Clinical Endoscopy

Review

Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy: Sun Gyo Lim, Chan Gyoo Kim; Received June 30, 2023 Accepted September 11, 2023 Published online February 23, 2024; DOI: https://doi.org/10.5946/ce.2023.160 [Epub ahead of print]

Abstract PDF PubReader ePub: Malignant gastric outlet obstruction (GOO) is a condition characterized by blockage or narrowing where the stomach empties its contents into the small intestine due to primary malignant tumors or metastatic diseases. This condition leads to various symptoms such as nausea, vomiting, abdominal pain, and weight loss. To manage malignant GOO, different treatment options have been employed, including surgical gastrojejunostomy (SGJ), gastroduodenal stenting (GDS) using self-expandable metallic stent (SEMS), and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This review focuses on comparing the clinical outcomes of endoscopic stenting (GDS and EUS-GJ) with SGJ for malignant GOO. Studies have shown that GDS with SEMS provides comparable clinical outcomes and safety for the palliation of obstructive symptoms. The choice between covered and uncovered SEMS remains controversial, as different studies have reported varying results. EUS-GJ, performed via endoscopic ultrasound guidance, has shown promising efficacy and safety in managing malignant GOO, but further studies are needed to establish it as the primary treatment option. Comparative analyses suggest that GDS has higher recurrence and reintervention rates compared to EUS-GJ and SGJ, with similar overall procedural complications. However, bleeding rates were lower with GDS than with SGJ. Randomized controlled trials are required to determine the optimal treatment approach for malignant GOO.

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Original Articles

Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study: Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim; Clin Endosc 2021;54(3):390-396. Published online September 10, 2020; DOI: https://doi.org/10.5946/ce.2020.096

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

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Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study
Toshiki Horii, Sho Suzuki, Akihiro Sugita, Misa Yamauchi, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
Journal of Gastroenterology and Hepatology.2023; 38(5): 752. CrossRef
Comparison of the clinical efficacy of cold snare polypectomy using a thin-wire snare and thick-wire snare for small colorectal polyps
Hong Jin Yoon, Yunho Jung, Young Sin Cho, Il-Kwun Chung
International Journal of Gastrointestinal Intervention.2023; 12(4): 183. CrossRef
Big Issues on Small Polyps: An Ideal Device, But Is It for an Ideal Indication?
Yoji Takeuchi
Clinical Endoscopy.2021; 54(3): 297. CrossRef
Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence
Raquel Ortigão, Jochen Weigt, Ahmed Afifi, Diogo Libânio
United European Gastroenterology Journal.2021; 9(8): 938. CrossRef

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Bleeding after Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis: A Multicenter Propensity Score-Matched Analysis: In Kyung Yoo, Chan Gyoo Kim, Young Ju Suh, Younkyung Oh, Gwang Ho Baik, Sun Moon Kim, Young Dae Kim, Chul-Hyun Lim, Jung Won Jeon, Su Jin Hong, Byoung Wook Bang, Joon Sung Kim, Jun-Won Chung; Clin Endosc 2020;53(4):452-457. Published online October 25, 2019; DOI: https://doi.org/10.5946/ce.2019.107

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Background
/Aims: Frequent bleeding after endoscopic resection (ER) has been reported in patients with end-stage renal disease (ESRD). We aimed to evaluate the association and clinical significance of bleeding with ER in ESRD patients on dialysis.
Methods
Between February 2008 and December 2018, 7,571 patients, including 47 ESRD patients on dialysis who underwent ER for gastric neoplasia, were enrolled. A total of 47 ESRDpatients on dialysis were propensity score-matched 1:10 to 470 non-ESRD patients, to adjust for between-group differences in variables such as age, sex, comorbidities, anticoagulation use, tumor characteristics, and ER method. Matching was performed using an optimal matching algorithm. For the matched data, clustered comparisons were performed using the generalized estimating equation method. Medical records were retrospectively reviewed. Frequency and outcomes of post-ER bleeding were evaluated.
Results
Bleeding was more frequent in the ESRD with dialysis group than in the non-ESRD group. ESRD with dialysis conferred a significant risk of post-ER bleeding (odds ratio, 6.1; 95% confidence interval, 2.7–13.6; p<0.0001). All post-ER bleeding events were controlled using endoscopic hemostasis except in 1 non-ESRD case that needed surgery.
Conclusions
ESRD with dialysis confers a bleeding risk after ER. However, all bleeding events could be managed endoscopically without sequelae. Concern about bleeding should not stop endoscopists from performing ER in ESRD patients on dialysis.

