Clinical Endoscopy

Review

Recent advances in surveillance colonoscopy for dysplasia in inflammatory bowel disease: Soo-Young Na, Won Moon; Clin Endosc 2022;55(6):726-735. Published online November 18, 2022; DOI: https://doi.org/10.5946/ce.2022.132

Inflammatory bowel disease (IBD) has a global presence with rapidly increasing incidence and prevalence. Patients with IBD including those with ulcerative colitis and Crohn’s disease have a higher risk of developing colorectal cancer (CRC) compared to the general population. Risk factors for CRC in patients with IBD include long disease duration, extensive colitis, primary sclerosing cholangitis, family history of CRC, stricture, and prior dysplasia. Surveillance colonoscopy for CRC in patients with IBD should be tailored to individualized risk factors and requires careful monitoring every year to every five years. The current surveillance techniques are based on several guidelines. Chromoendoscopy with targeted biopsy is being recommended increasingly, and high-definition colonoscopy is gradually replacing standard-definition colonoscopy. However, it remains unclear whether chromoendoscopy, virtual chromoendoscopy, or white-light endoscopy has better efficiency when a high-definition scope is used. With the development of new endoscopic instruments and techniques, the paradigm of surveillance strategy has gradually changed. In this review, we discuss cutting-edge surveillance colonoscopy in patients with IBD including a review of literature.

Citations

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Potential Oral Microbial Markers for Differential Diagnosis of Crohn’s Disease and Ulcerative Colitis Using Machine Learning Models
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American Journal of Gastroenterology.2023; 118(10): 1748. CrossRef

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Original Article

Efficacy and Safety of Etomidate in Comparison with Propofol or Midazolam as Sedative for Upper Gastrointestinal Endoscopy: Jae Hyun Kim, Sanghwan Byun, Youn Jung Choi, Hye Jung Kwon, Kyoungwon Jung, Sung Eun Kim, Moo In Park, Won Moon, Seun Ja Park; Clin Endosc 2020;53(5):555-561. Published online March 31, 2020; DOI: https://doi.org/10.5946/ce.2019.210

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Background
/Aims: In this study, we compared the efficacy and safety of etomidate with those of propofol or midazolam for the maintenance of sedation during endoscopy.
Methods
The study enrolled patients who underwent sedative endoscopy in our hospital and divided them into three groups. Patients in each group were administered midazolam as induction therapy and were subsequently administered either midazolam (M + M group), propofol (M + P group), or etomidate (M + E group) as maintenance medication. The primary outcome was overall cardiovascular and respiratory adverse events.
Results
In total, 105 patients who underwent sedative endoscopic examination were enrolled. The outcomes related to the procedure and sedation were not significantly different among the groups. Overall cardiovascular and respiratory adverse events were observed in 9 patients (25.7%) in the M + M group, 8 patients (23.5%) in the M + P group, and 10 patients (27.8%) in the M + E group. The logistic regression analysis revealed that etomidate use was not an independent risk factor for overall cardiovascular and respiratory adverse events.
Conclusions
The outcomes following the use of etomidate for maintenance after induction with midazolam for sedation in upper gastrointestinal endoscopy were not inferior to those following midazolam or propofol use from the perspectives of safety and efficacy.

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Comparison of ciprofol–alfentanil and propofol–alfentanil sedation during bidirectional endoscopy: A prospective, double-blind, randomised, controlled trial
Jiqiang Zhang, Ruijuan Liu, Ruirui Bi, Xia Li, Mengjun Xu, Lijuan Li, Yuxi su, Wenjun Yan
Digestive and Liver Disease.2024; 56(4): 663. CrossRef
Effects of Earmuffs and Eye Masks on Propofol Sedation during Spinal Anesthesia for Orthopedic Surgery: A Randomized Controlled Trial
Jin-Woo Park, Sung Il Bae, Jungyul Ryu, Seung Hyun Chung, Sang-Hwan Do
Journal of Clinical Medicine.2023; 12(3): 899. CrossRef
Effect of intravenous anesthesia by etomidate in combination with propofol on gastrointestinal endoscopy
Bo CHEN, Ke ZHANG, Mingshuai YU
Minerva Surgery.2023;[Epub] CrossRef
New sedatives and analgesic drugs for gastrointestinal endoscopic procedures
Jae Min Lee, Yehyun Park, Jin Myung Park, Hong Jun Park, Jun Yong Bae, Seung Young Seo, Jee Hyun Lee, Hyung Ku Chon, Jun-Won Chung, Hyun Ho Choi, Jun Kyu Lee, Byung-Wook Kim
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Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
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Comparative Safety Profiles of Sedatives Commonly Used in Clinical Practice: A 10-Year Nationwide Pharmacovigilance Study in Korea
Yeo-Jin Choi, Seung-Won Yang, Won-Gun Kwack, Jun-Kyu Lee, Tae-Hee Lee, Jae-Yong Jang, Eun-Kyoung Chung
Pharmaceuticals.2021; 14(8): 783. CrossRef
Physical and Chemical Compatibility of Etomidate and Propofol Injectable Emulsions
Chunling Wang, Shengnan Wang, Cuishuan Wu, Li Lei, Dong-Xin Wang, Qiang Zhang
Pharmacology.2021; 106(11-12): 644. CrossRef

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Case Report

Is it Possible to Successfully Treat Locally Advanced Colon Cancer Using Pre-Operative Chemoradiotherapy?: Ji Hun Choi, Jae Hyun Kim, Won Moon, Seung Hun Lee, Sung Uhn Baek, Byung Kwon Ahn, Jung Gu Park, Seun Ja Park; Clin Endosc 2019;52(2):191-195. Published online November 9, 2018; DOI: https://doi.org/10.5946/ce.2018.088

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Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.

