Articles

Characteristics of Missed Simultaneous Gastric Lesions Based on Double-Check Analysis of the Endoscopic Image: Eun Jeong Gong, Jeong Hoon Lee, Kyoungwon Jung, Charles J. Cho, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2017;50(3):261-269. Published online August 22, 2016; DOI: https://doi.org/10.5946/ce.2016.056

Abstract PDF PubReader ePub

Background
/Aims: The detection of multifocal lesions is important for the successful management of gastric neoplasms. We investigated the characteristics of missed simultaneous lesions and the reason for the missed diagnoses.
Methods
A total of 140 patients who underwent repeat endoscopy before endoscopic resection between June 2013 and June 2014 were retrospectively reviewed. We classified simultaneous lesions into three groups based on a review of earlier images: group 1, no images of the location of simultaneous lesions were taken; group 2, no corresponding lesion was evident in the previous images; and group 3, simultaneous lesions were visible in the earlier images but a biopsy was not performed.
Results
Simultaneous lesions were found in 12 patients (8.6%) with 13 lesions, comprising 10 dysplasia (76.9%) and three adenocarcinoma (23.1%). Regarding the reasons for missed diagnoses, seven lesions (53.8%) were classified as group 3, five (38.5%) as group 1, and the remaining lesion (7.7%) as group 2. There were no significant differences in the characteristics of the patients with and without simultaneous lesions.
Conclusions
Lesions disregarded or unnoticed during endoscopic examination were the main reason for missed diagnosis of simultaneous lesions. Endoscopists should consider the possibility of simultaneous lesions and attempt to meticulously evaluate the entire gastric mucosa.

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Ana Isabel Ferreira, Tiago Lima Capela, Vítor Macedo Silva, Sofia Xavier, Pedro Boal Carvalho, Joana Magalhães, José Cotter
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High Expression of Claudin-4 Is Associated with Synchronous Tumors in Patients with Early Gastric Cancer
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Chang Bong Yang, Sang Hoon Kim, Yun Jeong Lim
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Thomas K.L. Lui, Vivien W.M. Tsui, Wai K. Leung
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Common Locations of Gastric Cancer: Review of Research from the Endoscopic Submucosal Dissection Era
Su Jin Kim, Cheol Woong Choi
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Characteristics of Synchronous and Metachronous Multiple Gastric Tumors after Endoscopic Submucosal Dissection of Early Gastric Neoplasm
Hyun Jik Lee, Yoo Jin Lee, Ju Yup Lee, Eun Soo Kim, Woo Jin Chung, Byoung Kuk Jang, Kyung Sik Park, Jae Seok Hwang, Kwang Bum Cho
Clinical Endoscopy.2018; 51(3): 266. CrossRef
Cost Effectiveness of Gastric Cancer Screening According to Race and Ethnicity
Monica Saumoy, Yecheskel Schneider, Nicole Shen, Michel Kahaleh, Reem Z. Sharaiha, Shailja C. Shah
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Characteristics of Missed Synchronous Gastric Epithelial Neoplasms
Bong Eun Lee
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Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review: Pamela Sarkar, Alice Cole, Neil J. Scolding, Claire M. Rice; Clin Endosc 2017;50(3):270-278. Published online October 13, 2016; DOI: https://doi.org/10.5946/ce.2016.106

Abstract PDF PubReader ePub

Background
/Aims: With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome.
Methods
A retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items “percutaneous endoscopic gastrostomy” and “neurology” or “neurodegenerative disease.”
Results
Short-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin.
Conclusions
This study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.

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Sean Lee, Abheek Ghosh, Aislynn Raymond, Nabeel M. Akhter
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Brittany Marie Zaita, Abheek Ghosh, Sean Lee, Aislynn Raymond, Tanvir Agnihotri, Nabeel M. Akhter
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C. Paynter, S. Mathers, H. Gregory, A. P. Vogel, M. Cruice
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External Validation of the Endoscopic Features of Sessile Serrated Adenomas in Expert and Trainee Colonoscopists: Hyo-Joon Yang, Jeong In Lee, Soo-Kyung Park, Yoon Suk Jung, Jin Hee Sohn, Kyu Yong Choi, Dong Il Park; Clin Endosc 2017;50(3):279-286. Published online September 13, 2016; DOI: https://doi.org/10.5946/ce.2016.107

