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Volume 46(5); September 2013
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Special Issue Articles of IDEN 2013
Highlights of International Digestive Endoscopy Network 2013
Kwang An Kwon, Il Ju Choi, Eun Young Kim, Seok Ho Dong, Ki Baik Hahm
Clin Endosc 2013;46(5):425-435.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.425
AbstractAbstract PDFPubReaderePub

Rapid advances in the technology of gastrointestinal endoscopy as well as the evolution of science have made it necessary for us to continue update in either various endoscopic techniques or state of art lectures relevant to endoscopy. International Digestive Endoscopy Network (IDEN) 2013 was held in conjunction with Korea-Japan Joint Symposium on Gastrointestinal Endoscopy (KJSGE) during June 8 to 9, 2013 at Seoul, Korea. Two days of impressive scientific program dealt with a wide variety of basic concerns from upper gastrointestine (GI), lower GI, pancreaticobiliary endoscopy to advanced knowledge including endoscopic submucosal dissection forum. IDEN seems to be an excellent opportunity to exchange advanced information of the latest issues on endoscopy with experts from around the world. In this special issue of Clinical Endoscopy, we prepared state of art review articles from contributing authors and the current highlights will skillfully deal with very hot spots of each KJSGE, upper GI, lower GI, and pancreaticobiliary sessions by associated editors of Clinical Endoscopy.

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Tissue Acquisition in Gastric Epithelial Tumor Prior to Endoscopic Resection
Chan Gyoo Kim
Clin Endosc 2013;46(5):436-440.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.436
AbstractAbstract PDFPubReaderePub

Endoscopic forceps biopsy is essential before planning an endoscopic resection of upper gastrointestinal epithelial tumors. However, forceps biopsy is limited by its superficiality and frequency of sampling errors. Histologic discrepancies between endoscopic forceps biopsies and resected specimens are frequent. Factors associated with such histologic discrepancies are tumor size, macroscopic type, surface color, and the type of medical facility. Precise targeting of biopsies is recommended to achieve an accurate diagnosis, curative endoscopic resection, and a satisfactory oncologic outcome. Multiple deep forceps biopsies can induce mucosal ulceration in early gastric cancer. Endoscopic resection for early gastric cancer with ulcerative findings is associated with piecemeal resection, incomplete resection, and a risk for procedure-related complications such as bleeding and perforation. Such active ulcers caused by forceps biopsy and following submucosal fibrosis might also be mistaken as an indication for more aggressive procedures, such as gastrectomy with D2 lymph node dissection. Proton pump inhibitors might be prescribed to facilitate the healing of biopsy-induced ulcers if an active ulcer is predicted after deep biopsy. It is unknown which time interval from biopsy to endoscopic resection is appropriate for a safe procedure and a good oncologic outcome. Further investigations are needed to conclude the appropriate time interval.

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    Jung Ho Kim
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Endoscopic Ultrasound-Fine Needle Aspiration versus Core Biopsy for the Diagnosis of Subepithelial Tumors
Kevin Webb, Joo Ha Hwang
Clin Endosc 2013;46(5):441-444.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.441
AbstractAbstract PDFPubReaderePub

Subepithelial lesions are frequently encountered and remain a diagnostic challenge. Imaging of subepithelial lesions using endoscopic ultrasound (EUS) can be helpful in narrowing the differential diagnosis of the lesion; however, definitive diagnosis typically requires tissue. Many methods for acquiring tissue exist including EUS-guided fine needle aspiration, Trucut biopsy, and fine needle biopsy. Obtaining adequate tissue is important for cytologic and histologic exams including immunohistochemical stains, thus a great deal of effort has been made to increase tissue acquisition in order to improve diagnostic yield in subepithelial lesions.

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    Journal of Digestive Cancer Research.2022; 10(1): 16.     CrossRef
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    Woo Hyun Paik, Dong Wan Seo
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  • Via mucosa incision EUS-guided sampling for the diagnosis of conventional endoscopic biopsy-negative gastric wall thickening
    Hongbo Shan, Xiaoyan Gao, Guangyu Luo, Jieqing Xiang, Bilv Zhong, Xiaofang Qiu, Shiyong Lin, Shuhong Li, Yin Li, Guoliang Xu, Rong Zhang
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    Eun Young Kim
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    Eun Young Kim
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  • 8 Crossref
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Confocal Microscopy in the Esophagus and Stomach
Adam Templeton, Joo Ha Hwang
Clin Endosc 2013;46(5):445-449.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.445
AbstractAbstract PDFPubReaderePub

Probe-based confocal microscopy (pCLE) is actively being investigated for applications in the esophagus and stomach. The use of pCLE allows real-time in vivo microscopy to evaluate the microarchitecture of the mucosal epithelium. pCLE appears to be particularly useful in identifying mucosal dysplasia and early malignancies that cannot be clearly distinguished using high-definition white light endoscopy, chromoendoscopy, or magnification endoscopy. In addition, the ability to detect dysplastic tissue in real-time may shift the current screening practice from random biopsy to targeted biopsy of esophageal and gastric cancers and their precursor lesions. We will review the use of pCLE for detection and surveillance of upper gastrointestinal early luminal malignancy.

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Endoscopic Treatment for Early Foregut Neuroendocrine Tumors
Moo In Park
Clin Endosc 2013;46(5):450-455.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.450
AbstractAbstract PDFPubReaderePub

Foregut neuroendocrine tumors (NETs) include those arising in the esophagus, stomach, pancreas, and duodenum and seem to have a broad range of clinical behavior from benign to metastatic. Several factors including the advent of screening endoscopy may be related to increased incidence of gastrointestinal NETs; thus, many foregut NETs are diagnosed at an early stage. Early foregut NETs, such as those of the stomach and duodenum, can be managed with endoscopic treatment because of a low frequency of lymph node and distant metastases. However, controversy continues concerning the optimal management of early foregut NETs due to a lack of controlled prospective studies. Several issues such as indications, technical issues, and outcomes of endoscopic treatment for early foregut NETs are reviewed based on some published studies.

