Clinical Endoscopy

Review

Multidisciplinary and Multisociety Practice Guideline on Reprocessing Flexible Gastrointestinal Endoscopes and Endoscopic Accessories: Dae Young Cheung, Byung Ik Jang, Sang Wook Kim, Jie-Hyun Kim, Hyung Keun Kim, Jeong Eun Shin, Won Jae Yoon, Yong Kang Lee, Kwang Hyun Chung, Soo-Jeong Cho, Hyun Phil Shin, Sun Young Cho, Woon Geon Shin, Kee Don Choi, Byung-Wook Kim, Joong Goo Kwon, Hee Chan Yang, Tae-Geun Gweon, Hyun Gun Kim, Dong-Won Ahn, Kwang Bum Cho, Sun Hee Kim, Kyong Hwa Hwang, Hee Hyuk Im; Clin Endosc 2020;53(3):276-285. Published online May 29, 2020; DOI: https://doi.org/10.5946/ce.2020.106

The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.

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Dong Jun Oh, Yea Je Lee, Sang Hoon Kim, Joowon Chung, Hyun Seok Lee, Ji Hyung Nam, Yun Jeong Lim, Thomas Lui Ka Luen
PLOS ONE.2024; 19(5): e0295774. CrossRef
EUS-Guided Vascular Interventions: Recent Advances
Sahib Singh, Saurabh Chandan, Sumant Inamdar, Kambiz S. Kadkhodayan, Jahnvi Dhar, Jayanta Samanta, Antonio Facciorusso
Journal of Clinical Medicine.2024; 13(16): 4835. CrossRef
Current status of the gastric cancer screening program in Korea
Young-Il Kim, Il Ju Choi
Journal of the Korean Medical Association.2022; 65(5): 250. CrossRef
Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement
Enrique Rodríguez de Santiago, Mario Dinis-Ribeiro, Heiko Pohl, Deepak Agrawal, Marianna Arvanitakis, Robin Baddeley, Elzbieta Bak, Pradeep Bhandari, Michael Bretthauer, Patricia Burga, Leigh Donnelly, Axel Eickhoff, Bu'Hussain Hayee, Michal F. Kaminski,
Endoscopy.2022; 54(08): 797. CrossRef
Current Evidence for a Paradigm Shift in Gastric Cancer Prevention From Endoscopic Screening toHelicobacter pyloriEradication in Korea
Young-Il Kim, Il Ju Choi
Journal of Gastric Cancer.2022; 22(3): 169. CrossRef
General guideline in the endoscopy room to avoid air-borne infection during the COVID-19 pandemic
Kwang Hyun Chung, Soo-Jeong Cho
Clinical Endoscopy.2022; 55(5): 688. CrossRef
Efficacy of a novel channel-cleaning ball brush for endoscope reprocessing: a randomized controlled trial
Kwang Hyun Chung, Jeong Don Chae, Wonho Choe, Hyo Young Lee, Il Hwan Oh, Byoung Kwan Son
Clinical Endoscopy.2022; 55(5): 674. CrossRef
Endoscopes that Complete Pre-Cleaning may be Stored Overnight until Next Morning for the Subsequent Reprocessing
Soo-Jeong Cho
Clinical Endoscopy.2021; 54(4): 449. CrossRef
Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey
Giancarlo Spinzi, Angelo Milano, Piero Brosolo, Paola Da Massa Carrara, Maurizio Labardi, Alberto Merighi, Luisa Riccardi, Francesco Torresan, Maurizio Capelli
Endoscopy International Open.2021; 09(11): E1627. CrossRef
Sans Standardization: Effective Endoscope Reprocessing
Sameer K. Avasarala, Lawrence F. Muscarella, Atul C. Mehta
Respiration.2021; 100(12): 1208. CrossRef