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: It is unclear whether the endoscopic features of sessile serrated adenomas (SSAs) would be useful to trainee colonoscopists to predict SSA. Therefore, the present study aimed to identify features that expert and trainee colonoscopists can use to independently and reliably predict SSA by using high-resolution white-light endoscopy.
Methods
Endoscopic images of 81 polyps (39 SSAs, 22 hyperplastic polyps, and 20 tubular adenomas) from 43 patients were retrospectively evaluated by 10 colonoscopists (four experts and six trainees). Eight endoscopic features of SSAs were assessed for each polyp.
Results
According to multivariable analysis, a mucous cap (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.72 to 19.07), indistinctive borders (OR, 4.21; 95% CI, 2.74 to 7.16), dark spots (OR, 3.64; 95% CI, 1.89 to 7.00), and cloud-like surface (OR, 2.43; 95% CI, 1.27 to 4.668) were independent predictors of SSAs. Among these, a mucous cap, indistinctive borders, and cloud-like surface showed moderate interobserver agreement (mean κ >0.40) among experts and trainees. When ≥1 of the three predictors was observed, the sensitivity and specificity for diagnosing SSAs were 79.0% and 81.4%, respectively.
Conclusions
Colonoscopy trainees and experts can use several specific endoscopic features to independently and reliably predict SSAs.

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Accuracy and Inter-observer Agreement Among Endoscopists for Visual Identification of Colorectal Polyps Using Endoscopy Images
Thi Khuc, Amol Agarwal, Feng Li, Sergey Kantsevoy, Bryan Curtin, Matilda Hagan, Mary Harris, Anurag Maheshwari, Amit Raina, Elinor Zhou, Paul Thuluvath
Digestive Diseases and Sciences.2023; 68(2): 616. CrossRef
Polyp Fact or Polyp Fiction: Endoscopic Identification of Polyps Using Established Criteria to Improve the Quality of Endoscopic Evaluation and Cost Effectiveness
Ihsan Al Bayati, Sarah Al Obaidi, Mohammed Bashashati
Digestive Diseases and Sciences.2023; 68(2): 344. CrossRef
Risk factors for sessile serrated lesions among Chinese patients undergoing colonoscopy
Ru Zhang, Yunbi Ni, Cosmos LT Guo, Rashid NS Lui, William KK Wu, Joseph JY Sung, Vincent WS Wong, Sunny H Wong
Journal of Gastroenterology and Hepatology.2023; 38(9): 1468. CrossRef
Risk factors of traditional serrated adenoma and clinicopathologic characteristics of synchronous conventional adenoma
Jeongseok Kim, Ji Young Lee, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Ja Eun Koo, Hyo Jeong Lee, Jaewon Choe, Jeong-Sik Byeon
Gastrointestinal Endoscopy.2019; 90(4): 636. CrossRef
Identification of risk factors for sessile and traditional serrated adenomas of the colon by using big data analysis
Jeung Hui Pyo, Sang Yun Ha, Sung Noh Hong, Dong Kyung Chang, Hee Jung Son, Kyoung‐Mee Kim, Hyeseung Kim, Kyunga Kim, Jee Eun Kim, Yoon‐Ho Choi, Young‐Ho Kim
Journal of Gastroenterology and Hepatology.2018; 33(5): 1039. CrossRef
Sessile Serrated Adenoma; the Hard-to-Catch Culprit of Interval Cancer
Suk Pyo Shin
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Proximal Sessile Serrated Adenomas Are More Prevalent in Caucasians, and Gastroenterologists Are Better Than Nongastroenterologists at Their Detection
Malav P. Parikh, Sujit Muthukuru, Yash Jobanputra, Kushal Naha, Niyati M. Gupta, Vaibhav Wadhwa, Rocio Lopez, Prashanthi N. Thota, Madhusudhan R. Sanaka
Gastroenterology Research and Practice.2017; 2017: 1. CrossRef

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Colonic Postpolypectomy Bleeding Is Related to Polyp Size and Heparin Use: Flavia Pigò, Helga Bertani, Mauro Manno, Vincenzo Giorgio Mirante, Angelo Caruso, Santi Mangiafico, Raffaele Manta, Anna Maria Rebecchi, Rita Luisa Conigliaro; Clin Endosc 2017;50(3):287-292. Published online February 9, 2017; DOI: https://doi.org/10.5946/ce.2016.126