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Preventing and Controlling Bleeding in Gastric Endoscopic Submucosal Dissection
Chan Hyuk Park, Sang Kil Lee
Clin Endosc 2013;46(5):456-462.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.456
AbstractAbstract PDFPubReaderePub

Although techniques and instruments for endoscopic submucosal dissection (ESD) have improved, bleeding is still the most common complication. Minimizing the occurrence of bleeding is important because blood can interfere with subsequent procedures. Generally, ESD-related bleeding can be divided into intraprocedural and postprocedural bleedings. Postprocedural bleeding can be further classified into early post-ESD bleeding which occurs within 48 hours after ESD and late post-ESD bleeding which occurs later than 48 hours after ESD. A basic principle for avoiding intraprocedural bleeding is to watch for vessels and coagulate them before cutting. Several countertraction devices have been designed to minimize intraprocedural bleeding. Methods for reducing postprocedural bleeding include administration of proton-pump inhibitors or prophylactic coagulation after ESD. Medical adhesive spray such as n-butyl-2-cyanoacrylate is also an option for preventing postprocedural bleeding. Various endoscopic treatment modalities are used for both intraprocedural and postprocedural bleeding. However, hemoclipping is infrequently used during ESD because the clips interfere with subsequent resection. Bleeding that occurs as a result of ESD can usually be managed easily. Nonetheless, more effective ways to prevent bleeding, including reliable ESD techniques, must be developed.

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    Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong
    Clinical Endoscopy.2020; 53(2): 142.     CrossRef
  • Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer
    Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong
    The Korean Journal of Gastroenterology.2020; 75(5): 264.     CrossRef
  • Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer
    Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2020; 20(2): 117.     CrossRef
  • Comparative efficacy of various anti-ulcer medications after gastric endoscopic submucosal dissection: a systematic review and network meta-analysis
    Eun Hye Kim, Se Woo Park, Eunwoo Nam, Jae Gon Lee, Chan Hyuk Park
    Surgical Endoscopy.2019; 33(4): 1271.     CrossRef
  • Haemostasis and prevention of bleeding related to ER: The role of a novel self‐assembling peptide
    Sharmila Subramaniam, Kesavan Kandiah, Sreedhari Thayalasekaran, Gaius Longcroft-Wheaton, Pradeep Bhandari
    United European Gastroenterology Journal.2019; 7(1): 155.     CrossRef
  • Management of antithrombotic agents and current issues in patients undergoing endoscopic submucosal dissection
    Chan Hyuk Park
    International Journal of Gastrointestinal Intervention.2019; 8(3): 116.     CrossRef
  • Safety and effectiveness of endoscopic mucosal resection or endoscopic submucosal dissection for gastric neoplasia within 2 days’ hospital stay
    Joon Young Choi, Young Soo Park, Gyeongjae Na, Sung Jae Park, Hyuk Yoon, Cheol Min Shin, Nayoung Kim, Dong Ho Lee
    Medicine.2019; 98(32): e16578.     CrossRef
  • Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding
    Minho Park, Jong Woo Kim, Ji Hoon Shin
    International Journal of Gastrointestinal Intervention.2019; 8(3): 134.     CrossRef
  • Role of second‐look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: A systematic review and meta‐analysis
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  • Oral esomeprazole vs injectable omeprazole for the prevention of hemorrhage after endoscopic submucosal dissection
    Takashi Uchiyama, Takuma Higurashi, Hitoshi Kuriyama, Yoshinobu Kondo, Yasuo Hata, Atsushi Nakajima
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    Jung Ho Bae, Gwang Ha Kim, Bong Eun Lee, Tae Kyun Kim, Do Youn Park, Dong Hoon Baek, Geun Am Song
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    Osamu Komatsu, Tomohito Matsushita, Kyo Kishimoto, Wataru Adachi
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Long-Term Outcome of Extended Endoscopic Submucosal Dissection for Early Gastric Cancer with Differentiated Histology
Ji Yong Ahn, Hwoon-Yong Jung
Clin Endosc 2013;46(5):463-466.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.463
AbstractAbstract PDFPubReaderePub

Endoscopic mucosal resection was introduced in the 1990s, and endoscopic submucosal dissection (ESD) in 2003. Currently, ESD is becoming the main procedure for the resection of early gastric cancer (EGC) and is leading to the development of extended indications for endoscopic resection. Many reports showed that the endoscopic and oncologic outcome of endoscopic treatment in the extended indication group was acceptable in terms of curability and safety. Especially, ESD showed better results to remove extended indication EGCs with relatively high resection rate and low local recurrence rate. However, more long-term follow-up data are needed for clinical application of the extended criteria of ESD due to the risk of lymph node metastasis. We should also keep in mind that accurate diagnosis, characterization of the lesion, and proper appreciation of technical aspects are most essential in therapeutic endoscopy.

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Debates on Colorectal Endoscopic Submucosal Dissection - Traction for Effective Dissection: Gravity Is Enough
Bo-In Lee
Clin Endosc 2013;46(5):467-471.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.467
AbstractAbstract PDFPubReaderePub

Colorectal endoscopic submucosal dissection (ESD) still remains a technically difficult procedure. The maintenance of tissue tension and good submucosal exposure during dissection is one of the most important factors for an effective and safe dissection. Although various traction methods have been developed, traction by gravity is one of the most useful method for colorectal ESD. Traction using adjunctive devices can thus be reserved for extremely difficult cases or for endoscopists in their learning periods for colorectal ESD.

