Clinical Endoscopy

Original Article

Performance comparison between two computer-aided detection colonoscopy models by trainees using different false positive thresholds: a cross-sectional study in Thailand: Kasenee Tiankanon, Julalak Karuehardsuwan, Satimai Aniwan, Parit Mekaroonkamol, Panukorn Sunthornwechapong, Huttakan Navadurong, Kittithat Tantitanawat, Krittaya Mekritthikrai, Salin Samutrangsi, Peerapon Vateekul, Rungsun Rerknimitr; Clin Endosc 2024;57(2):217-225. Published online February 7, 2024; DOI: https://doi.org/10.5946/ce.2023.145

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: This study aims to compare polyp detection performance of “Deep-GI,” a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model.
Methods
Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen.
Results
In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p<0.01) and the lowest PMR (0.6% vs. 14.6% vs. 33.3%, p<0.01) when compared to CADe and trainees, respectively. Compared to CADe, Deep-GI demonstrated lower FPR at FP thresholds of ≥0.5 (12.1 vs. 22.4) and ≥1 second (4.4 vs. 6.8) (both p<0.05). However, when the threshold was raised to ≥1.5 seconds, the FPR became comparable (2 vs. 2.4, p=0.3), while the PMR increased from 2% to 10%.
Conclusions
Compared to CADe, Deep-GI demonstrated a higher PDS with significantly lower FPR at ≥0.5- and ≥1-second thresholds. At the ≥1.5-second threshold, both systems showed comparable FPR with increased PMR.

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Reviews

Computer-aided polyp characterization in colonoscopy: sufficient performance or not?: Natalie Halvorsen, Yuichi Mori; Clin Endosc 2024;57(1):18-23. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.092

Abstract PDF PubReader ePub: Computer-assisted polyp characterization (computer-aided diagnosis, CADx) facilitates optical diagnosis during colonoscopy. Several studies have demonstrated high sensitivity and specificity of CADx tools in identifying neoplastic changes in colorectal polyps. To implement CADx tools in colonoscopy, there is a need to confirm whether these tools satisfy the threshold levels that are required to introduce optical diagnosis strategies such as “diagnose-and-leave,” “resect-and-discard” or “DISCARD-lite.” In this article, we review the available data from prospective trials regarding the effect of multiple CADx tools and discuss whether they meet these thresholds.

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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; Clin Endosc 2023;56(5):553-562. Published online July 26, 2023; DOI: https://doi.org/10.5946/ce.2023.055

Abstract PDF PubReader ePub

Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.

Citations

Citations to this article as recorded by

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
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef

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Systematic Review and Meta-analysis

Use of abdominal compression device in colonoscopy: a systematic review and meta-analysis: Yousaf Zafar, Ahmed Mustafa Rashid, Syed Sarmad Javaid, Ahmed Kamal Siddiqi, Adnan Zafar, Arsalan Zafar Iqbal, Jagpal Singh Klair, Rajesh Krishnamoorthi; Clin Endosc 2023;56(4):446-452. Published online May 26, 2023; DOI: https://doi.org/10.5946/ce.2022.304

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes.
Methods
We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated.
Results
Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device.
Conclusions
Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.

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Reviews

Simulator-based training method in gastrointestinal endoscopy training and currently available simulators: Yuri Kim, Jeong Hoon Lee, Gin Hyug Lee, Ga Hee Kim, Gunn Huh, Seung Wook Hong, Hwoon-Yong Jung; Clin Endosc 2023;56(1):1-13. Published online January 6, 2023; DOI: https://doi.org/10.5946/ce.2022.191

Abstract PDF PubReader ePub

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM’s advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator’s validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

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Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition: Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases; Clin Endosc 2022;55(6):703-725. Published online October 13, 2022; DOI: https://doi.org/10.5946/ce.2022.136

Abstract PDF Supplementary Material PubReader ePub

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index
Jung Ho Lee, Hyunseok Cho, Sang Hoon Lee, Sung Joon Lee, Chang Don Kang, Dae Hee Choi, Jin Myung Park, Seung-Joo Nam, Tae Suk Kim, Ji Hyun Kim, Sung Chul Park
The Korean Journal of Gastroenterology.2024; 83(4): 143. CrossRef
A survey of current practices in post-polypectomy surveillance in Korea
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
Intestinal Research.2024; 22(2): 186. CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. 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
Understanding colorectal polyps to prevent colorectal cancer
Dong-Hoon Yang
Journal of the Korean Medical Association.2023; 66(11): 626. CrossRef
Classification and endoscopic diagnosis of colorectal polyps
Ji Hyun Kim, Sung Chul Park
Journal of the Korean Medical Association.2023; 66(11): 633. CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. 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

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Original Article

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

Abstract PDF PubReader ePub

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

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Review

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

Abstract PDF PubReader ePub

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.

