Focused Review Series: Endoscopic Submucosal Dissection for Colorectal Tumors
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Management of Complications of Colorectal Submucosal Dissection
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Eun Ran Kim, Dong Kyung Chang
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Clin Endosc 2019;52(2):114-119. Published online March 29, 2019
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DOI: https://doi.org/10.5946/ce.2019.063
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Abstract
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- Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure- related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication.
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Commentary
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How to Detect Sessile Serrated Adenoma/Polyps
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Eun Ran Kim, Dong Kyung Chang
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Clin Endosc 2018;51(4):313-314. Published online July 31, 2018
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DOI: https://doi.org/10.5946/ce.2018.108
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Dan Qiao, Xiao-Yan Liu, Lie Zheng, Ya-Li Zhang, Ren-Ye Que, Bing-Jing Ge, Hong-Yan Cao, Yan-Cheng Dai
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Focused Review Series: Current Issues and Future Directions of Small Bowel Endoscopic Evaluation
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The Role of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding
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Yang Won Min, Dong Kyung Chang
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Clin Endosc 2016;49(1):16-20. Published online January 28, 2016
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DOI: https://doi.org/10.5946/ce.2016.49.1.16
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Abstract
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- Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention.
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Original Articles
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Indications for Detection, Completion, and Retention Rates of Small Bowel Capsule Endoscopy Based on the 10-Year Data from the Korean Capsule Endoscopy Registry
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Yun Jeong Lim, Oh Young Lee, Yoon Tae Jeen, Chi Yeon Lim, Dae Young Cheung, Jae Hee Cheon, Byong Duk Ye, Hyun Joo Song, Jin Su Kim, Jae Hyuk Do, Kwang Jae Lee, Ki-Nam Shim, Dong Kyung Chang, Cheol Hee Park, Byung Ik Jang, Jeong Seop Moon, Hoon Jai Chun, Myung-Gyu Choi, Jin Oh Kim, Korean Gut Image Study Group
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Clin Endosc 2015;48(5):399-404. Published online September 30, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.5.399
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Abstract
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- Background/Aims
Capsule endoscopy (CE) is widely used. However, CE has limitations including incomplete examination, inadequate bowel preparation, and retention. The aim of this study was to estimate the indications for and detection, completion, and retention rates of small intestine CE based on the 10-year data from the Korean Capsule Endoscopy Registry.
MethodsTwenty-four hospitals participated in this study. Clinical information, such as reasons for CE, method and quality of bowel preparation, and incomplete examination and capsule retention rates, was collected and analyzed.
ResultsA total of 2,914 CEs were registered. The most common reason for CE was obscure gastrointestinal bleeding (59%). Significant lesions were detected in 66% of cases. Positive CE diagnosis occurred in 63% of cases. The preparation method did not significantly affect the quality of bowel preparation for CE. The overall incomplete rate was 33%, and was high in the elderly and those with poor bowel preparation. Capsule retention was 3% and high in patients with small bowel tumors and Crohn's disease and in children under 10 years of age.
ConclusionsCE is a valuable technique; while the overall detection rate is high, incompletion and retention rates are also relatively high. CE should be carefully considered in the elderly and children less than 10 years of age, as well as in patients with small bowel tumors and Crohn's disease.
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Usefulness of Ready-to-Use 0.4% Sodium Hyaluronate (Endo-Ease) in the Endoscopic Resection of Gastrointestinal Neoplasms
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Eun Ran Kim, Yun Gyoung Park, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim, Jung Ho Park, Dong Il Park, Dong Kyung Chang
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Clin Endosc 2015;48(5):392-398. Published online September 30, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.5.392
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- Background/Aims
Commercially available sodium hyaluronate solutions are usually too thick to inject through catheters and need dilution with normal saline (NS) before use, which increases the risk of contamination. We evaluated the usefulness of ready-to-use 0.4% sodium hyaluronate, Endo-Ease (EE; UNIMED Pharm. Inc., Seoul, Korea).
MethodsWe performed a prospective multicenter randomized study from May 2011 to September 2012. Patients requiring endoscopic resection (ER) for gastric or colorectal neoplasm at two referral hospitals were enrolled.
ResultsOne hundred fifty-four patients (72 with a gastric neoplasm and 82 with a colorectal neoplasm) were included in intention-to-treat analysis. Thirty-seven gastric neoplasms and 43 colorectal neoplasms were enrolled in the EE group. The usefulness rate was significantly higher in the EE group than in the NS group (89.2% vs. 60.0% for gastric neoplasms and 95.3% vs. 67.7% for colorectal neoplasms, p<0.001). In the EE group, the ease of mucosal resection was significantly higher than in the NS group (p<0.001). The injected volume was smaller in the EE group than in the NS group (p<0.05).
ConclusionsThe use of EE reduced the need for additional injections and improved the ease of ER. A submucosal injection of EE is useful for the ER of both gastric and colorectal neoplasms.
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Commentary
Reviews
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Stricture Occurring after Endoscopic Submucosal Dissection for Esophageal and Gastric Tumors
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Gwang Ha Kim, Sam Ryong Jee, Jae Young Jang, Sung Kwan Shin, Kee Don Choi, Jun Haeng Lee, Sang Gyun Kim, Jae Kyu Sung, Suck Chei Choi, Seong Woo Jeon, Byung Ik Jang, Kyu Chan Huh, Dong Kyung Chang, Sung-Ae Jung, Bora Keum, Jin Woong Cho, Il Ju Choi, Hwoon-Yong Jung, Korean ESD Study Group
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Clin Endosc 2014;47(6):516-522. Published online November 30, 2014
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DOI: https://doi.org/10.5946/ce.2014.47.6.516
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Abstract
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Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.
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Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding
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Ki-Nam Shim, Jeong Seop Moon, Dong Kyung Chang, Jae Hyuk Do, Ji Hyun Kim, Byung Hoon Min, Seong Ran Jeon, Jin-Oh Kim, Myung-Gyu Choi, Korean Gut Image Study Group
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Clin Endosc 2013;46(1):45-53. Published online January 31, 2013
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DOI: https://doi.org/10.5946/ce.2013.46.1.45
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Abstract
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Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal Endoscopy. Operation teams for developing the guideline were organized into four areas: obscure gastrointestinal bleeding, small bowel preparation, Crohn's disease, and small bowel tumor. A total of 20 key questions were selected. In preparing this guideline, MEDLINE, Cochrane library, KMbase, KISS, and KoreaMed literature searches were performed. After writing a draft of the guideline, opinions from various experts were reflected before approving the final document. The guideline should be regarded as recommendations only to gastroenterologists in providing care to their patients. These are not absolute rules and should not be construed as establishing a legal standard of care. Although further revision may be necessary as new data appear, this guideline is expected to play a role for adequate diagnostic approaches of various small bowel diseases.
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Special Issue Articles of IDEN 2012
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Current Status of Colorectal Endoscopic Submucosal Dissection in Korea
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Dong Kyung Chang
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Clin Endosc 2012;45(3):288-289. Published online August 22, 2012
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DOI: https://doi.org/10.5946/ce.2012.45.3.288
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Abstract
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Colorectal endoscopic submucosal dissection (ESD) is not yet fully popularized in Korea, but is increasing steadily. The outcomes of colorectal ESD in Korea are comparable to those in Japan and other countries. ESD-related complication rates are decreasing as experiences accumulate. Particularly for rectal laterally spreading tumors, ESD is becoming more prevalent than transanal endoscopic microsurgery. Standard indication, qualified training system, and full medical insurance coverage should be established for the procedure to become popular in the long run.
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Citations
Citations to this article as recorded by

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