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Endoscopic Management of Refractory Benign Colorectal Strictures
Yong Hwan Kwon, Seong Woo Jeon, Yong Kook Lee
Clin Endosc 2013;46(5):472-475.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.472
AbstractAbstract PDFPubReaderePub

In colonoscopic study, benign colorectal strictures with or without symptomatic pain are not rarely encountered. Benign colorectal stricture can be caused by a number of problems, such as anastomotic stricture after surgery, inflammatory bowel disease, postendoscopic submucosal dissection, diverticular disease, ischemic colitis, and so on. There are various modalities for the management of benign colorectal stricture. Endoscopic balloon dilatation is generally considered as the primary treatment for benign colorectal stricture. In refractory benign colorectal strictures, several treatment sessions of balloon dilatation are needed for successful dilatation. The self-expandable metal stent and many combined techniques are performed at present. However, there is no specific algorithmic modality for refractory benign colorectal strictures.

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Lower Gastrointestinal Bleeding: Is Urgent Colonoscopy Necessary for All Hematochezia?
Byung Ik Jang
Clin Endosc 2013;46(5):476-479.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.476
AbstractAbstract PDFPubReaderePub

Lower gastrointestinal bleeding (LGIB) is defined as acute or chronic abnormal blood loss distal to the ligament of Treitz. The incidence of LGIB is only one fifth of that of the upper gastrointestinal tract and is estimated to be 21 to 27 cases per 100,000 adults per year. Acute bleeding is arbitrarily defined as bleeding of <3 days' duration resulting in instability of vital signs, anemia, and/or need for blood transfusion. Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult fecal blood, intermittent melena, or scant hematochezia. Bleeding means that the amounts of blood in the feces are too small to be seen but detectable by chemical tests. LGIB is usually chronic and stops spontaneously. Bleeding stop (80%), but male gender and older patients suffer from more severe LGIB. The optimal timing of colonoscopic intervention for LGIB remains uncertain. Urgent colonoscopy may serve to decrease hospital stay. However, urgent colonoscopy is difficult to control, and showed no evidence of improving clinical outcomes or lowering costs as compared with routine elective colonoscopy.

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    Е.А. ДЖУСИПБЕКОВ, Д.У. СМАГУЛОВА, Г.Т. СУЛТАНКУЛОВА, Д.Ж. КУАТБЕКОВ
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Deep Enteroscopy: Which Technique Will Survive?
Seong Ran Jeon, Jin-Oh Kim
Clin Endosc 2013;46(5):480-485.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.480
AbstractAbstract PDFPubReaderePub

The advent of deep enteroscopy (DE) has dramatically changed diagnostic and therapeutic approaches to small bowel diseases. Unlike capsule endoscopy, which is unable to obtain biopsies or treat a disease, DE techniques have diagnostic and therapeutic capabilities. Double-balloon enteroscopy (DBE) was introduced in 2001, and single-balloon enteroscopy (SBE) and spiral enteroscopy (SE) were subsequently developed for small bowel investigation. In published reports comparing these different enteroscopy techniques, most comparative parameters (depth of insertion, complications, learning curve, diagnostic yield, and therapeutic yield) were comparable among DBE, SBE, and SE. However, the procedure duration appears to be shorter for SE than for DBE and SBE. The rate of complete enteroscopy is clearly superior for DBE, compared with SE and SBE. Because these results do not indicate an increase in diagnostic or therapeutic yield, the clinical impact of complete enteroscopy remains controversial. According to previous studies, the three DE methods seem to be equally effective and safe in the clinical setting. Although larger randomized controlled trials are needed to evaluate the procedural characteristics and clinical impact, the selection of an enteroscopic technique should be based on availability and the endoscopist's experience.

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Refractory Gastrointestinal Bleeding: Role of Angiographic Intervention
Ji Hoon Shin
Clin Endosc 2013;46(5):486-491.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.486
AbstractAbstract PDFPubReaderePub

Although endoscopic hemostasis remains initial treatment modality for nonvariceal gastrointestinal (GI) bleeding, severe bleeding despite endoscopic management occurs in 5% to 10% of the patients, requiring surgery or transcatheter arterial embolization (TAE). TAE is now considered the first-line therapy for massive GI bleeding refractory to endoscopic management. GI endoscopists need to be familiar with indications, principles, outcomes, and complications of TAE, as well as embolic materials available.

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Tips and Tricks for Better Endoscopic Treatment of Colorectal Tumors: Usefulness of Cap and Band in Colorectal Endoscopic Mucosal Resection
Seun Ja Park
Clin Endosc 2013;46(5):492-494.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.492
AbstractAbstract PDFPubReaderePub

Endoscopic mucosal resection (EMR) is an endoscopic alternative to surgical resection of mucosal and submucosal neoplastic lesions. Prior to the development of knives, EMR could be performed with accessories to elevate the lesion. After the development of various knives, en bloc resection was possible without other accessories. So, recently, simple snaring without suction or endoscopic submucosal dissection using knife in the epithelial lesions such as adenoma or early mucosal cancer has been performed. However, for easy and complete resection of subepithelial lesions such as carcinoid tumor, a few accessories are needed. Complete resection of rectal carcinoid tumors is difficult to achieve with conventional endoscopic resection techniques because these tumors often extend into the submucosa. The rate of positive resection margin for tumor is lower in the group of EMR using a cap (EMR-C) or EMR with a ligation device (EMR-L) than conventional EMR group. EMR-C and EMR-L (or endoscopic submucosal resection with a ligation device) may be a superior method to conventional EMR for removing small rectal carcinoid tumors.