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S. Redondo Evangelista, M. Sierra Morales, I. Bartolomé Oterino, P. García Centeno, A. Santos Rodríguez
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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

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249 Download
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6 Crossref

Systematic Review and Meta-Analysis

Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis: Arun Sivananthan, Scarlet Nazarian, Lakshmana Ayaru, Kinesh Patel, Hutan Ashrafian, Ara Darzi, Nisha Patel; Clin Endosc 2022;55(3):355-364. Published online May 12, 2022; DOI: https://doi.org/10.5946/ce.2021.228

Abstract PDF PubReader ePub

Background
/Aims: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.
Methods
A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.
Results
Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09–0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02–0.07).
Conclusions
CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.

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Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth?
James Weiquan Li, Lai Mun Wang, Katsuro Ichimasa, Kenneth Weicong Lin, James Chi-Yong Ngu, Tiing Leong Ang
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As how artificial intelligence is revolutionizing endoscopy
Jean-Francois Rey
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Eye tracking technology in endoscopy: Looking to the future
Arun Sivananthan, Jabed Ahmed, Alexandros Kogkas, George Mylonas, Ara Darzi, Nisha Patel
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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
KI-Werkzeuge als smarte Helfer in Klinik und Forschung

Zeitschrift für Gastroenterologie.2023; 61(11): 1544. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef
The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization
Edward Young, Louisa Edwards, Rajvinder Singh
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Artificial intelligence for colorectal neoplasia detection during colonoscopy: a systematic review and meta-analysis of randomized clinical trials
Shenghan Lou, Fenqi Du, Wenjie Song, Yixiu Xia, Xinyu Yue, Da Yang, Binbin Cui, Yanlong Liu, Peng Han
eClinicalMedicine.2023; 66: 102341. CrossRef
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Reviews

Quality indicators in colonoscopy: the chasm between ideal and reality: Su Bee Park, Jae Myung Cha; Clin Endosc 2022;55(3):332-338. Published online April 4, 2022; DOI: https://doi.org/10.5946/ce.2022.037

Abstract PDF PubReader ePub

Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice.

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Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
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AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
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Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef

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Can Computed Tomography Colonography Replace Optical Colonoscopy in Detecting Colorectal Lesions?: State of the Art: Alessia Chini, Michele Manigrasso, Grazia Cantore, Rosa Maione, Marco Milone, Francesco Maione, Giovanni Domenico De Palma; Clin Endosc 2022;55(2):183-190. Published online February 24, 2022; DOI: https://doi.org/10.5946/ce.2021.254

Abstract PDF PubReader ePub

Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions <5 mm or flat lesions, which, although rarely, can have a malignant potential.

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Multi-view orientational attention network combining point-based affinity for polyp segmentation
Yan Liu, Yan Yang, Yongquan Jiang, Zhuyang Xie
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Original Article

Comparison of conventional and new endoscopic band ligation devices for colonic diverticular bleeding: Ayaka Takasu, Takashi Ikeya, Yasutoshi Shiratori; Clin Endosc 2022;55(3):408-416. Published online February 18, 2022; DOI: https://doi.org/10.5946/ce.2021.200

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic band ligation (EBL) is used to treat colonic diverticular bleeding (CDB). An endoscopic variceal ligation device for esophageal varices is used as a conventional EBL device (C-EBL). A new EBL device (N-EBL) was developed by Sumitomo Bakelite Co. in August 2018. We aimed to evaluate the clinical outcomes of N-EBL compared with those of C-EBL.
Methods
Seventy-nine patients who underwent EBL for CDB at St. Luke’s International Hospital, Japan, between 2017 and 2020 were included in this retrospective study. Patients were divided into the C-EBL and N-EBL groups. Their clinical outcomes, including achieving initial hemostasis, early rebleeding, procedure time, and EBL-associated adverse events, were evaluated.
Results
Of the 79 patients, 36 (45.6%) were in the C-EBL group and 43 (54.4%) were in the N-EBL group. The rate of achieving initial hemostasis was 100% in the C-EBL group and 93.0% in the N-EBL group. No significant difference was noted in the early rebleeding rate between the groups (p=0.24). The N-EBL group achieved a shorter median EBL procedure time than the C-EBL group (18.2 minutes vs. 14.2 minutes, p=0.02). No adverse events were observed in either group.
Conclusions
The N-EBL device is safe and useful and may reduce EBL procedure time.