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Original Article

Endoscopic Mucosal Resection with Circumferential Mucosal Incision for Colorectal Neoplasms: Comparison with Endoscopic Submucosal Dissection and between Two Endoscopists with Different Experiences: Dong-Hoon Yang, Min-Seob Kwak, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Hyun Gun Kim, Shai Friedland; Clin Endosc 2017;50(4):379-387. Published online March 7, 2017; DOI: https://doi.org/10.5946/ce.2016.058

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic mucosal resection with circumferential mucosal incision (CMI-EMR) may offer benefits comparable to those of endoscopic submucosal dissection (ESD), while requiring less technical proficiency than ESD.
Methods
We retrospectively compared the outcomes of CMI-EMR (n=34) and size-matched ESD (n=102), which were performed by a Korean endoscopist for colorectal epithelial lesions of 20–35 mm. Procedural parameters of CMI-EMRs performed by an American ESD novice ((n=30) were compared with those performed by the Korean endoscopist.
Results
The lesion size was 22.3±3.9 mm and 22.9±2.4 mm in the CMI-EMR and size-matched ESD groups, respectively (p=0.730). The resection time was 12.7±7.0 minutes in the CMI-EMR group and 45.6±30.1 minutes in the ESD group (p<0.001). The en bloc resection rate was 94.1% in the CMI-EMR group and 100% in the ESD group (p=0.061). There were no differences in the en bloc resection and complication rates of CMI-EMRs between a Korean and an American endoscopist.
Conclusions
For the treatment of moderate-size colorectal lesions, CMI-EMR showed a trend toward lower en bloc resection rate, but required shorter procedure time than ESD. CMI-EMR outcomes were similar when performed by a Korean ESD expert and an American ESD novice.

Citations

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Endoscopic mucosal resection with a circumferential incision in the removal of colon neoplasms. Results of a randomized trial.
E. U. Abdulzhalieva, A. A. Likutov, V. V. Veselov, D. A. Mtvralashvili, O. M. Yugai, E. A. Khomyakov, S. V. Chernyshov, O. I. Sushkov
Koloproktologia.2024; 23(1): 21. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
Yunho Jung
The Korean Journal of Internal Medicine.2024; 39(4): 563. CrossRef
Hybrid Endoscopic Resection With Endo-knife and Snare for Colorectal Lesions: A Systematic Review and Meta-analysis
Shinji Yoshii, Takefumi Kikuchi, Yuki Hayashi, Masahiro Nojima, Hiro-o Yamano, Hiroshi Nakase
Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(2): 135. CrossRef
Multicenter evaluation of recurrence in endoscopic submucosal dissection and endoscopic mucosal resection in the colon: A Western perspective
Mike T Wei, Margaret J Zhou, Andrew A Li, Andrew Ofosu, Joo Ha Hwang, Shai Friedland
World Journal of Gastrointestinal Endoscopy.2023; 15(6): 458. CrossRef
Comparison of precutting endoscopic mucosal resection and endoscopic submucosal dissection for large (20–30 mm) flat colorectal lesions
Chang Kyo Oh, Young Wook Cho, In Hyoung Choi, Han Hee Lee, Chul‐Hyun Lim, Jin Su Kim, Bo‐In Lee, Young‐Seok Cho
Journal of Gastroenterology and Hepatology.2022; 37(3): 568. CrossRef
A systematic review and meta-analysis of endoscopic mucosal resection vs endoscopic submucosal dissection for colorectal sessile/non-polypoid lesions
Endrit Shahini, Roberto Passera, Giacomo Lo Secco, Alberto Arezzo
Minimally Invasive Therapy & Allied Technologies.2022; 31(6): 835. CrossRef
Endoscopic mucosal resection with a circumferential incision in the removal of colorectal neoplasms (preliminary results of the prospective randomized study)
A. U. Abdulzhalieva, A. A. Likutov, D. A. Mtvralashvili, V. V. Veselov, Yu. E. Vaganov, S. V. Chernyshov, O. A. Mainovskaya, O. I. Sushkov
Koloproktologia.2022; 21(4): 21. CrossRef
Efficacy and Safety of Complete Endoscopic Resection of Colorectal Neoplasia Using a Stepwise Endoscopic Protocol with SOUTEN, a Novel Multifunctional Snare
Shinji Yoshii, Marina Kubo, Mio Matsumoto, Takefumi Kikuchi, Yasunari Takakuwa
Clinical Endoscopy.2020; 53(2): 206. CrossRef
Tip-in versus conventional endoscopic mucosal resection for flat colorectal neoplasia 10 mm or larger in size
Soo Min Noh, Jin Yong Kim, Jae Cheol Park, Eun Hye Oh, Jeongseok Kim, Nam Seok Ham, Sung Wook Hwang, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Dong-Hoon Yang
International Journal of Colorectal Disease.2020; 35(7): 1283. CrossRef
Long‐term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasia with or without the hybrid technique
DU Kang, JC Park, SW Hwang, SH Park, DH Yang, KJ Kim, BD Ye, SJ Myung, SK Yang, JS Byeon
Colorectal Disease.2020; 22(12): 2008. CrossRef
Pyogenic Liver Abscess Caused by Endoscopic Submucosal Dissection for Early Colon Cancer
Joon Seop Lee, Yong Hwan Kwon
Clinical Endoscopy.2019; 52(6): 620. CrossRef
Endoscopic submucosal dissection in the West: Current status and future directions
Michael X. Ma, Michael J. Bourke
Digestive Endoscopy.2018; 30(3): 310. CrossRef
Introduction of endoscopic submucosal dissection in the West
David Friedel, Stavros Nicholas Stavropoulos
World Journal of Gastrointestinal Endoscopy.2018; 10(10): 225. CrossRef
Filling the Technical Gap between Standard Endoscopic Mucosal Resection and Full Endoscopic Submucosal Dissection for 20–35 mm Sized Colorectal Neoplasms
Sung Noh Hong
Clinical Endoscopy.2017; 50(4): 313. CrossRef

