Clinical Endoscopy

Original Articles

Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study: Dong Seok Lee, Gin Hyug Lee, Sang Gyun Kim, Kook Lae Lee, Ji Won Kim, Ji Bong Jeong, Yong Jin Jung, Hyoun Woo Kang; Clin Endosc 2023;56(5):604-612. Published online May 18, 2023; DOI: https://doi.org/10.5946/ce.2022.163

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Background
/Aims: We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists.
Methods
An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. Between March 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-related factors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts.
Results
Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator had several benefits, including better marking of the target lesion’s limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulness of the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforation rate decreased after 4 sessions (12 procedures).
Conclusions
We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performing real-time ESD procedures in patients.

Citations

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The Current Landscape of Endoscopic Submucosal Training in the United States
Mike T. Wei, Shai Friedland, Joo Ha Hwang
Current Gastroenterology Reports.2025;[Epub] CrossRef
Meaningful progress towards a high-fidelity endoscopic submucosal dissection training simulator model
Gin Hyug Lee, So Young Byun
Clinical Endoscopy.2025; 58(1): 77. CrossRef
There is no royal road: a shortcut for endoscopic submucosal dissection training
Seong Woo Jeon
Clinical Endoscopy.2023; 56(5): 590. CrossRef

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Efficacy of an assistive guide tube for improved endoscopic access to gastrointestinal lesions: an in vivo study in a porcine model: Dong Seok Lee, Jeong-Sik Byeon, Sang Gyun Kim, Ji Won Kim, Kook Lae Lee, Ji Bong Jeong, Yong Jin Jung, Hyoun Woo Kang; Clin Endosc 2024;57(1):82-88. Published online April 18, 2023; DOI: https://doi.org/10.5946/ce.2022.161

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Guide tube-assisted endoscopy for procedures that require repeated endoscopic access is safer and more effective than conventional endoscopy. However, its effectiveness has not been confirmed in animal studies. We assessed the usefulness of guide tube-assisted endoscopic procedures in an in vivo porcine model.
Methods
Five different guide tube-assisted endoscopic procedures were performed by experienced endoscopists on a pig weighing 32 kg. To evaluate the efficacy of these procedures, we compared the endoscopic approach time when a guide tube was used to that when it was not. Additional endoscopic procedures using a guide tube were performed, including multiple foreign body extractions, multiple polypectomies, and multiple submucosal dissections. To evaluate safety, we compared the insertion force into the proximal esophagus between the guide tube and conventional overtube methods.
Results
Using the endoscopic approach with a guide tube required a shorter average approach time to reach the three target lesions than when using the endoscopic approach without a guide tube (p<0.001). Compared to the conventional overtube method, the guide tube method produced a lower average resistance during insertion into the upper esophagus (p<0.001).
Conclusions
Guide tube-assisted endoscopic procedures are effective and safe for repeated endoscopic access in an in vivo porcine model.

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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, the Committees of Quality Management and Conscious Sedation of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2022;55(2):234-239. Published online October 12, 2021; DOI: https://doi.org/10.5946/ce.2021.126

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Background
/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions.
Methods
This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction.
Results
A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups.
Conclusions
Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

Citations

Citations to this article as recorded by

Insights into anesthesia administration for elderly individuals undergoing painless gastroenteroscopy: A bibliometric study
Gang Wang, Biao Zhen, Jia-Jun Li, Chun-Nv Jin, Jun Jia, Bo-Hai Liu, Yan-Hui Bai
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea
Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee
Clinical Endoscopy.2024; 57(4): 476. CrossRef
The effective dose of butorphanol tartrate in patients of different ages undergoing painless gastroscopy
Yaorui Sun, Shujiao Liu, Wenli Si, Quanyi Zhang, Fei Yu, Ming Su, Chao Sun
Journal of International Medical Research.2024;[Epub] CrossRef
Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy: a cohort study
Yuan-rui Zhao, Ke-sheng Huang, Guo Hou, Lan Yao, Li-ping Lu, Song Xu, Ying-tao Lian, Zhun Yao, Zhui Yu
World Journal of Emergency Medicine.2023; 14(1): 31. CrossRef
Effective dose of propofol combined with a low-dose esketamine for gastroscopy in elderly patients: A dose finding study using dixon’s up-and-down method
Yuling Zheng, Yafei Xu, Bixin Huang, Ying Mai, Yiwen Zhang, Zhongqi Zhang
Frontiers in Pharmacology.2022;[Epub] CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef

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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.

Citations

Citations to this article as recorded by

Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam
Roberto Piro, Eleonora Casalini, Matteo Fontana, Carla Galeone, Patrizia Ruggiero, Sofia Taddei, Giulia Ghidoni, Giulia Patricelli, Nicola Facciolongo
Thoracic Cancer.2022; 13(4): 533. CrossRef
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
Clinical Endoscopy.2022; 55(2): 234. CrossRef
[Retracted] Efficacy of Analgesic Propofol/Esketamine and Propofol/Fentanyl for Painless Induced Abortion: A Randomized Clinical Trial
Naixing Xin, Wei Yan, Shuangfen Jin, Min Tang
BioMed Research International.2022;[Epub] CrossRef
Endoscopist-Driven Sedation Practices in South Korea: Re-evaluation Considering the Nationwide Survey in 2019
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
Gut and Liver.2022; 16(6): 899. CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef
Risk Factors for Prolonged Hospital Stay after Endoscopy
Toshihiro Nishizawa, Shuntaro Yoshida, Osamu Toyoshima, Tatsuya Matsuno, Masataka Irokawa, Toru Arano, Hirotoshi Ebinuma, Hidekazu Suzuki, Takanori Kanai, Kazuhiko Koike
Clinical Endoscopy.2021; 54(6): 851. CrossRef

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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.