Citations

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Special Article: Celebrating the 10th Anniversary of Clinical Endoscopy

Document Network and Conceptual and Social Structures of Clinical Endoscopy from 2015 to July 2021 Based on the Web of Science Core Collection: A Bibliometric Study: Sun Huh; Clin Endosc 2021;54(5):641-650. Published online September 30, 2021; DOI: https://doi.org/10.5946/ce.2021.207

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The present study investigated the relevance and network of institutions, keywords, and authors’ countries of the articles in Clinical Endoscopy published from 2015 to May 2021 based on the Web of Science Core Collection.
Methods
The Web of Science Core Collection was searched with the term Clinical Endoscopy as the publication title on July 12, 2021. All 776 citations published from 2015 to May 2021 and 2,964 articles citing those 776 articles were analyzed using Biblioshiny.
Results
The corresponding authors were from 73 countries. Document coupling showed that the colorectal cancer-colonoscopyrandomized controlled trial cluster had the most significant impact and highest centrality. There were 442 articles with corresponding authors from Korea (57.0%). The number of collaborative works by Korean authors with the authors of other countries was 33 (7.5%). The articles were cited 2,964 times by corresponding authors from 37 countries.
Conclusions
The above results show that Clinical Endoscopy has published several studies on gastrointestinal endoscopy. A large proportion of citations (84.7 %) were from outside Korea, indicating that the journal content is useful for global physicians. Collaborative work between authors from Korea and other countries should be encouraged to promote the journal.

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Journal metrics, document network, and conceptual and social structures of the Korean Journal of Anesthesiology from 2017 to July 2022: a bibliometric study
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Korean Journal of Anesthesiology.2023; 76(1): 3. CrossRef
Promotion to Top-Tier Journal and Development Strategy of the Annals of Laboratory Medicine for Strengthening its Leadership in the Medical Laboratory Technology Category: A Bibliometric Study
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Original Article

Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan: Jandos Amankulov, Dilyara Kaidarova, Zhamilya Zholdybay, Marianna Zagurovskaya, Nurlan Baltabekov, Madina Gabdullina, Akmaral Ainakulova, Dias Toleshbayev, Alexandra Panina, Elvira Satbayeva, Zhansaya Kalieva; Clin Endosc 2022;55(1):101-112. Published online July 15, 2021; DOI: https://doi.org/10.5946/ce.2021.066

Abstract PDF PubReader ePub: Background
/Aims: The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods
A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results
Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions
Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.

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1 Web of Science

Focused Review Series: Image-Enhanced Endoscopy: Update on Clinical Practice

Clinical Applications of Linked Color Imaging and Blue Laser/Light Imaging in the Screening, Diagnosis, and Treatment of Superficial Colorectal Tumors: Taku Sakamoto, Hourin Cho, Yutaka Saito; Clin Endosc 2021;54(4):488-493. Published online July 14, 2021; DOI: https://doi.org/10.5946/ce.2021.157

Abstract PDF PubReader ePub

Considering its contribution to reducing colorectal cancer morbidity and mortality, the most important task of colonoscopy is to find all existing polyps. Moreover, the accurate detection of existing polyps determines the risk of colorectal cancer morbidity and is an important factor in deciding the appropriate surveillance program for patients. Image-enhanced endoscopy is an easy-to-use modality with improved lesion detection. Linked color imaging (LCI) and blue laser/light imaging (BLI) are useful modalities for improving colonoscopy quality. Each mode has unique optical features; therefore, their intended use differs. LCI contributes to improved polyp detection due to its brightness and high color contrast between the lesion and normal mucosa, while BLI contributes to the characterization of detected polyps by evaluating the vessel and surface patterns of detected lesions. The proper use of these observation modes allows for more efficient endoscopic diagnosis. Moreover, recent developments in artificial intelligence will soon change the clinical practice of colonoscopy and this system will provide an efficient education modality for novice endoscopists.