Abstract PDF PubReader ePub

Background
/Aims: We studied factors influencing colon postpolypectomy bleeding (PPB), with a focus on antithrombotic and anticoagulation therapy.
Methods
We conducted a retrospective case-control study of all patients who underwent polypectomy at our tertiary referral center in Italy between 2007 and 2014. Polyp characteristics (number of polyps removed per patient, size, morphology, location, resection technique, prophylactic hemostasis methods) and patient characteristics (age, sex, comorbidities, medication) were analyzed.
Results
The case and control groups included 118 and 539 patients, respectively. The two groups differed in the frequency of comorbidities (69% vs. 40%, p=0.001), polyps removed (27% vs. 18%, p=0.02), and use of heparin therapy (23% vs. 1%, p<0.001). A total of 279 polyps in the case group and 966 in the control group were nonpedunculated (69% vs. 81%, p=0.01) and measured ≥10 mm (78% vs. 32%, p=0.001). Multivariate analysis showed that polyps ≥10 mm (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.3–15.5), administration of heparin (OR, 16.5; 95% CI, 6.2–44), comorbidity (OR, 2.3; 95% CI, 1.4–3.9), and presence of ≥2 risk factors (OR, 3.2; 95% CI, 1.7–6.0) were associated with PPB.
Conclusions
The incidence of PPB increases with polyp size ≥10 mm, heparin use, comorbidity, and presence of ≥2 risk factors.

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Risk factors for post-polypectomy bleeding in patients with end-stage renal disease undergoing colonoscopic polypectomy
Jung Hyun Ji, Hyun Woo Kim, Jihye Park, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Jae Jun Park
Surgical Endoscopy.2023;[Epub] CrossRef
Polypectomy for Diminutive and Small Colorectal Polyps
Melissa Zarandi-Nowroozi, Roupen Djinbachian, Daniel von Renteln
Gastrointestinal Endoscopy Clinics of North America.2022; 32(2): 241. CrossRef
Effects of antithrombotic agents on post-operative bleeding after endoscopic resection of gastrointestinal neoplasms and polyps: A systematic review and meta-analysis
Bing-Jie Xiang, Yu-Hong Huang, Min Jiang, Cong Dai
World Journal of Meta-Analysis.2020; 8(5): 410. CrossRef
Effects of antithrombotic agents on post-operative bleeding after endoscopic resection of gastrointestinal neoplasms and polyps: A systematic review and meta-analysis
Bing-Jie Xiang, Yu-Hong Huang, Min Jiang, Cong Dai
World Journal of Meta-Analysis.2020; 8(5): 411. CrossRef
Post-polypectomy Visible Vessel
Matthew Woo, Robert Bechara
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Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type
Isabel Portillo, Isabel Idigoras, Isabel Bilbao, Eunate Arana-Arri, María José Fernández-Landa, Jose Luis Hurtado, Cristina Sarasaqueta, Luis Bujanda
Endoscopy International Open.2018; 06(09): E1149. CrossRef
Prediction and Prevention of Postpolypectomy Bleeding: Necessity of a Different Approach for Patients Using Antithrombotic Agents
Duk Hwan Kim
Clinical Endoscopy.2017; 50(3): 217. CrossRef

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Case Reports

Endoscopic Management of Gastrointestinal Leaks and Perforation with Polyglycolic Acid Sheets: Sojung Han, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee; Clin Endosc 2017;50(3):293-296. Published online March 8, 2017; DOI: https://doi.org/10.5946/ce.2016.121

Abstract PDF PubReader ePub

Gastrointestinal (GI) leakage, fistulae, and perforations can be serious and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. Here, we report two cases of endoscopic closure of a GI fistula and perforation using polyglycolic acid (PGA) sheets with fibrin glue. The first case is of an anastomotic leak detected after subtotal gastrectomy with gastroduodenostomy. After failed application of endoclips, a PGA sheet was applied, and the fistula was successfully closed. The second case was of a 15-mm large perforated gastric ulcer, which was also successfully closed with a PGA sheet. This is the first case report that PGA sheet was used for the treatment of overt perforation. The outcome of these cases suggest that endoscopic closure using PGA sheets can be considered as a useful alternative for the management of GI leakage, fistulae, and perforations.