Citations

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Efficacy of Oral Sulfate Tablet and 2 L-Polyethylene Glycol With Ascorbic Acid for Bowel Preparation: A Prospective Randomized KASID Multicenter Trial
Yunho Jung, Hyun Gun Kim, Dong-Hoon Yang, Hyoun Woo Kang, Jae Jun Park, Dong Hoon Baek, Jaeyoung Chun, Tae-Geun Gweon, Hyeon Jeong Goong, Min Seob Kwak, Hyun Jung Lee, Soo-Kyung Park, Jong Hoon Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
Observation of the application effect of low-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) combined with ascorbic acid tablets in bowel preparation for colonoscopy in hospitalized patients
Le-Can Wu, En-Dian Zheng, Hao-Yue Sun, Xi-Zhou Lin, Ju-Yi Pan, Xiao-Xiao Lin
Frontiers in Oncology.2023;[Epub] CrossRef
Comparison of the efficacy and safety of an oral sulfate solution and 3-L polyethylene glycol on bowel preparation before colonoscopy: a phase III multicenter randomized controlled trial
Peng Pan, Shengbing Zhao, Shuling Wang, Yihang Song, Lun Gu, Youxiang Chen, Jiangrong Zhao, Lungen Lu, Xiuling Li, Hongzhi Xu, Gaifang Liu, Yanqing Li, Le Xu, Jiangbin Wang, Zhaoshen Li, Yu Bai
Gastrointestinal Endoscopy.2023; 98(6): 977. CrossRef
Randomized trial of oral sulfate solution versus polyethylene glycol–ascorbic acid for bowel cleansing in elderly people
Seung‐Joo Nam, Sung Chul Park, Sung Joon Lee, Sang Hoon Lee, Ji Hyun Kim, Chang Seok Bang, Hyun Il Seo
Journal of Gastroenterology and Hepatology.2022; 37(2): 319. CrossRef
Comparison of 2 L Polyethylene Glycol Plus Ascorbic Acid and 4 L Polyethylene Glycol in Elderly Patients Aged 60–79: A Prospective Randomized Study
Sung Hoon Jung, Chul-Hyun Lim, Tae-Geun Gweon, Jinsu Kim, Jung Hwan Oh, Kyu-Tae Yoon, Jee Young An, Jeong‑Seon Ji, Hwang Choi
Digestive Diseases and Sciences.2022; 67(10): 4841. CrossRef
Oral sulfate solution benefits polyp and adenoma detection during colonoscopy: Meta‐analysis of randomized controlled trials
Cheng Chen, Mengyang Shi, Zhongli Liao, Weiqing Chen, Yongzhong Wu, Xu Tian
Digestive Endoscopy.2022; 34(6): 1121. CrossRef
Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study
Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
Journal of Crohn's and Colitis.2022; 16(11): 1706. CrossRef
How to Choose the Optimal Bowel Preparation Regimen for Colonoscopy
Ji Eun Na, Eun Ran Kim
The Ewha Medical Journal.2021; 44(4): 122. CrossRef
Oral Sulfate Solution is as Effective as 2 L Polyethylene Glycol Plus Ascorbic Acid
Sung Hyun Shin, Kwang An Kwon
Clinical Endoscopy.2020; 53(5): 503. CrossRef

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Focused Review Series: Updates on Gastrointestinal and Pancreaticobiliary Stents

Upper Gastrointestinal Stent Insertion in Malignant and Benign Disorders: Hyoun Woo Kang, Sang Gyun Kim; Clin Endosc 2015;48(3):187-193. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.187

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Upper gastrointestinal (GI) stents are increasingly being used to manage upper GI obstructions. Initially developed for palliative treatment of esophageal cancer, upper GI stents now play an emerging role in benign strictures of the upper GI tract. Because recurrent obstruction and stent-related complications are common, new modifications of stents have been implemented. Self-expandable metal stents (SEMS) have replaced older plastic stents. In addition, newly designed SEMS have been developed to prevent complications. This review provides an overview of the various types, indications, methods, complications, and clinical outcomes of upper GI stents in a number of malignant and benign disorders dividing the esophagus and gastroduodenum.

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Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
Sun Gyo Lim, Chan Gyoo Kim
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A. K. Çağatay, Süleyman Sayar, Ebru Tarıkçı Kılıç, Resul Kahraman, Oğuzhan Öztürk, Kamil Özdil
Indian Journal of Palliative Care.2023; 29: 64. CrossRef
CIRSE Standards of Practice on Oesophageal and Gastroduodenal Stenting
Athanasios Diamantopoulos, Shuvro Roy Choudhury, Farah Gillian Irani, Hugo Rio Tinto, Tarun Sabharwal
CardioVascular and Interventional Radiology.2023; 46(5): 562. CrossRef
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Rui Silva
GE - Portuguese Journal of Gastroenterology.2023; 30(Suppl. 1): 35. CrossRef
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Wangqu Liu, Soo Jin Choi, Derosh George, Ling Li, Zijian Zhong, Ruili Zhang, Si Young Choi, Florin M. Selaru, David H. Gracias
Expert Opinion on Drug Delivery.2023; 20(12): 1801. CrossRef
Endoscopic Procedures for Upper Gastrointestinal Tract Lesions and a Brief Review of Literature
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Istanbul Medical Journal.2022; 23(2): 154. CrossRef
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