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Antonello Trecca, Raffaele Borghini, Daniela Medicina, Rachele Del Sordo, Giulio Mandelli, Antonino Bella, Giuseppe Galloro, Kuang-I Fu, Vincenzo Villanacci
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Comparison of LED and LASER Colonoscopy About Linked Color Imaging and Blue Laser/Light Imaging of Colorectal Tumors in a Multinational Study
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Case Report

Endoscopic Treatment of Iatrogenic Perforation of Sigmoid Diverticulum: A Case Report of Multidisciplinary Management: Giacomo Emanuele Maria Rizzo, Giuseppina Ferro, Giovanna Rizzo, Giovanni Di Carlo, Alessandro Cantone, Gaetano Giuseppe Di Vita, Carmelo Sciumè; Clin Endosc 2022;55(2):292-296. Published online June 7, 2021; DOI: https://doi.org/10.5946/ce.2021.005

Abstract PDF PubReader ePub: Iatrogenic perforations are severe complications of gastrointestinal endoscopy; therefore, their management should be adequately planned. A 77-year-old man with a history of diverticulosis underwent a colonoscopy for anemia. During the procedure, an iatrogenic perforation occurred suddenly in the sigmoid colon, near a severe angle among the numerous diverticula. Through-the-scope clips were immediately applied to treat it and close mucosal edges. Laboratory tests showed increased levels of inflammation and infection, and although there were no complaints of abdominal pain, the patient had an extremely distended abdomen. A multidisciplinary board began management based on a conservative approach. Pneumoperitoneum was treated with computed tomography-assisted drainage. After 72 hours, his intestinal canalization and laboratory tests were normal. Though this adverse event is rare, a multidisciplinary board should be promptly gathered upon occurrence, even if the patient appears clinically stable, to consider a conservative approach and avoid surgical treatment.

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Original Article

Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: John Alexander Lata Guacho, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Bruna Furia Buzetti Hourneaux de Moura, Megui Marilia Mansilla Gallegos, Thomas McCarty, Ricardo Katsuya Toma, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(2):242-249. Published online March 25, 2021; DOI: https://doi.org/10.5946/ce.2020.275

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Carbon dioxide is increasingly used in insufflation during colonoscopy in adult patients; however, air insufflation remains the primary practice among pediatric gastroenterologists. This systematic review and meta-analysis aims to evaluate insufflation using CO₂ versus air in colonoscopies in pediatric patients.
Methods
Individualized search strategies were performed using MEDLINE, Cochrane Library, EMBASE, and LILACS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane working methodology. Randomized control trials (RCTs) were selected for the present meta-analysis. Pooled proportions were calculated for outcomes including procedure time and abdominal pain immediately and 24 hours post-procedure.
Results
The initial search yielded 644 records, of which five RCTs with a total of 358 patients (CO₂: n=178 versus air: n=180) were included in the final analysis. The procedure time was not different between the CO₂ and air insufflation groups (mean difference, 10.84; 95% confidence interval [CI], -2.55 to 24.22; p=0.11). Abdominal pain immediately post-procedure was significantly lower in the CO₂ group (risk difference, -0.15; 95% CI; -0.26 to -0.03; p=0.01) while abdominal pain at 24 hours post-procedure was similar (risk difference, -0.05; 95% CI; -0.11 to 0.01; p=0.11).
Conclusions
Based on this systematic review and meta-analysis of RCT data, CO₂ insufflation reduced abdominal pain immediately following the procedure, while pain was similar at 24 hours post-procedure. These results suggest that CO₂ is a preferred insufflation technique when performing colonoscopy in pediatric patients.

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Elevations in End-Tidal CO2 With CO2 Use During Pediatric Endoscopy With Airway Protection: Is This Physiologically Significant?
Chinenye R. Dike, Andrew Huang Pacheco, Elizabeth Lyden, David Freestone, Ojasvini Choudhry, Warren P. Bishop, Mohanad Shukry
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Reviews

Current Status of Colorectal Cancer and Its Public Health Burden in Thailand: Kasenee Tiankanon, Satimai Aniwan, Rungsun Rerknimitr; Clin Endosc 2021;54(4):499-504. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.245-IDEN

Abstract PDF PubReader ePub

Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalent cancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program as a response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, while there are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage of endoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel, reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemical test (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FIT cutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify the priority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies and the current status of the Thailand CRC screening program.

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Preventive Medicine.2023; 175: 107694. CrossRef
An Assessment of Physicians’ Recommendations for Colorectal Cancer Screening and International Guidelines Awareness and Adherence: Results From a Thai National Survey
Nonthalee Pausawasdi, Pongkamon Tongpong, Tanawat Geeratragool, Phunchai Charatcharoenwitthaya
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Biomedicine & Pharmacotherapy.2022; 151: 113214. CrossRef

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Artificial Intelligence in Lower Gastrointestinal Endoscopy: The Current Status and Future Perspective: Sebastian Manuel Milluzzo, Paola Cesaro, Leonardo Minelli Grazioli, Nicola Olivari, Cristiano Spada; Clin Endosc 2021;54(3):329-339. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.082