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A Randomized Controlled Trial of Fibrin Glue to Prevent Bleeding After Gastric Endoscopic Submucosal Dissection
Hyun Deok Lee, Eunwoo Lee, Sang Gyun Kim, Cheol Min Shin, Jun Chul Park, Kee Don Choi, Seokyung Hahn, Soo-Jeong Cho
American Journal of Gastroenterology.2023; 118(5): 892. CrossRef
Large anastomotic leak: endoscopic treatment using combined fibrin glue and polyglycolic acid (PGA) sheets
Soo In Choi, Ji Young Park
BMJ Case Reports.2021; 14(8): e240188. CrossRef
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Masatsugu Hiraki, Toshiya Tanaka, Tadayuki Kanai, Takuya Shimamura, Osamu Ikeda, Makio Yasunaga, Shinichi Ogata, Kenji Kitahara
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Brian Larson, Douglas G. Adler
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Endoscopic closure of an anastomo-cutaneous fistula: Filling and shielding using polyglycolic acid sheets and fibrin glue with easily deliverable technique
Hideaki Kawabata, Yuji Okazaki, Naonori Inoue, Yukino Kawakatsu, Misuzu Hitomi, Masatoshi Miyata, Shigehiro Motoi
Endoscopy International Open.2018; 06(08): E994. CrossRef
Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor
Ko Watanabe, Takuto Hikichi, Jun Nakamura, Minami Hashimoto, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Naoki Konno, Mika Takasumi, Yuki Sato, Hiroki Irie, Takashi Kimura, Akira Kenjo, Shigeru Marubashi, Katsutoshi Obara, Hiromasa Ohira
Case Reports in Gastroenterology.2018; 12(3): 679. CrossRef

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Endoscopic Ultrasound-Guided Perirectal Abscess Drainage without Drainage Catheter: A Case Series: Eun Kwang Choi, Ji Hyun Kim, Seung Uk Jeong, Soo-Young Na, Sun-Jin Boo, Heung Up Kim, Byung-Cheol Song; Clin Endosc 2017;50(3):297-300. Published online April 11, 2017; DOI: https://doi.org/10.5946/ce.2016.123

Abstract PDF PubReader ePub

A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.

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Stephen Hasak, Vladimir Kushnir
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6 Crossref

Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique: Kwangwoo Nam, Jun-Ho Choi; Clin Endosc 2017;50(3):301-304. Published online November 7, 2016; DOI: https://doi.org/10.5946/ce.2016.120

Abstract PDF PubReader ePub: We report the successful conversion of percutaneous cholecystostomy (PC) to endoscopic transpapillary gallbladder stenting (ETGS) with insertion of an antegrade guidewire into the duodenum. An 84-year-old man presented with severe acute cholecystitis and septic shock. He had significant comorbidities, and emergent PC was successfully performed. Subsequent ETGS was attempted but unsuccessful owing to difficulties with cystic duct cannulation. However, via the PC tract, the guidewire was passed antegradely into the duodenum, and ETGS with a double-pigtail plastic stent was successfully performed with the rendezvous technique. The PC tube was removed, and no recurrence was reported during the 17-month follow-up period. Conversion of PC to ETGS is a viable option in patients with acute cholecystitis who are not candidates for surgery. Antegrade guidewire insertion via the PC tract may increase the success rate of conversion and decrease the risk of procedure-related complications.

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Brief Report

Pseudocholangiocarcinoma Sign: Management of Portal Cavernoma Biliopathy with Fully-Covered Self-Expandable Metal Stent: Luís C Lourenço, David V Horta, Catarina G Rodrigues, Jorge Canena, Jorge Reis; Clin Endosc 2017;50(3):305-307. Published online January 26, 2017; DOI: https://doi.org/10.5946/ce.2016.108

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Citations

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Letter to the Editor

Colonoscopy Procedure Time: Does the Learning Environment Matter?: Neel Sharma; Clin Endosc 2017;50(3):308-308. Published online May 31, 2017; DOI: https://doi.org/10.5946/ce.2016.131

Abstract PDF PubReader ePub: Jain and colleagues pushed boundaries in their study by focusing on colonoscopy procedure time and the factors that may influence this [1]. Two of these factors included the level of experience of the endoscopist and the time of day with procedures performed in the afternoon associated with poorer outcomes. As a medical educationalist and gastroenterologist, I want to share scholarship with the academic community regarding current movements allied to the learning environment. Research is now emerging on the learning space in question to enhance competency [2]. Many case studies have indicated the value added in ensuring that the learning environment promotes appropriate engagement between learners and mentors, with workspaces that are technology specific to learning complimented with flipped learning approaches, team-based interactions, debriefing rooms, inter-professional discussions, writing spaces, and so on. This also has implications on the physical construct, with alterations in seating design to ensure this is optimized. The learning environment is a novel element to competency and, from a gastroenterologist’s perspective, is an often-overlooked facet. Research on the endoscopy center environment and its physicality may have relevance in endoscopy procedure performance and efficiency. Further work is needed in this regard.

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