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Volume 55(4); July 2022
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Reviews
Recent developments in small bowel endoscopy: the “black box” is now open!
Luigina Vanessa Alemanni, Stefano Fabbri, Emanuele Rondonotti, Alessandro Mussetto
Clin Endosc 2022;55(4):473-479.   Published online July 14, 2022
DOI: https://doi.org/10.5946/ce.2022.113
AbstractAbstract PDFPubReaderePub
Over the last few years, capsule endoscopy has been established as a fundamental device in the practicing gastroenterologist’s toolbox. Its utilization in diagnostic algorithms for suspected small bowel bleeding, Crohn’s disease, and small bowel tumors has been approved by several guidelines. The advent of double-balloon enteroscopy has significantly increased the therapeutic possibilities and release of multiple devices (single-balloon enteroscopy and spiral enteroscopy) aimed at improving the performance of small bowel enteroscopy. Recently, some important innovations have appeared in the small bowel endoscopy scene, providing further improvement to its evolution. Artificial intelligence in capsule endoscopy should increase diagnostic accuracy and reading efficiency, and the introduction of motorized spiral enteroscopy into clinical practice could also improve the therapeutic yield. This review focuses on the most recent studies on artificial-intelligence-assisted capsule endoscopy and motorized spiral enteroscopy.

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Citations to this article as recorded by  
  • Deep learning–based lesion detection and severity grading of small-bowel Crohn’s disease ulcers on double-balloon endoscopy images
    Wanqing Xie, Jing Hu, Pengcheng Liang, Qiao Mei, Aodi Wang, Qiuyuan Liu, Xiaofeng Liu, Juan Wu, Xiaodong Yang, Nannan Zhu, Bingqing Bai, Yiqing Mei, Zhen Liang, Wei Han, Mingmei Cheng
    Gastrointestinal Endoscopy.2024; 99(5): 767.     CrossRef
  • Capsule Endoscopy for the Diagnosis of Suspected Small Bowel Bleeding
    P. P. Polyakov, A. Ya. Alimetov, A. V. Onopriev, A. V. Avakimyan, A. Kh. Kade, S. A. Zanin, E. S. Zanina, Z. S. Popov, A. I. Trofimenko, Z. T. Jndoyan, A. A. Avagimyan
    Innovative Medicine of Kuban.2023; (3): 121.     CrossRef
  • Outcomes of Double Balloon-Enteroscopy in Elderly vs. Adult Patients: A Retrospective 16-Year Single-Centre Study
    Margherita Trebbi, Cesare Casadei, Silvia Dari, Andrea Buzzi, Mario Brancaccio, Valentina Feletti, Alessandro Mussetto
    Diagnostics.2023; 13(6): 1112.     CrossRef
  • 3,248 View
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  • 2 Web of Science
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Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice
Kyeong Ok Kim
Clin Endosc 2022;55(4):480-488.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2022.108
AbstractAbstract PDFPubReaderePub
Endoscopy is vital for diagnosing, assessing treatment response, and monitoring surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

Citations

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  • Plasminogen Activator Inhibitor 1 Is a Novel Faecal Biomarker for Monitoring Disease Activity and Therapeutic Response in Inflammatory Bowel Diseases
    Boldizsár Jójárt, Tamás Resál, Diána Kata, Tünde Molnár, Péter Bacsur, Viktória Szabó, Árpád Varga, Kata Judit Szántó, Petra Pallagi, Imre Földesi, Tamás Molnár, József Maléth, Klaudia Farkas
    Journal of Crohn's and Colitis.2024; 18(3): 392.     CrossRef
  • Ocular endothelial dysfunction in pediatric inflammatory bowel disease
    Giovanni Di Nardo, Mariachiara Di Pippo, Letizia Zenzeri, Maurizio Mennini, Marisa Piccirillo, Silvia Furio, Giovanna Quatrale, Melania Evangelisti, Pasquale Parisi, Livia Lucchini, Alessandro Ferretti, Maria Pia Villa, Gianluca Scuderi, David Sarzi Amadè
    Journal of Pediatric Gastroenterology and Nutrition.2024; 78(6): 1297.     CrossRef
  • Different levels of healing in inflammatory bowel diseases: mucosal, histological, transmural, barrier and complete healing
    Markus F Neurath, Michael Vieth
    Gut.2023; 72(11): 2164.     CrossRef
  • Use of Standardized Inflammatory Bowel Disease Endoscopy Scores in Clinical Practice
    Jill K J Gaidos, Badr Al Bawardy, Francis A Farraye, Miguel Regueiro
    Crohn's & Colitis 360.2023;[Epub]     CrossRef
  • Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing
    Alina Ecaterina Jucan, Otilia Gavrilescu, Mihaela Dranga, Iolanda Valentina Popa, Ioana-Ruxandra Mihai, Vasile-Claudiu Mihai, Gabriela Stefanescu, Vasile Liviu Drug, Cristina Cijevschi Prelipcean, Radu-Alexandru Vulpoi, Oana-Bogdana Barboi, Irina Ciortesc
    Biomedicines.2023; 11(11): 3090.     CrossRef
  • Active Assessment of Inflammatory Bowel Disease
    金良 肖
    Advances in Clinical Medicine.2022; 12(12): 11023.     CrossRef
  • 6,205 View
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  • 5 Web of Science
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Post-polypectomy surveillance: the present and the future
Masau Sekiguchi, Takahisa Matsuda, Kinichi Hotta, Yutaka Saito
Clin Endosc 2022;55(4):489-495.   Published online July 11, 2022
DOI: https://doi.org/10.5946/ce.2022.097
AbstractAbstract PDFPubReaderePub
An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