Abstract PDF PubReader ePub

The present manuscript aims to review the history, recent advances, evidence, and challenges of artificial intelligence (AI) in colonoscopy. Although it is mainly focused on polyp detection and characterization, it also considers other potential applications (i.e., inflammatory bowel disease) and future perspectives. Some of the most recent algorithms show promising results that are similar to human expert performance. The integration of AI in routine clinical practice will be challenging, with significant issues to overcome (i.e., regulatory, reimbursement). Medico-legal issues will also need to be addressed. With the exception of an AI system that is already available in selected countries (GI Genius; Medtronic, Minneapolis, MN, USA), the majority of the technology is still in its infancy and has not yet been proven to reach a sufficient diagnostic performance to be adopted in the clinical practice. However, larger players will enter the arena of AI in the next few months.

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Uday C. Ghoshal, Saikat Chakrabarti, Mahesh K. Goenka
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Original Article

Comparative Study of Narrow-Band Imaging and i-scan for Predicting the Histology of Intermediate-to-Large Colorectal Polyps: A Prospective, Randomized Pilot Study: Joon Seop Lee, Seong Woo Jeon, Yong Hwan Kwon; Clin Endosc 2021;54(6):881-887. Published online January 6, 2021; DOI: https://doi.org/10.5946/ce.2020.257

Abstract PDF PubReader ePub

Background
/Aims: To date, no reports have compared the diagnostic efficacy of narrow-band imaging (NBI) and i-scan for the histologic prediction of intermediate-to-large colorectal polyps. We aimed to compare the diagnostic accuracy of NBI and i-scan in predicting histology, and their inter-/intra-observer agreement.
Methods
We performed a prospective, randomized study that included 66 patients (NBI, n=33 vs. i-scan, n=33) with colorectal polyps (size >10 mm but <50 mm) who underwent colonoscopic resection. During the procedure, three endoscopists documented their prediction using the Japan NBI Expert Team (JNET) classification. Two months after study completion, the endoscopists reviewed still images and video clips for analysis.
Results
The overall diagnostic accuracies in the NBI and i-scan groups were 73.7% (73/99) and 75.8% (75/99), respectively, and there was no statistical significance between the two groups (p=0.744). The JNET classification as applied to NBI and i-scan showed substantial inter-observer agreement (NBI κ-value 0.612, p=0.001 vs. i-scan κ-value 0.662, p=0.002). Additionally, the κ-values of intra-observer agreement were in the range of 0.385–0.660 with NBI and 0.364–0.741 with i-scan.
Conclusions
NBI and i-scan have similar diagnostic accuracies for the histologic prediction of intermediate-to-large colorectal polyps. Furthermore, the inter-/intra-observer agreement was acceptable for both modalities when the JNET classification was applied.

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Case Report

Fatal Necrotizing Fasciitis Following Uncomplicated Colonoscopic Polypectomy: A Case Report: Min Kyu Chae, Sang Youn Shin, Min Seob Kwak, Jin Young Yoon, Ha Il Kim, Jae Myung Cha; Clin Endosc 2021;54(2):280-284. Published online December 11, 2020; DOI: https://doi.org/10.5946/ce.2020.117

Abstract PDF PubReader ePub: Necrotizing fasciitis (NF) is a life-threatening infection that can be caused by various procedures or surgery and may develop in healthy elderly patients. Here, we report a case of a 66-year-old man with diabetes mellitus who underwent colonoscopic polypectomy, without complications. However, he visited the emergency department 24 hours after the procedure complaining of abdominal pain. Abdominopelvic computed tomography revealed multiple air bubbles in the right lateral abdominal muscles. After a diagnosis of NF was made, immediate surgical debridement was performed. However, despite three sessions of extensive surgical debridement and best supportive care at the intensive care unit, the patient died because of sepsis and NF-associated multiple-organ failure. In conclusion, physicians should pay special attention to the possibility of NF if a patient with risk factors for NF develops sepsis after colonoscopic polypectomy.