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Evaluation of colon cancer prognostic factors by CT and MRI: an up-to-date review
Ruggeri B. Guimarães, Eduardo O. Pacheco, Serli N. Ueda, Dario A. Tiferes, Fernanda L. Mazzucato, Aley Talans, Ulysses S. Torres, Giuseppe D’Ippolito
Abdominal Radiology.2024;[Epub] CrossRef

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Original Article

Effect of Sending Educational Video Clips via Smartphone Mobile Messenger on Bowel Preparation before Colonoscopy: Sung Chan Jeon, Jae Hyun Kim, Sun Jung Kim, Hye Jung Kwon, Youn Jung Choi, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park; Clin Endosc 2019;52(1):53-58. Published online August 29, 2018; DOI: https://doi.org/10.5946/ce.2018.072

Abstract PDF PubReader ePub

Background
/Aim: We aimed to evaluate the efficacy of sending educational video clips via smartphone mobile messenger (SMM) on enhancing bowel preparation before colonoscopy.
Methods
This was a prospective, endoscopist-blinded, randomized controlled study. Patients in the SMM group received two video clips sent via SMM that explained the diet and regimen for bowel preparation, whereas those in the control group did not receive any video clips. We compared the quality of bowel preparation between the two groups, which was assessed by an endoscopist using the Ottawa scale.
Results
Between August and November 2014, 140 patients in the SMM group and 141 patients in the control group underwent colonoscopic examination. The total Ottawa score of the SMM group was significantly lower than that of the control group (5.47±1.74 vs. 5.97±1.78, p=0.018). These results were particularly prominent in the younger age group; the total Ottawa score of patents in the SMM group aged <40 years was significantly lower than that of patients in the control group aged <40 years (5.10±1.55 vs. 6.22±2.33, p=0.034).
Conclusions
We demonstrated that sending educational video clips via SMM could result in better bowel preparation, especially in the younger age group.

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Reviews

Chronological Review of Endoscopic Indices in Inflammatory Bowel Disease: Joon Seop Lee, Eun Soo Kim, Won Moon; Clin Endosc 2019;52(2):129-136. Published online August 21, 2018; DOI: https://doi.org/10.5946/ce.2018.042

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD) is considered a chronic condition characterized by mucosal or transmural inflammation in the gastrointestinal tract. Endoscopic diagnosis and surveillance in patients with IBD have become crucial. In addition, endoscopy is a useful modality in estimation and evaluation of the disease, treatment results, and efficacy of treatment delivery and surveillance. In relation to these aspects, endoscopic disease activity has been commonly estimated in clinical practices and trials.
At present, many endoscopic indices of ulcerative colitis have been introduced, including the Truelove and Witts Endoscopy Index, Baron Index, Powell-Tuck Index, Sutherland Index, Mayo Clinic Endoscopic Sub-Score, Rachmilewitz Index, Modified Baron Index, Endoscopic Activity Index, Ulcerative Colitis Endoscopic Index of Severity, Ulcerative Colitis Colonoscopic Index of Severity, and Modified Mayo Endoscopic Score. Endoscopic indices have been also suggested for Crohn’s disease, such as the Crohn’s Disease Endoscopic Index of Severity, Simple Endoscopic Score for Crohn’s Disease, and Rutgeerts Postoperative Endoscopic Index. However, most endoscopic indices have not been validated owing to the complexity of their parameters and inter-observer variations. Therefore, a chronological approach for understanding the various endoscopic indices relating to IBD is needed to improve the management.

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Optimal Diagnostic Approaches for Patients with Suspected Small Bowel Disease: Jae Hyun Kim, Won Moon; Clin Endosc 2016;49(4):364-369. Published online June 22, 2016; DOI: https://doi.org/10.5946/ce.2016.074

Abstract PDF PubReader ePub

While the domain of gastrointestinal endoscopy has made great strides over the last several decades, endoscopic assessment of the small bowel continues to be challenging. Recently, with the development of new technology including video capsule endoscopy, device-assisted enteroscopy, and computed tomography/magnetic resonance enterography, a more thorough investigation of the small bowel is possible. In this article, we review the systematic approach for patients with suspected small bowel disease based on these advanced endoscopic and imaging systems.