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Colonic Perforation: Can We Manage It Endoscopically?
Jeong-Sik Byeon
Clin Endosc 2013;46(5):495-499.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.495
AbstractAbstract PDFPubReaderePub

Colonic perforation occurs in a variety of clinical scenarios and colonoscopy-associated perforation is one of the important reasons for colonic perforation. Colonoscopy-associated perforation may be diagnosed during colonoscopy procedure by the visualization of evident colonic wall defect or, after the completion of colonoscopy, by the visualization of leaked air in the peritoneal or retroperitoneal space. Recently, the incidence of colonoscopy-associated perforation increased because of the introduction of colorectal endoscopic submucosal dissection. Traditionally, colonoscopy-associated perforation was managed surgically. However, medical management has been introduced widely and endoscopic clipping is the most important component for the medical management of colonoscopy-associated perforation. Timely administration of antibiotics is also important. Large perforations, diagnostic colonoscopy-associated perforations, large amount of pneumoperitoneum, and severe abdominal pain have been reported to be predictive of the necessity of surgery after endoscopic clipping. Surgery should be performed if patients show clinical deterioration even after the initiation of medical management.

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    Tülay DİKEN ALLAHVERDİ, Yusuf GÜNERHAN
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Metal versus Plastic Stent for Transmural Drainage of Pancreatic Fluid Collections
Ji Young Bang, Shyam Varadarajulu
Clin Endosc 2013;46(5):500-502.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.500
AbstractAbstract PDFPubReaderePub

The conventional management of pancreatic fluid collections (PFCs) involves surgery or percutaneous drainage. While surgery is associated with significant complications and mortality, percutaneous drainage is associated with prolonged hospitalization and oftentimes the need for other adjunctive treatment measures. Therefore, the use of endoscopy to drain PFCs is becoming increasingly popular. Randomized trials have demonstrated that endoscopic ultrasound-guided drainage is superior to conventional endoscopy in terms of technical success and potentially decreases the rates of procedural complications. While transmural drainage is usually undertaken by deployment of plastic endoprosthesis, of late, fully covered self-expandable metal stents are being placed with increasing frequency. However, the benefits of this approach are unclear and require further validation in prospective trials.

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Procore and Flexible 19 Gauge Needle Can Replace Trucut Biopsy Needle?
Ji Young Bang, Shyam Varadarajulu
Clin Endosc 2013;46(5):503-505.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.503
AbstractAbstract PDFPubReaderePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is routinely performed for establishing tissue diagnosis in patients with gastrointestinal tumors. The concept of delivering chemotherapy based on molecular markers and the ability to establish a reliable diagnosis in lieu of an onsite cytopathologist has fuelled the recent trend in procuring core tissue by means of EUS-guided fine needle biopsy. To overcome the technical limitations induced by the rigidity of the Trucut biopsy needle, a new ProCore needle with reverse bevel technology has been developed. Recent data suggests that the newly developed flexible 19 gauge needle can also procure core tissue and has easy maneuverability when navigating the transduodenal route. Irrespective of the needles being used, the best clinical outcomes can be attained only by practicing evidence-based techniques, procuring adequate quantity of sample for ancillary studies, and processing the specimens appropriately.

Citations

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    Eun Young Kim
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Pancreatic Fluid Collection Drainage by Endoscopic Ultrasound: An Update
Shashideep Singhal, Stephen R. Rotman, Monica Gaidhane, Michel Kahaleh
Clin Endosc 2013;46(5):506-514.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.506
AbstractAbstract PDFPubReaderePub

Endoscopic management of symptomatic pancreatic fluid collections (PFCs) is now considered to be first line therapy. Expanded use of endoscopic ultrasound (EUS) techniques has resulted in increased applicability, safety, and efficacy of endoscopic transluminal PFC drainage. Steps include EUS-guided trangastric or transduodenal fistula creation into the PFC followed by stent placement or nasocystic drain deployment in order to decompress the collection. With the remarkable improvement in the available accessories and stents and development of exchange free access device; EUS drainage techniques have become simpler and less time consuming. The use of self-expandable metal stents with modifications to drain PFC has helped in overcoming some previously encountered challenges. PFCs considered suitable for endoscopic drainage include collection present for greater than 4 weeks, possessing a well-formed wall, position accessible endoscopically and located within 1 cm of the duodenal or gastric walls. Indications for EUS-guided drainage have been increasing which include unusual location of the collection, small window of entry, nonbulging collections, coagulopathy, intervening varices, failed conventional transmural drainage, indeterminate adherence of PFC to the luminal wall or suspicion of malignancy. In this article, we present a review of literature to date and discuss the recent developments in EUS-guided PFC drainage.

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Functional Self-Expandable Metal Stents in Biliary Obstruction
Chang-Il Kwon, Kwang Hyun Ko, Ki Baik Hahm, Dae Hwan Kang
Clin Endosc 2013;46(5):515-521.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.515
AbstractAbstract PDFPubReaderePub

Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each stent type for benign biliary stricture and describes newly introduced FSEMSs according to their functional categories.

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Endoscopic Treatments of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations
Tae Hoon Lee, Joung-Ho Han, Sang-Heum Park
Clin Endosc 2013;46(5):522-528.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.522
AbstractAbstract PDFPubReaderePub

Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.