Citations

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  • Protocolo diagnóstico del seguimiento de pólipos colónicos
    S. Redondo Evangelista, M. Sierra Morales, I. Bartolomé Oterino, P. García Centeno, A. Santos Rodríguez
    Medicine - Programa de Formación Médica Continuada Acreditado.2024; 14(4): 219.     CrossRef
  • Metabolic‐associated fatty liver disease is associated with colorectal adenomas in young and older Korean adults
    Jiwon Chang, Yoosoo Chang, Yoosun Cho, Hyun‐Suk Jung, Dong‐Il Park, Soo‐Kyung Park, Soo‐Youn Ham, Sarah H. Wild, Christopher D. Byrne, Seungho Ryu
    Liver International.2023; 43(11): 2548.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • Understanding colorectal polyps to prevent colorectal cancer
    Dong-Hoon Yang
    Journal of the Korean Medical Association.2023; 66(11): 626.     CrossRef
  • 3,561 View
  • 249 Download
  • 5 Web of Science
  • 6 Crossref
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Endoscopic treatment for rectal neuroendocrine tumor: which method is better?
Seung Min Hong, Dong Hoon Baek
Clin Endosc 2022;55(4):496-506.   Published online July 11, 2022
DOI: https://doi.org/10.5946/ce.2022.115
AbstractAbstract PDFPubReaderePub
Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mm without atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probability of patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resection of rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations for technique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopic characteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover, the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resection is the most suitable resection method for rectal NETs of <10 mm, because it is an effective and safe technique that is relatively simple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be considered when the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopic mucosal resection does not work well.

Citations

Citations to this article as recorded by  
  • Treatment strategy and post‐treatment management of colorectal neuroendocrine tumor
    Masau Sekiguchi, Takahisa Matsuda, Yutaka Saito
    DEN Open.2024;[Epub]     CrossRef
  • Comparison of endoscopic resection therapies for rectal neuroendocrine tumors
    Meijiao Lu, Hongxia Cui, Mingjie Qian, Yating Shen, Jianhong Zhu
    Minimally Invasive Therapy & Allied Technologies.2024; : 1.     CrossRef
  • A Review of Colonoscopy in Intestinal Diseases
    Seung Min Hong, Dong Hoon Baek
    Diagnostics.2023; 13(7): 1262.     CrossRef
  • Treatment of localized well-differentiated rectal neuroendocrine tumors: A focused review
    Shigenobu Emoto, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Hiroyuki Matsuzaki, Yuichiro Yokoyama, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Soichiro Ishihara
    Formosan Journal of Surgery.2023; 56(3): 73.     CrossRef
  • Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
    Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
    International Journal of Gastrointestinal Intervention.2023; 12(3): 105.     CrossRef
  • Endoscopic submucosal dissection coupled with �modified clip coupled with elastic ring� traction removing rectal neuroendocrine tumor
    Jing Zhou, Li-Sheng Wang, De-Feng Li, Rui-Yue Shi
    Revista Española de Enfermedades Digestivas.2023;[Epub]     CrossRef
  • 3,994 View
  • 285 Download
  • 6 Web of Science
  • 6 Crossref
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Systematic Review and Meta-Analysis
Endoscopic diagnosis of gastric metastases from malignant melanoma: systematic review
Helena Campoli Reggiani, Ana Clara Aguiar Pongeluppi, Vitória Froes Miraglia Martins Ferreira, Isadora Pinheiro Felix, Paulo Moacir de Oliveira Campoli
Clin Endosc 2022;55(4):507-515.   Published online June 28, 2022
DOI: https://doi.org/10.5946/ce.2022.035
AbstractAbstract PDFPubReaderePub
Background
/Aims: Metastases of malignant melanoma (MM) are rare and associated with poor prognosis. The objective of this study was to analyze the clinical and endoscopic characteristics of gastric metastases of MM by systematically reviewing cases and case series involving patients diagnosed using upper gastrointestinal endoscopy.
Methods
The PubMed and LILACS databases were searched. Reports containing individual patient data were included. Outcomes such as clinical data, endoscopic findings, treatments, and survival were analyzed.
Results
A total of 88 studies with individual data from 113 patients with gastric metastases of MM were included. The primary sites of MM were the skin (62%), eyes (10%), and mucous membranes (6%). Most patients (56%) had multiple metastases in the stomach, located predominantly in the gastric body (approximately 80%). The overall survival rate at 2 years was 4%. There was a significant reduction in the survival of patients with multiple gastric metastases compared to that of patients with single metastasis (hazard ratio, 0.459; 95% confidence interval, 0.235−0.895; p=0.022).
Conclusions
Gastric metastases of MM have a poor prognosis, especially in patients with multiple implants in the stomach. Additional studies are needed to verify whether ocular and mucosal melanomas are associated with a higher risk of gastric metastases than that of cutaneous melanomas.