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Original Article

Observer Variability in Gastric Neoplasm Assessment Using the Vessel Plus Surface Classification for Magnifying Endoscopy with Narrow Band Imaging: Chan Hui Yoo, Moo In Park, Seun Ja Park, Won Moon, Hyung Hun Kim, Jun Young Song, Do Hyun Kim; Clin Endosc 2014;47(1):74-78. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.74

Abstract PDF PubReader ePub

Background/Aims

Recent studies have demonstrated that magnifying endoscopy with narrow band imaging (ME-NBI) facilitates differentiation of early gastric cancer from gastric adenoma using vessel plus surface (VS) classification. This study estimated the interobserver and intraobserver agreement of endoscopists using the Yao VS classification system for the gastric mucosal surface.

Methods

We retrospectively reviewed patients who underwent endoscopic submucosal dissection or endoscopic mucosal resection, and selected cases in which preoperative ME-NBI was conducted. Before testing endoscopists, a 20-minute training module was given. Static ME-NBI images (n=47 cases) were presented to seven endoscopists (two experts and five trainees) who were asked to assess the images in 20 seconds using the Yao VS classification system. After 2 weeks, the endoscopists were asked to analyze the images again. The κ statistic was calculated for intraobserver and interobserver variability.

Results

The mean κ for intraobserver agreement was 0.69 (experts, 0.74; trainees, 0.64). The mean κ for interobserver agreement was 0.42 (experts, 0.49; trainees, 0.40).

Conclusions

We obtained reliable results as assessed by observer variability, with only brief training on VS classification. The VS classification appears to provide an objective assessment of ME-NBI for trainees who are not familiar with ME-NBI.

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Case Report

Successful Endoscopic Mucosal Resection of a Low Esophageal Carcinoid Tumor: Chang Sup Lim, Seun Ja Park, Moo In Park, Won Moon, Hyung Hun Kim, Jun Sik Lee, Bong Jin Kim, Dong Young Ku; Clin Endosc 2013;46(5):576-578. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.576

Abstract PDF PubReader ePub

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

Citations

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Harishankar Gopakumar, Vinay Jahagirdar, Jagadish Koyi, Dushyant Singh Dahiya, Hemant Goyal, Neil R. Sharma, Abhilash Perisetti
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A rare rarity: Neuroendocrine tumor of the esophagus
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Joel A. Friedlander, Quin Y. Liu, Benjamin Sahn, Koorosh Kooros, Catharine M. Walsh, Robert E. Kramer, Jenifer R. Lightdale, Julie Khlevner, Mark McOmber, Jacob Kurowski, Matthew J. Giefer, Harpreet Pall, David M. Troendle, Elizabeth C. Utterson, Herbert
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11 Crossref

Review

Optimal and Safe Bowel Preparation for Colonoscopy: Won Moon; Clin Endosc 2013;46(3):219-223. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.219

Abstract PDF PubReader ePub

Effective colonoscopy requires an adequate level of cleansing as a basic component. This review will describe a compact review about general considerations in bowel preparation for colonoscopy and specific considerations for various patients. A low-fiber diet instead of a regular diet on the day before colonoscopy is an independent predictor of adequate bowel preparation. Improved bowel cleansing does not result from the routine use of enemas or prokinetics in addition to oral bowel preparation. For morning colonoscopy, a split method of 4 L polyethylene glycol on the day before and the day of colonoscopy is recommended, while patients scheduled for afternoon colonoscopy typically receive a full method of 4 L polyethylene glycol on the day of the procedure. Valid alternatives are 2 L polyethylene glycol plus ascorbic acid or 2 L sodium picosulphate plus magnesium citrate. Although there are no statistically significant differences between polyethylene glycol and oral sodium phosphate for colon cleansing, polyethylene glycol-based bowel preparation is advisable in most situations because of safety concerns.

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Original Article

Effectiveness of Premedication with Pronase for Visualization of the Mucosa during Endoscopy: A Randomized, Controlled Trial: Gyu Jin Lee, Seun Ja Park, Sun Jung Kim, Hyung Hun Kim, Moo In Park, Won Moon; Clin Endosc 2012;45(2):161-164. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.161

Abstract PDF PubReader ePub

Background/Aims

Gastric mucus should be removed before endoscopic examination to increase visibility. In this study, the effectiveness of premedication with pronase for improving visibility during endoscopy was investigated.

Methods

From April 2010 to February 2011, 400 outpatients were randomly assigned to receive endoscopy with one of four premedications as follows: dimethylpolysiloxane (DMPS), pronase and sodium bicarbonate with 10 minutes premedication time (group A, n=100), DMPS and sodium bicarbonate with 10 minutes premedication time (group B, n=100), DMPS, pronase and sodium bicarbonate with 20 minutes premedication time (group C, n=100), and DMPS and sodium bicarbonate with 20 minute premedication time (group D, n=100). One endoscopist, who was unaware of the premedication types, calculated the visibility scores (range, 1 to 3) of the antrum, lower gastric body, upper gastric body and fundus. The sum of the scores from the four locations was defined as the total visibility score.

Results

Group C showed significantly lower scores than other groups (p=0.002). Group C also had the lowest frequency of flushing, which was significantly lower than that of group D. Groups C and D had significantly shorter durations of examination than groups A and B.

Conclusions

Using pronase 20 minutes before endoscopy significantly improved endoscopic visualization and decreased the frequency of water flushing.

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