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Percutaneous Transhepatic Cholangioscopy: Does Its Role Still Exist?
Joon Hyuk Choi, Sung Koo Lee
Clin Endosc 2013;46(5):529-536.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.529
AbstractAbstract PDFPubReaderePub

Percutaneous transhepatic cholangioscopy (PTCS) is the most widely used modality for diagnosis and treatment of biliary disease. Although many other novel technologies have been developed based on recent advances in endoscopy, PTCS has its own role. In diagnostics, PTCS is used for evaluation of indeterminate biliary strictures, bile duct tumors, and postoperative biliary strictures that cannot be reached by a peroral approach. In therapeutics, the removal of bile duct stones, dilatation of bile duct strictures including postoperative anastomosis site strictures, and local tumor therapy are indications of PTCS. Especially in a therapeutic role, PTCS has the advantage of maneuverability due to a shorter endoscopic length compared to other cholangioscopic modalities. Hence, PTCS has its own indispensable diagnostic and therapeutic roles.

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The Role of Direct Peroral Cholangioscopy Using an Ultraslim Endoscope for Biliary Lesions: Indications, Limitations, and Complications
Jong Ho Moon, Hyun Jong Choi
Clin Endosc 2013;46(5):537-539.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.537
AbstractAbstract PDFPubReaderePub

Advantages of direct peroral cholangioscopy (POC) using an ultraslim endoscope include use of conventional endoscopy equipment, operation by a single endoscopist, and superior image quality of the biliary tree with easy application of enhanced endoscopy and a large working channel. The major diagnostic indications of this system are an evaluation of biliary strictures, filling defects, or unclear findings on cholangiogram or other imaging studies. Therapeutic application using a direct POC system can be broadened by a larger working channel. However, direct POC is difficult to apply in patients with a narrow diameter bile duct, far distal common bile duct lesion, or failed anchoring of the scope with accessories. An air embolism is a rare complication of direct POC but can be a fatal problem. Cholangitis can also occur during or after the procedure. Use of a CO2 system instead of room air during the POC procedure and administration of antibiotics before and after the procedure are strongly recommended. Continuous development of specialized endoscopes and accessories is expected to facilitate the diagnostic and therapeutic roles of direct POC.

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Role of Repeated Endoscopic Ultrasound-Guided Fine Needle Aspiration for Inconclusive Initial Cytology Result
Eun Young Kim
Clin Endosc 2013;46(5):540-542.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.540
AbstractAbstract PDFPubReaderePub

For tissue diagnosis of suspected pancreatic cancer, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the procedure of choice with high safety and accuracy profiles. However, about 10% of cytologic findings of EUS-FNA are inconclusive. In that situation, careful observation, surgical exploration, or alternative diagnostic tools such as bile duct brushing with endoscopic retrograde cholangiopancreatography or computed tomography-guided biopsy can be considered. However, some concerns and/or risks of these options render repeat EUS-FNA a reasonable choice. Repeated EUS-FNA may impose substantial clinical impact with low risk.

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  • 4 Crossref
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Endoscopic Guided Biliary Drainage: How Can We Achieve Efficient Biliary Drainage?
Prashant Kedia, Monica Gaidhane, Michel Kahaleh
Clin Endosc 2013;46(5):543-551.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.543
AbstractAbstract PDFPubReaderePub

Currently, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary drainage for various pancreatico-biliary disorders. ERCP is successful in 90% of the cases, but is unsuccessful in cases with altered anatomy or with tumors obstructing access to the duodenum. Due to the morbidity and mortality associated with surgical or percutaneous approaches in unsuccessful ERCP cases, biliary endoscopists have been using endoscopic ultrasound-guided biliary drainage (EUS-BD) more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that incorporates various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS-BD techniques. Indications for EUS-BD include failed conventional ERCP, altered anatomy, tumor preventing access into the biliary tree and contraindication to percutaneous access (i.e., ascites, etc.). EUS-BD utilizing EUS-guided rendezvous technique is conducted by creating a tract from either the stomach or the duodenum into the bile duct. Although EUS-BD has rapidly been gaining attraction and popularity in the endoscopic world, the indications and methods have yet to be standardized. There are several access routes and techniques that are employed by advanced endoscopists throughout the world for BD. This article reviews the indications and currently practiced EUS-BD techniques, including indications, technical details (intrahepatic or extrahepatic approach), equipment, patient selection, complications, and overall advantages and limitations.

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Technical Advances in Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition for Pancreatic Cancers: How Can We Get the Best Results with EUS-Guided Fine Needle Aspiration?
Prashant Kedia, Monica Gaidhane, Michel Kahaleh
Clin Endosc 2013;46(5):552-562.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.552
AbstractAbstract PDFPubReaderePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.

Citations

Citations to this article as recorded by  
  • The role of endoscopic ultrasound-guided fine-needle aspiration/biopsy in the diagnosis of mediastinal lesions
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  • 9,583 View
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Case Reports
Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography
Su Jin Kim, Hyung Wook Kim, Choel Woong Choi, Jong Kun Ha, Young Mi Hong, Jin Hyun Park, Soo Bum Park, Dae Hwan Kang
Clin Endosc 2013;46(5):563-567.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.563
AbstractAbstract PDFPubReaderePub

Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.