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Effect of renal insufficiency on the short‐ and long‐term outcomes of endoscopic submucosal dissection for early gastric cancer: Propensity score‐matched analysis
Tae‐Se Kim, Byung‐Hoon Min, Sun‐Young Baek, Kyunga Kim, Yang Won Min, Hyuk Lee, Poong‐Lyul Rhee, Jae J. Kim, Jun Haeng Lee
Digestive Endoscopy.2023; 35(7): 869. CrossRef
Safeness of Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis
Sun-Jin Boo
Clinical Endoscopy.2020; 53(4): 381. CrossRef

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Focused Review Series: The New Era of Therapeutic Endoscopy - Endoscopic Submucosal Surgery

Endoscopic Full-Thickness Resection Combined with Laparoscopic Surgery: Chan Gyoo Kim; Clin Endosc 2018;51(1):33-36. Published online January 12, 2018; DOI: https://doi.org/10.5946/ce.2017.153

Abstract PDF PubReader ePub

Endoscopic full-thickness resection combined with laparoscopic surgery was recently developed. These procedures could be categorized as “Cut first and then suture” and “Suture first and then cut”. “Cut first and then suture” includes laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR). Recent studies have demonstrated the safety and efficacy of LECS and LAEFR. However, these techniques are limited by the related exposure of the tumor and gastric mucosa to the peritoneal cavity and manipulation of these organs, which could lead to viable cancer cell seeding and the spillage of gastric juice into the peritoneal cavity. In the “Suture first and then cut” technique, the serosal side of the stomach is sutured to invert the stomach and subsequently endoscopic resection is performed. In this article, details of these techniques, including their advantages and limitations, are described.

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Noriaki Kashu, Noriyuki Nishiwaki, Tetsuya Kagawa, Tomokazu Kakishita, Shinji Hato
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Endoscopic Full Thickness Resection: A Systematic Review
Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
Journal of Digestive Endoscopy.2022; 13(03): 152. CrossRef
Choice of LECS Procedure for Benign and Malignant Gastric Tumors
Jae-Seok Min, Kyung Won Seo, Sang-Ho Jeong
Journal of Gastric Cancer.2021; 21(2): 111. CrossRef
Combined surgical and endoscopic approaches to full-thickness resection
Thomas C. Tsai, Ozanan R. Meireles
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Combined Laparoscopic-Endoscopic Techniques for Removal of Small Gastric Tumors: Advantages and Tricks
Eva Intagliata, Rosario Vecchio
Clinical Endoscopy.2019; 52(4): 390. CrossRef
Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits
Yuki Aisu, Daiki Yasukawa, Yusuke Kimura, Tomohide Hori
World Journal of Gastrointestinal Oncology.2018; 10(11): 381. CrossRef

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Original Article

Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study: Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han; Clin Endosc 2018;51(1):61-65. Published online August 29, 2017; DOI: https://doi.org/10.5946/ce.2017.027

Abstract PDF PubReader ePub

Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.
Methods
This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.
Results
A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.
Conclusions
The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