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Original Articles

Changes in Policy and Endoscopic Procedures during the 2019 Coronavirus Disease Outbreak: A Single Center Experience: Adi Lahat, Avidan Benjamin; Clin Endosc 2021;54(1):48-54. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.132

Abstract PDF PubReader ePub

Background
/Aims: The coronavirus disease-19 (COVID-19) pandemic forced endoscopy units to enact major changes on daily practice and policy. The Chaim Sheba Medical Center is a tertiary referral center located in the center of Israel, and serves cities with high infection rates. Our aim was to review the policies enacted during this outbreak and study their influence on the performance of endoscopic procedures.
Methods
Following the revision of work protocols, personnel were divided into two permanent and physically separate working groups and screening procedures were rescheduled. Relevant data including the number of endoscopic examinations, type of procedure performed, and patient referrals and indications were taken from a computerized database and evaluated. The study included data for January–March 2018–2020, and a comparison among the data from each year was performed.
Results
As of March 2020, the total number of endoscopic examinations performed reduced by 44% (p<0.0001) as compared to previous years, gastroscopy examinations reduced by 39% (p=0.02), and lower endoscopy procedures reduced by 57% (p<0.0001). Meanwhile, the number of advanced endoscopic procedures performed remained consistent with previous years. The indications for performance of gastroscopy and lower endoscopy were different in March 2020, while these remained unchanged for advanced endoscopic procedures.
Conclusions
The current policy appears to serve both our initial goals: protecting personnel and patients’ safety and minimizing potential damage from delayed endoscopic procedures. A longer term follow-up study is needed in order to fully analyze our results.

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Comparison of Fentanyl versus Meperidine in Combination with Midazolam for Sedative Colonoscopy in Korea: Gwan Woo Hong, Jun Kyu Lee, Jung Hyeon Lee, Ji Hun Bong, Sung Hun Choi, Hyeki Cho, Ji Hyung Nam, Dong Kee Jang, Hyoun Woo Kang, Jae Hak Kim, Yun Jeong Lim, Moon Soo Koh, Jin Ho Lee; Clin Endosc 2020;53(5):562-567. Published online July 3, 2020; DOI: https://doi.org/10.5946/ce.2020.022

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Background
/Aims: Combination of midazolam and opioids is used widely for endoscopic sedation. Compared with meperidine, fentanyl is reportedly associated with rapid recovery, turnover rate of endoscopy room, and quality of endoscopy. We compared fentanyl with meperidine when combined with midazolam for sedative colonoscopy.
Methods
A retrospective, cross-sectional, 1:2 matching study was conducted. Induction and recovery time were compared as the primary outcomes. Moreover, cecal intubation time, withdrawal time, total procedure time of colonoscopy, paradoxical reaction, adenoma detection rate, and adverse effect of midazolam or opioids were assessed as the secondary outcomes.
Results
A total of 129 subjects (43 fentanyl vs. 86 meperidine) were included in the analysis. The fentanyl group showed significantly more rapid induction time (4.5±2.7 min vs. 7.5±4.7 min, p<0.001), but longer recovery time (59.5±25.6 min vs. 50.3±10.9 min, p=0.030) than the meperidine group. In multivariate analysis, the induction time of the fentanyl group was 3.40 min faster (p<0.001), but the recovery time was 6.38 min longer (p=0.046) than that of the meperidine group. There was no difference in withdrawal time and adenoma detection rate between the two groups.
Conclusions
The fentanyl group had more rapid sedation induction time but longer recovery time than the meperidine group.

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Roberto Piro, Eleonora Casalini, Matteo Fontana, Carla Galeone, Patrizia Ruggiero, Sofia Taddei, Giulia Ghidoni, Giulia Patricelli, Nicola Facciolongo
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Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam
Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang
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Seon-Young Park, Jun Kyu Lee, Chang-Hwan Park, Byung-Wook Kim, Chang Kyun Lee, Hong Jun Park, Byung Ik Jang, Dong Uk Kim, Jin Myung Park, Jae Min Lee, Young Sin Cho, Hyung Ku Chon, Seung Young Seo, Woo Hyun Paik
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Endoscopic Findings in Patients Under the Age of 40 Years with Hematochezia in Singapore: Man Hon Tang, Fung Joon Foo, Chee Yung Ng; Clin Endosc 2020;53(4):466-470. Published online June 18, 2020; DOI: https://doi.org/10.5946/ce.2019.029

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Background
/Aims: Sigmoidoscopy is performed in most medical centers to evaluate the distal colons of young adults presenting with hematochezia who are at risk of developing proximal lesions. Colonoscopies offer more complete evaluations but are associated with a higher incidence of complications and possible low yield.
Methods
An analysis was conducted on colonoscopies performed in our center on patients 40 years of age or younger. The study population was sub-divided into 2 age groups for analysis: <30 years of age and 30–39 years of age.
Results
We recruited 453 patients for the study. Patients were 115 and 338 individuals that were <30 and 30–39 years of age, respectively. Hemorrhoids was identified as the cause of bleeding in the majority of cases. The overall incidence of polyps was 6.5%; this was significantly higher in the 30–39 age group (7.4% vs. 1.7%, p=0.026). There were two cases of advanced/malignant polyps. While the majority of the polyps were in the distal colon, 28% of the polyps in the older age group were found in the proximal colon. There was one case of colonic perforation.
Conclusions
Colonic polyps are more prevalent in patients aged 30–39. Colonoscopies should be considered for patients over the age of 30 with rectal bleeding.