Citations

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  • Synchronous duodenal mucosa-associated lymphoid tissue lymphoma and gastric cancer
    Keiichiro Yokota, Tsutomu Namikawa, Masahiro Maeda, Nobuhisa Tanioka, Jun Iwabu, Sunao Uemura, Masaya Munekage, Hiromichi Maeda, Hiroyuki Kitagawa, Michiya Kobayashi, Kazuhiro Hanazaki
    Clinical Journal of Gastroenterology.2021; 14(1): 109.     CrossRef
  • Early, Isolated Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma Presenting without Symptoms or Grossly Apparent Endoscopic Lesions and Diagnosed by Random Duodenal Biopsies
    Mihajlo Gjeorgjievski, Issa Makki, Pradeep Khanal, Mitual B. Amin, Ann Marie Blenc, Tusar Desai, Mitchell S. Cappell
    Case Reports in Gastroenterology.2016; 10(2): 323.     CrossRef
  • 7,797 View
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A Case of Gastric Inverted Hyperplastic Polyp Found with Gastritis Cystica Profunda and Early Gastric Cancer
Sang Jin Lee, Jong Kyu Park, Hyun Il Seo, Koon Hee Han, Young Don Kim, Woo Jin Jeong, Gab Jin Cheon, Dae-Woon Eom
Clin Endosc 2013;46(5):568-571.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.568
AbstractAbstract PDFPubReaderePub

A gastric inverted hyperplastic polyp is a rare type of gastric polyp and is characterized by downward growth of a variety of mucosal components into the submucosa. The polyp consists of columnar cells resembling foveolar epithelium and pyloric gland epithelium and can coexist with gastritis cystica profunda. Frequently, adenocarcinoma can coexist, but the relation is not clear. A 77-year-old male underwent endoscopic submucosal dissection due to early gastric cancer. A gastric inverted hyperplastic polyp was found in the removed specimen and gastric cystica profunda was also found. We report a case of gastric inverted hyperplastic polyp coexisting with gastric cystica profunda and gastric adenocarcinoma.

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  • A gastric inverted polyp with atypical hyperplasia
    Yanyang Zou, Yusheng Tian
    Asian Journal of Surgery.2024; 47(3): 1686.     CrossRef
  • Clinicopathologic and endoscopic characteristics of ten patients with gastric hamartomatous inverted polyp: a single center case series
    Ningning Dong, Fandong Meng, Bing Yue, Junzhen Hou
    BMC Gastroenterology.2024;[Epub]     CrossRef
  • Gastric hamartomatous inverted polyp: Report of three cases with a review of the endoscopic and clinicopathological features
    Takuya Ohtsu, Yu Takahashi, Mitsuo Tokuhara, Tomomitsu Tahara, Mitsuaki Ishida, Chika Miyasaka, Koji Tsuta, Makoto Naganuma
    DEN Open.2023;[Epub]     CrossRef
  • Gastric Inverted Hyperplastic Polyp Removed Using Endoscopic Submucosal Dissection
    Jee Won Boo, Joon Sung Kim, Byung-Wook Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(1): 63.     CrossRef
  • Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) by endoscopic submucosal dissection: A case report
    Yi-Ping Han, Cong-Cong Min, Yu-Bei Li, Yun-Qing Chen, Hua Liu, Zi-Bin Tian, Xiao-Yan Yin
    Medicine.2023; 102(13): e33443.     CrossRef
  • Gastritis Cystica Profunda: A Rare Disease, a Challenging Diagnosis, and an Uncertain Malignant Potential: A Case Report and Review of the Literature
    Francesca De Stefano, Giorgio M. P. Graziano, Jacopo Viganò, Aurelio Mauro, Andrea Peloso, Jacopo Peverada, Raffaele Fellegara, Alessandro Vanoli, Giuseppe G. Faillace, Luca Ansaloni
    Medicina.2023; 59(10): 1770.     CrossRef
  • Large gastric hamartomatous inverted polyp accompanied by advanced gastric cancer: A case report
    Gyerim Park, Jihye Kim, Sung Hak Lee, Younghoon Kim
    World Journal of Clinical Cases.2023; 11(28): 6967.     CrossRef
  • Coexistence of early gastric cancer and benign submucosal lesions mimic invasive cancer: a retrospective multicenter experience
    Huawei Yang, Zhen Li, Zhi Wei, Guodong Li, Yi Li, Shanbin Wu, Rui Ji
    BMC Gastroenterology.2023;[Epub]     CrossRef
  • Activating KRAS and GNAS mutations in heterotopic submucosal glands of the stomach
    Hourin Cho, Taiki Hashimoto, Tomoaki Naka, Yasushi Yatabe, Ichiro Oda, Yutaka Saito, Takaki Yoshikawa, Shigeki Sekine
    Journal of Gastroenterology.2022; 57(5): 333.     CrossRef
  • A retrospective analysis of 13 cases of gastritis cystica profunda treated by endoscopic resection and surgery
    Ya Nan Yu, Xiao Wei Wang, Yun Qing Chen, Zheng Cui, Zi Bin Tian, Qing Xi Zhao, Tao Mao, Man Xie, Xiao Yan Yin
    Journal of Digestive Diseases.2022; 23(3): 186.     CrossRef
  • Gastric Inverted Polyps—Distinctive Subepithelial Lesions of the Stomach
    Ji-Ye Kim, Soomin Ahn, Kyoung-Mee Kim, Sun Hee Chang, Han Seong Kim, Jun Haeng Lee, Jae J. Kim, Tae Sung Sohn, Hye Ju Kang, Mee Joo
    American Journal of Surgical Pathology.2021; 45(5): 680.     CrossRef
  • Bile reflux gastritis cystica profunda
    Shenghe Deng, Yinghao Cao, Liming Shen, Jiliang Wang, Kaixiong Tao, Guobin Wang, Jiang Li, Kailin Cai
    Medicine.2019; 98(17): e15295.     CrossRef
  • Synchronous double superficial mixed gastrointestinal mucus phenotype gastric cancer with gastritis cystica profunda and submucosal lipoma
    Dandan Huang, Qiang Zhan, Shudong Yang, Qi Sun, Zhiyi Zhou
    Medicine.2018; 97(22): e10825.     CrossRef
  • Inverted Hyperplastic Polyp in Stomach: A Case Report and Literature Review
    Yeon Ho Lee, Moon Kyung Joo, Beom Jae Lee, Ji-Ae Lee, Taehyun Kim, Jin Gu Yoon, Jung Min Lee, Jong-Jae Park
    The Korean Journal of Gastroenterology.2016; 67(2): 98.     CrossRef
  • Inflammatory myofibroblastic tumor‐like stromal proliferation within gastric inverted hyperplastic polyp
    Byeong‐Joo Noh, Ji Won Min, Ji‐Youn Sung, Yong‐Koo Park, Juhie Lee, Youn Wha Kim
    Pathology International.2016; 66(3): 180.     CrossRef
  • Gastric inverted hyperplastic polyp: A rare cause of iron deficiency anemia
    Jin Tak Yun, Seung Woo Lee, Dong Pil Kim, Seung Hwa Choi, Seok-Hwan Kim, Jun Kyu Park, Sun Hee Jang, Yun Jung Park, Ye Gyu Sung, Hae Jung Sul
    World Journal of Gastroenterology.2016; 22(15): 4066.     CrossRef
  • Gastric Inverted Hyperplasic Polyp Composed Only of Pyloric Glands
    Minsun Jung, Kyueng-Whan Min, Young-Joon Ryu
    International Journal of Surgical Pathology.2015; 23(4): 313.     CrossRef
  • Gastritis cystica profunda in a previously unoperated stomach: A case report
    Xiong-Fei Yu
    World Journal of Gastroenterology.2015; 21(12): 3759.     CrossRef
  • A Gastric Hamartomatous Inverted Polyp Preoperatively Diagnosed as a Mesenchymal Tumor Treated by Laparoscopic Wedge Resection
    Taro Isobe, Jun Akiba, Kousuke Hashimoto, Junya Kizaki, Satoru Matono, Tetsushi Kinugasa, Keishiro Aoyagi, Hirohisa Yano, Yoshito Akagi
    The Japanese Journal of Gastroenterological Surgery.2015; 48(3): 201.     CrossRef
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Gastrointestinal Cancers in a Peutz-Jeghers Syndrome Family: A Case Report
Sang Hee Song, Kun Woo Kim, Won Hee Kim, Chang Il Kwon, Kwang Hyun Ko, Ki Baik Hahm, Pil Won Park, Sung Pyo Hong
Clin Endosc 2013;46(5):572-575.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.572
AbstractAbstract PDFPubReaderePub