Citations

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  • A Rare Case of Gastric Metastasis from a Rare Case of Mucosal Malignant Melanoma
    Zaim Gashi, Astrit Hamza, Blerina Ukimeri, Valon Hamza, Marigona Zubaku-Rakovic
    Open Access Macedonian Journal of Medical Sciences.2024; 12(2): 362.     CrossRef
  • Case report: Malignant melanoma of the lower limb with gastric metastasis
    Qiang Hu, Fengru Zhou, Yuanshui Sun
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • 2,393 View
  • 172 Download
  • 1 Web of Science
  • 2 Crossref
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Editorials
Prevention of stricture after endoscopic submucosal dissection for esophageal cancer: intralesional steroid infusion using a spray tube
Jong Yeul Lee
Clin Endosc 2022;55(4):516-517.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2022.164
PDFPubReaderePub

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  • The endoscopic management of oesophageal strictures
    Benjamin Charles Norton, Apostolis Papaefthymiou, Nasar Aslam, Andrea Telese, Charles Murray, Alberto Murino, Gavin Johnson, Rehan Haidry
    Best Practice & Research Clinical Gastroenterology.2024; 69: 101899.     CrossRef
  • 2,211 View
  • 119 Download
  • 1 Crossref
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Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation
Se Woo Park
Clin Endosc 2022;55(4):518-519.   Published online July 13, 2022
DOI: https://doi.org/10.5946/ce.2022.110
PDFPubReaderePub

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  • Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy
    Sonja Skiljic, Dino Budrovac, Ana Cicvaric, Nenad Neskovic, Slavica Kvolik
    Life.2023; 13(2): 473.     CrossRef
  • 1,797 View
  • 123 Download
  • 2 Web of Science
  • 1 Crossref
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Original Articles
Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer
Atsushi Goto, Takeshi Okamoto, Ryo Ogawa, Kouichi Hamabe, Shinichi Hashimoto, Jun Nishikawa, Taro Takami
Clin Endosc 2022;55(4):520-524.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2021.262
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety.
Methods
Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment.
Results
Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed.
Conclusions
Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis Clinical trial number (UMIN000037567).
  • 2,736 View
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Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection
Wang Fangjun, Leng Xia, Gao Yi, Shen Xiuyun, Wang Wenping, Liu Huamin, Liu Pengfei
Clin Endosc 2022;55(4):525-531.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2021.241
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods
From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results
The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p>0.05).
Conclusions
The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.
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Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases
Luca Elli, Erica Centorrino, Andrea Costantino, Maurizio Vecchi, Stefania Orlando, Mirella Fraquelli
Clin Endosc 2022;55(4):532-539.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2021.224
AbstractAbstract PDFPubReaderePub
Background
/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods
We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results
A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions
CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

Citations

Citations to this article as recorded by  
  • Past, Present, and Future of Noninvasive Tests to Assess Gluten Exposure, Celiac Disease Activity, and End-Organ Damage
    Jocelyn A. Silvester, Luca Elli, Chaitan Khosla, Jason A. Tye-Din
    Gastroenterology.2024; 167(1): 159.     CrossRef
  • A practical approach for small bowel bleeding
    Sung Eun Kim, Hyun Jin Kim, Myeongseok Koh, Min Cheol Kim, Joon Sung Kim, Ji Hyung Nam, Young Kwan Cho, A Reum Choe
    Clinical Endoscopy.2023; 56(3): 283.     CrossRef
  • Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound?
    Roberta Elisa Rossi, Anita Busacca, Luca Brandaleone, Benedetta Masoni, Sara Massironi, Mirella Fraquelli, Alessandro Repici
    Current Gastroenterology Reports.2023; 25(12): 430.     CrossRef
  • 2,131 View
  • 139 Download
  • 1 Web of Science
  • 3 Crossref
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Factors influencing endoscopic estimation of colon polyp size in a colon model
Koen Robert Beukema, Jaimy A. Simmering, Marjolein Brusse-Keizer, Sneha John, Rutger Quispel, Peter B. Mensink
Clin Endosc 2022;55(4):540-548.   Published online July 28, 2022
DOI: https://doi.org/10.5946/ce.2022.017
AbstractAbstract PDFPubReaderePub
Background
/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation.
Methods
Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope’s tip. Participants were asked to estimate the diameter and volume of each polyp.
Results
Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62–0.71) for diameter and 0.56 (95% CI, 0.50–0.62) for volume. Polyp size estimated at 3 cm from the colonoscope’s tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size.
Conclusions
Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.