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Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps
Zhiang Li, Fei Yu, Chaoqian Wang, Zhang Du
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Tuane Colles, Patrícia K. Ziegelmann, Daniel C. Damin
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Usefulness of Colonoscopy in Patients with Hematochezia Aged under 40 Years
Hee Chan Yang, Sang Wook Kim
Clinical Endoscopy.2020; 53(4): 385. CrossRef

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Review

Trends of Colorectal Cancer Prevalence in Kazakhstan Related to Screening: Alma Zhylkaidarova, Dilyara Kaidarova, Kanat Batyrbekov, Oxana Shatkovskaya, Dinara Begimbetova; Clin Endosc 2021;54(1):32-37. Published online May 25, 2020; DOI: https://doi.org/10.5946/ce.2019.198

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We carried out an analysis of the total incidence of colon cancer throughout Kazakhstan. Retrospectively, according to the regional reports on endoscopic screening, the study showed an increase in the age-related incidence of colorectal cancer (CRC) cases from 2004–2008 to 2009–2014. The peak of morbidity in both periods was noted in the age category of >70 years. The indicators of the territorial distribution of CRC incidence make it possible to divide the regions into areas with low or high rates of CRC. Specific indicators showed newly diagnosed cases of CRC stages I, II, III, and IV in 2004–2018. The incidence rates of stages I and II showed a two-fold increase (35%–67.4%) and the incidence of stage IV showed a decline from 19.3% to 13.1% and of stage III from 45.7% to 19.5% from 2004 to 2018, respectively. An analysis of CRC incidence throughout Kazakhstan showed an increase in the overall incidence. Since population-based CRC screening was introduced in 2011, the morbidity was found to increase for stages I and II.

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Original Article

Comparison of Oral Sulfate Solution and Polyethylene Glycol Plus Ascorbic Acid on the Efficacy of Bowel Preparation: Ji Hyung Nam, Seok Bo Hong, Yun Jeong Lim, Seongju Lee, Hyoun Woo Kang, Jae Hak Kim, Jin Ho Lee; Clin Endosc 2020;53(5):568-574. Published online April 24, 2020; DOI: https://doi.org/10.5946/ce.2019.209

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Background
/Aims: The quality of bowel preparation is one of the quality indicators for colonoscopy. The aim of this study was to compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol plus ascorbic acid (PEG-AA) for bowel preparation.
Methods
The study involved 167 patients who underwent diagnostic colonoscopies. Inadequate bowel preparation was defined as any score of ≤1 in each colon section based on the Boston Bowel Preparation Scale. Multivariate logistic regression was used to compare the efficacy of OSS and PEG-AA. Subgroup analyses were performed based on patient characteristics.
Results
Overall, 106 (63.5%) patients received OSS, and 61 (36.5%) patients received PEG-AA. The rate of inadequate bowel preparation was 12.3% in patients receiving OSS and 32.8% in patients receiving PEG-AA (p=0.001). OSS (odds ratio [OR] = 0.26; p=0.003) and morning examination (OR=0.11; p=0.038) were significantly associated with efficient bowel preparation. The efficacy of OSS compared with PEG-AA was only significant in patients ≥50 years of age vs. <50 years of age (OR=0.13; p=0.001 vs. OR=0.96; p=0.959) and female vs. male patients (OR=0.06; p=0.002 vs. OR=0.58; p=0.339).
Conclusions
OSS was significantly more efficient for bowel preparation than PEG-AA, especially in patients ≥50 years of age and female patients. Morning examination led to a good quality of bowel preparation, irrespective of the preparation regimen.