A 17-year-old man was diagnosed as Peutz-Jeghers syndrome (PJS) because of pigmented lip and multiple gastrointestinal polyps. He had anemia and underwent polypectomy on the duodenum and colon. His maternal family members were patients with PJS. His mother used to be screened with endoscopy to remove large polyps. One and half years later, he underwent jejunal segmental resection due to intussusceptions. He underwent endoscopic polypectomy every 2 to 3 years. When he was 23 years old, high-grade dysplasia was found in colonic polyp and his mother underwent partial pancreatectomy due to intraductal papillary mucinous carcinoma. When he was 27 years old, diffuse gastric polyps on the greater curvature of corpus expanded and grew. Therefore, wide endoscopic polypectomy was done. Histological examination revealed focal intramucosal carcinoma and low-grade dysplasia in hamartomatous polyps. We report cases of cancers occurred in first-degree relatives with PJS.

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  • Familial and hereditary gastric cancer, an overview
    Fátima Carneiro
    Best Practice & Research Clinical Gastroenterology.2022; 58-59: 101800.     CrossRef
  • Small bowel intussusception and concurrent sigmoid polyp with malignant transformation in Peutz–Jeghers syndrome
    Maidah Algarni, Enas Raml, Nora Trabulsi, Mohammed Nassif
    Journal of Surgical Case Reports.2019;[Epub]     CrossRef
  • The first European family with gastric adenocarcinoma and proximal polyposis of the stomach: case report and review of the literature
    Rudolf Repak, Darina Kohoutova, Miroslav Podhola, Stanislav Rejchrt, Marek Minarik, Lucie Benesova, Michal Lesko, Jan Bures
    Gastrointestinal Endoscopy.2016; 84(4): 718.     CrossRef
  • Gastric Hamartomatous Polyps—Review and Update
    Monika Vyas, Xiu Yang, Xuchen Zhang
    Clinical Medicine Insights: Gastroenterology.2016; 9: CGast.S38452.     CrossRef
  • Giant rectal polyp prolapse in an adult patient with the Peutz-Jeghers syndrome
    Ana Delfina Cano-Contreras, Arturo Meixueiro-Daza, Peter Grube-Pagola, Jose Maria Remes-Troche
    BMJ Case Reports.2016; : bcr2016215629.     CrossRef
  • Prevention Strategies for Gastric Cancer: A Global Perspective
    Jin Young Park, Lawrence von Karsa, Rolando Herrero
    Clinical Endoscopy.2014; 47(6): 478.     CrossRef
  • 6,881 View
  • 69 Download
  • 6 Crossref
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Successful Endoscopic Mucosal Resection of a Low Esophageal Carcinoid Tumor
Chang Sup Lim, Seun Ja Park, Moo In Park, Won Moon, Hyung Hun Kim, Jun Sik Lee, Bong Jin Kim, Dong Young Ku
Clin Endosc 2013;46(5):576-578.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.576
AbstractAbstract PDFPubReaderePub

Esophageal carcinoid tumors remain some of the rarest of all carcinoid tumors, with only several cases previously reported in the literature. The endoscopic mucosal resection of selected carcinoid tumors has been shown to be a valid, safe, and effective method of treatment. Endoscopic ultrasonography is the technique of choice to select patients eligible for endoscopic resection. Here, we report successful endoscopic mucosal resection of a low esophageal carcinoid tumor and review the relevant literature. The present case is the first reported case of esophageal carcinoid tumor in Korea.