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Bariatric surgery and reproduction-implications for gynecology and obstetrics
Isaac A. Babarinsa, Mohammed Bashir, Husham AbdelRahman Ahmed, Badreldeen Ahmed, Justin C. Konje
Best Practice & Research Clinical Obstetrics & Gynaecology.2023; 90: 102382. CrossRef
Current status in endoscopic management of upper gastrointestinal perforations, leaks and fistulas
Shannon Melissa Chan, Kitty Kit Ying Auyeung, Siu Fung Lam, Philip Wai Yan Chiu, Anthony Yuen Bun Teoh
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Endoscopic vacuum therapy (EVT) for acute esophageal perforation: Could it replace surgery?
Petros Stathopoulos, Malte Zumblick, Sabine Wächter, Leif Schiffmann, Thomas M. Gress, Detlef Bartsch, Guido Seitz, Ulrike W. Denzer
Endoscopy International Open.2022; 10(05): E686. CrossRef
Acquired Benign Tracheoesophageal Fistula
Hasnain S. Bawaadam, Matthew Russell, Yaron B. Gesthalter
Journal of Bronchology & Interventional Pulmonology.2022; 29(3): e38. CrossRef
Exclusión pilórica con dispositivo Ovesco (over-thescope) en caso de fístula yeyunal en obstrucción duodenal de etiología maligna
Raul Eduardo Pinilla Morales, Helena Facundo Navia, Elio Fabio Sánchez Cortés, Ivette C. Jiménez Lafourie, Álvaro Eduardo Sánchez Hernández, Luis Carlos Llorente Portillo
Revista colombiana de Gastroenterología.2022; 37(3): 320. CrossRef
Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis
Pawel Rogalski, Agnieszka Swidnicka-Siergiejko, Justyna Wasielica-Berger, Damian Zienkiewicz, Barbara Wieckowska, Eugeniusz Wroblewski, Andrzej Baniukiewicz, Magdalena Rogalska-Plonska, Grzegorz Siergiejko, Andrzej Dabrowski, Jaroslaw Daniluk
Surgical Endoscopy.2021; 35(3): 1067. CrossRef
Endoscopic management of gastro‐bronchial fistula following two‐stage esophagectomy using over‐the‐scope‐clip (OTSC): Case series
Chih Y. Tan, Htet A. Kyaw, Neda Farhangmehr, Cheuk‐Bong Tang, Naga V. Jayanthi
Advances in Digestive Medicine.2021; 8(2): 84. CrossRef
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Shigenori Masaki, Keishi Yamada
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Stephanie G. Jordan, Gregory J. Nolan
ANZ Journal of Surgery.2021; 91(11): 2534. CrossRef
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A.V. Vodyasov, D.M. Kopaliani, P.A. Yartsev, O.Kh. Kaloeva
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An Approach to Accelerate Healing and Shorten the Hospital Stay of Patients With Anastomotic Leakage After Esophagectomy: An Explorative Study of Systematic Endoscopic Intervention
LeQi Zhong, JiuDi Zhong, ZiHui Tan, YiTong Wei, XiaoDong Su, ZheSheng Wen, TieHua Rong, Yi Hu, KongJia Luo
Frontiers in Oncology.2021;[Epub] CrossRef
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Jeffrey H. Lee, Prashant Kedia, Stavros N. Stavropoulos, David Carr-Locke
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Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
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Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series
Jiayue Wang, Degang Wang, Jianjiao Chen
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Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects
David J. Morrell, Joshua S. Winder, Ansh Johri, Salvatore Docimo, Ryan M. Juza, Samantha R. Witte, Vamsi V. Alli, Eric M. Pauli
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Therapie der Ösophagusleckagen
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Successful Closure of a Benign Refractory Tracheoesophageal Fistula Using an Over-the-Scope Clip after Failed Esophageal Stent Placement and Surgical Management
Nonthalee Pausawasdi, Chotirot Angkurawaranon, Tanyaporn Chantarojanasiri, Arunchai Chang, Wanchai Wongkornrat, Somchai Leelakusolvong, Asada Methasate
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World Journal of Gastroenterology.2020; 26(24): 3495. CrossRef
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Bram D. Vermeulen, Peter D. Siersema
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Pablo Priego, Pietro Giordano, Marta Cuadrado, Araceli Ballestero, Julio Galindo, Eduardo Lobo
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Case Report

Endoscopic Removal of a Migrated Coil after Embolization of a Splenic Pseudoaneurysm: A Case Report: Yoo Min Han, Jong Yeul Lee, Il Ju Choi, Chan Gyoo Kim, Soo-Jeong Cho, Jun Ho Lee, Hyun Beom Kim, Ji Min Choi; Clin Endosc 2014;47(2):183-187. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.183

Abstract PDF PubReader ePub

Splenic artery pseudoaneurysms can be caused by pancreatitis, trauma, or operation. Traditionally, the condition has been managed through surgery; however, nowadays, transcatheter arterial embolization is performed safely and effectively. Nevertheless, several complications of pseudoaneurysm embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after transcatheter arterial embolization of a splenic artery pseudoaneurysm. The migrated coil was successfully removed by performing endoscopic intervention.

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Tian Li, Bayan Alsuleiman, Manuel Martinez
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John P. Haydek, Augustin R. Attwell
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Yassin Naga, Mahendran Jayaraj, Yousif Elmofti, Annie Hong, Gordon Ohning
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Akshay Pratap, Bhavani Pokala, Luciano M Vargas, Dmitry Oleynikov, Vishal Kothari
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Yoshikatsu Nomura, Yasuko Gotake, Takuya Okada, Masato Yamaguchi, Koji Sugimoto, Yutaka Okita
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Special Issue Article of IDEN 2013

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

Abstract PDF PubReader ePub

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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Endoscopic predictors for undifferentiated histology in differentiated gastric neoplasms prior to endoscopic resection
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