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Focused Review Series: Application of Artificial Intelligence in GI Endoscopy

Artificial Intelligence in Gastrointestinal Endoscopy: Alexander P. Abadir, Mohammed Fahad Ali, William Karnes, Jason B. Samarasena; Clin Endosc 2020;53(2):132-141. Published online March 30, 2020; DOI: https://doi.org/10.5946/ce.2020.038

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Artificial intelligence (AI) is rapidly integrating into modern technology and clinical practice. Although in its nascency, AI has become a hot topic of investigation for applications in clinical practice. Multiple fields of medicine have embraced the possibility of a future with AI assisting in diagnosis and pathology applications.
In the field of gastroenterology, AI has been studied as a tool to assist in risk stratification, diagnosis, and pathologic identification. Specifically, AI has become of great interest in endoscopy as a technology with substantial potential to revolutionize the practice of a modern gastroenterologist. From cancer screening to automated report generation, AI has touched upon all aspects of modern endoscopy.
Here, we review landmark AI developments in endoscopy. Starting with broad definitions to develop understanding, we will summarize the current state of AI research and its potential applications. With innovation developing rapidly, this article touches upon the remarkable advances in AI-assisted endoscopy since its initial evaluation at the turn of the millennium, and the potential impact these AI models may have on the modern clinical practice. As with any discussion of new technology, its limitations must also be understood to apply clinical AI tools successfully.

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Daniela Cornelia Lazăr, Mihaela Flavia Avram, Alexandra Corina Faur, Adrian Goldiş, Ioan Romoşan, Sorina Tăban, Mărioara Cornianu
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Case Report

Acute Pancreatitis: A Rare Post-Colonoscopy Sequela: Sujit P. Nair, Prasanta Debnath, Suhas Udgirkar, Parmeshwar Junare, Sanjay Chandnani, Shubham Jain, Vinay B. Pawar, Pravin M. Rathi; Clin Endosc 2020;53(5):611-614. Published online February 12, 2020; DOI: https://doi.org/10.5946/ce.2019.151

Abstract PDF PubReader ePub

Abdominal pain is a common but benign symptom after colonoscopy. We report a case of acute pancreatitis that occurred just after an elective screening colonoscopy; this is a rare event with very few reported cases. A healthy, asymptomatic male underwent screening colonoscopy at our center and developed abdominal pain and emesis after the procedure. An abdominal X-ray ruled out perforation but laboratory tests revealed elevated levels of amylase and lipase. The patient had no etiological risk factors for pancreatitis. The presumed mechanism of pancreatitis in this case is mechanical and pressure trauma from excessive insufflation, external abdominal pressure, and repeated withdrawal of the colonoscope due to tight angulation of the splenic flexure, a structure that is in close proximity to the pancreatic tail. Acute pancreatitis should be considered in the differential diagnosis of patients who present with abdominal pain after colonoscopy once more common etiologies have been excluded.

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Aggravated pancreatitis after performing a colonoscopy
Han‐Lin Liao, Tyng‐Yuan Jang
Advances in Digestive Medicine.2024;[Epub] CrossRef
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Saima H Shawl, Usama Bilal, Chandra Essar Mal, Veera Durga Vaishnavi Kurra, Romil Singh
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CT imaging findings of complications of optical colonoscopy
Abhishek Keraliya, Hei Shun Yu, Jennifer W. Uyeda
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Original Article

Endocuff-Assisted versus Cap-Assisted Colonoscopy Performed by Trainees: A Retrospective Study: Yutaka Okagawa, Tetsuya Sumiyoshi, Yusuke Tomita, Shutaro Oiwa, Fumihiro Ogata, Takashi Jin, Masahiro Yoshida, Ryoji Fujii, Takeyoshi Minagawa, Kohtaro Morita, Hideyuki Ihara, Michiaki Hirayama, Hitoshi Kondo; Clin Endosc 2020;53(3):339-345. Published online January 10, 2020; DOI: https://doi.org/10.5946/ce.2019.124

Abstract PDF PubReader ePub

Background
/Aims: The adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The effcacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the effcacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the effcacy between EAC and CAC in trainees.
Methods
This was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups.
Results
The ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group.
Conclusions
Our results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees.

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The impact of EndoCuff-assisted colonoscopy on the polyp detection rate: A cross-over randomized back-to-back study
Mohammed Sherif Naguib, Ahmed Khairy, Hany Shehab, Hazem Abosheaishaa, Abdel Meguid Kassem
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Tae-Geun Gweon, Sang-Bum Kang
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Ai Li, Jing‐Ze Yang, Xiao‐Xiao Yang, Bing‐Cheng Feng, Ming‐Ming Zhang, Jun‐Yan Qu, Ru‐Chen Zhou, Peng Wang, Li‐Xiang Li, Xiu‐Li Zuo, Yan‐Qing Li
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Review

Endoscopic Management of Post-Polypectomy Bleeding: Aditya Gutta, Mark A. Gromski; Clin Endosc 2020;53(3):302-310. Published online September 17, 2019; DOI: https://doi.org/10.5946/ce.2019.062

Abstract PDF PubReader ePub

Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.

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