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  • Role of Advanced Gastrointestinal Endoscopy in the Comprehensive Management of Neuroendocrine Neoplasms
    Harishankar Gopakumar, Vinay Jahagirdar, Jagadish Koyi, Dushyant Singh Dahiya, Hemant Goyal, Neil R. Sharma, Abhilash Perisetti
    Cancers.2023; 15(16): 4175.     CrossRef
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    Lauren M Poston, Shreya Gupta, Christine E Alvarado, Jillian Sinopoli, Leonidas T Vargas, Philip A Linden, Christopher W Towe
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    Elisa Giannetta, Valentina Guarnotta, Francesca Rota, Federica de Cicco, Federica Grillo, Annamaria Colao, Antongiulio Faggiano
    Critical Reviews in Oncology/Hematology.2019; 137: 92.     CrossRef
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    Sarah K. Findeis, Atin Agarwal
    Human Pathology: Case Reports.2019; 16: 100294.     CrossRef
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    Konstantinos Triantafyllou, Paraskevas Gkolfakis, Nikos Viazis, Panagiotis Tsibouris, Athanasios Tsigaridas, Periklis Apostolopoulos, John Anastasiou, Eleni Hounda, Ioannis Skianis, Konstantina Katopodi, Xhoela Ndini, George Alexandrakis, Demetrios G. Kar
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    Joel A. Friedlander, Quin Y. Liu, Benjamin Sahn, Koorosh Kooros, Catharine M. Walsh, Robert E. Kramer, Jenifer R. Lightdale, Julie Khlevner, Mark McOmber, Jacob Kurowski, Matthew J. Giefer, Harpreet Pall, David M. Troendle, Elizabeth C. Utterson, Herbert
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    Ki-Nam Shim, Seong Ran Jeon, Hyun Joo Jang, Jinsu Kim, Yun Jeong Lim, Kyeong Ok Kim, Hyun Joo Song, Hyun Seok Lee, Jae Jun Park, Ji Hyun Kim, Jaeyoung Chun, Soo Jung Park, Dong-Hoon Yang, Yang Won Min, Bora Keum, Bo-In Lee
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    Francisco TUSTUMI, Flavio Roberto TAKEDA, Rodrigo Hideki UEMA, Guilherme Luiz Stelko PEREIRA, Rubens Antonio Aissar SALLUM, Ivan CECCONELLO
    Arquivos de Gastroenterologia.2017; 54(1): 4.     CrossRef
  • A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses
    J.G. Albert, O. Humbla, M.E. McAlindon, C. Davison, U. Seitz, C. Fraser, F. Hagenmüller, E. Noetzel, C. Spada, M.E. Riccioni, J. Barnert, N. Filmann, M. Keuchel
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    Cary G. Sauer, Steven H. Erdman
    Journal of Pediatric Gastroenterology and Nutrition.2015; 61(4): 381.     CrossRef
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    Joung Boom Hong
    World Journal of Gastroenterology.2015; 21(10): 2982.     CrossRef
  • 5,811 View
  • 50 Download
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Systemic Amyloidosis Manifested by Gastric Outlet Obstruction
Sung Woon Park, Hyun Woong Lee, Eun Jung Cho
Clin Endosc 2013;46(5):579-581.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.579
AbstractAbstract PDFPubReaderePub

Amyloidosis is characterized by extracellular deposition of insoluble protein fibrils that stain with Congo red application and appear apple green under polarized light. The presenting symptoms result from the involvement of many affected, nonspecific and generalized organ systems. Our patient was an 80-year-old woman with no medical history. She presented with a 2-week history of nausea and vomiting. An esophagogastroduodenoscopy showed erythematous and edematous mucosa on the antrum with pyloric stenosis. Histopathologic examination of the biopsy specimen showed the deposition of amorphous, homogeneous, and acidophilic material in the gastric mucosa. Amyloidal protein was proven by positive Congo red stain. A serum and urine immunfixation electrophoresis showed lambda light chain band. She developed symptoms of repeated greenish color vomiting. A follow-up esophagogastroduodenoscopy showed progressed antral obstruction. However, she refused further evaluation and treatment and was managed conservatively. She later died of disease progression after 34 hospital days.

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  • A Case of Primary Gastric Amyloidosis with Fulminant Heart Failure
    Seonghun Hong, Young-Woon Chang, Jong Kyu Byun, Min Je Kim, Jung Min Chae, Sun Hee Park, Chi Hyuk Oh, Yong-Koo Park
    The Korean Journal of Gastroenterology.2015; 66(4): 227.     CrossRef
  • 6,233 View
  • 62 Download
  • 1 Crossref
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Gastric Somatostatinoma: An Extremely Rare Cause of Upper Gastrointestinal Bleeding
Varayu Prachayakul, Pitulak Aswakul, Morakod Deesomsak, Ananya Pongpaibul
Clin Endosc 2013;46(5):582-585.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.582
AbstractAbstract PDFPubReaderePub

A 49-year-old woman presented with chronic abdominal discomfort, significant weight loss, and chronic intermittent diarrhea. She suddenly developed massive upper gastrointestinal bleeding and was referred for further treatment. Endoscopy indicated a large mass in the upper gastric body with antral and duodenal bulb involvement. Endosonography showed a large well-defined isoechoic gastric subepithelial mass with multiple intra-abdominal and peripancreatic lymphadenopathy, suspected to be malignant on the basis of fine needle aspiration cytology. The tumor was surgically removed, and histopathology showed typical characteristics of a neuroendocrine tumor. On the basis of immunohistochemical staining, somatostatinoma, a rare neuroendocrine tumor, was diagnosed. Gastrointestinal bleeding is a rare presentation and the stomach is an uncommon tumor location.

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  • 50 Download
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