Citations

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  • Usefulness and Educational Benefit of a Virtual Scale Endoscope in Measuring Colorectal Polyp Size
    Yudai Takehara, Ken Yamashita, Shin Morimoto, Fumiaki Tanino, Noriko Yamamoto, Yuki Kamigaichi, Hidenori Tanaka, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Shiro Oka
    Digestion.2024; 105(2): 73.     CrossRef
  • Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study
    Ioana Popescu Crainic, Roupen Djinbachian, Douglas K. Rex, Alan Barkun, Aasma Shaukat, James East, Cesare Hassan, Yuichi Mori, Heiko Pohl, Amit Rastogi, Prateek Sharma, Joseph C. Anderson, Mahsa Taghiakbari, Edgard Medawar, Daniel von Renteln
    Scandinavian Journal of Gastroenterology.2024; 59(5): 608.     CrossRef
  • 3,078 View
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Comparison of tube-assisted mapping biopsy with digital single-operator peroral cholangioscopy for preoperative evaluation of biliary tract cancer
Tsuyoshi Takeda, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Chinatsu Mori, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clin Endosc 2022;55(4):549-557.   Published online July 20, 2022
DOI: https://doi.org/10.5946/ce.2021.227
AbstractAbstract PDFPubReaderePub
Background
/Aims: Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited.
Methods
We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC.
Results
A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees.
Conclusions
Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.

Citations

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  • Cholangioscopy for biliary diseases
    Aymeric Becq, Adil Soualy, Marine Camus
    Current Opinion in Gastroenterology.2023; 39(2): 67.     CrossRef
  • Endoscopic evaluation of indeterminate biliary strictures: Cholangioscopy, endoscopic ultrasound, or both?
    Raymond S. Y. Tang
    Digestive Endoscopy.2023;[Epub]     CrossRef
  • 2,282 View
  • 151 Download
  • 2 Web of Science
  • 2 Crossref
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Bispectral index-guided propofol sedation during endoscopic ultrasonography
Ayana Okamoto, Ken Kamata, Takeshi Miyata, Tomoe Yoshikawa, Rei Ishikawa, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Toshiharu Sakurai, Naoshi Nishida, Masayuki Kitano, Masatoshi Kudo
Clin Endosc 2022;55(4):558-563.   Published online July 12, 2022
DOI: https://doi.org/10.5946/ce.2022.001
AbstractAbstract PDFPubReaderePub
Background
/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS).
Methods
This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room.
Results
The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001).
Conclusions
During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

Citations

Citations to this article as recorded by  
  • Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy
    Sonja Skiljic, Dino Budrovac, Ana Cicvaric, Nenad Neskovic, Slavica Kvolik
    Life.2023; 13(2): 473.     CrossRef
  • Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation
    Se Woo Park
    Clinical Endoscopy.2022; 55(4): 518.     CrossRef
  • Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report
    Jaesang Lee, Hosik Moon, Sungjin Hong, Jinyoung Chon, Hyejin Kwon, Hunwoo Park, Jiyung Lee
    Medicina.2022; 59(1): 65.     CrossRef
  • 3,309 View
  • 140 Download
  • 3 Web of Science
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Case Report
A remnant choledochal cyst after choledochal cyst excision treated with a lumen-apposing metal stent: a case report
Bo Kyung Kim, Jung Won Chun, Sang Hyub Lee, Ji Kon Ryu, Yong-Tae Kim, Woo Hyun Paik
Clin Endosc 2022;55(4):564-569.   Published online January 8, 2020
DOI: https://doi.org/10.5946/ce.2019.176
AbstractAbstract PDFPubReaderePub
A lumen-apposing metal stent (LAMS) is a saddle-shaped stent with large flanges at both ends, thereby preventing stent migration and helping with approximation of the adjacent structures. We report the case of a 25-year-old female with remnant choledochal cyst which was successfully treated with LAMS after initial treatment failure with a plastic stent. Although complete excision of the cyst is the definite treatment of choledochal cysts, endoscopic ultrasonography-guided cystoduodenostomy can be considered in cases wherein surgery is not feasible and dysplasia is not present. LAMS may be preferred to plastic stents for effective resolution of remnant choledochal cyst and prevention of ascending infection.

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