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Review

Painless Colonoscopy: Available Techniques and Instruments: Hyun Gun Kim; Clin Endosc 2016;49(5):444-448. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.132

Abstract PDF PubReader ePub

During colonoscopy, air insufflation to distend the lumen and facilitate careful inspection and scope insertion can induce pain and cause discomfort. Carbon dioxide (CO2) insufflation can decrease abdominal pain and discomfort during and after colonoscopy. The advantage of CO2 insufflation is the rapid absorption of the gas across the intestine. Another painless option is water-assisted colonoscopy. Two methods for water-assisted colonoscopy are available: water immersion and water exchange. In a recent direct comparison, the water exchange method was superior to water immersion, CO2 insufflation, and air insufflation with respect to pain during colonoscopy, although it still had the disadvantage of being a time-consuming procedure. Cap-assisted colonoscopy is a simple technique involving the use of a small transparent cap attached to the tip of the scope. Three studies showed an advantage of this technique in terms of reduced patient discomfort compared with the conventional method. Three robotic colonoscopy systems (Endotics System [Era Endoscopy], NeoGuide [NeoGuide Systems Inc.], and Invendoscope [Invendo Medical]) have been introduced to evaluate pain reduction during colonoscopy, but none has been widely adopted and used in practice. In this review, clinical trials of several techniques and new devices for painless colonoscopy are described and summarized.

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MorphGI: A Self-Propelling Soft Robotic Endoscope Through Morphing Shape
Julius E. Bernth, Guokai Zhang, Dionysios Malas, George Abrahams, Bu Hayee, Hongbin Liu
Soft Robotics.2024; 11(4): 670. CrossRef
Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future
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Robotic Colonoscopy and Beyond: Insights into Modern Lower Gastrointestinal Endoscopy
Emanuele Tumino, Pierfrancesco Visaggi, Valeria Bolognesi, Linda Ceccarelli, Christian Lambiase, Sergio Coda, Purushothaman Premchand, Massimo Bellini, Nicola de Bortoli, Emanuele Marciano
Diagnostics.2023; 13(14): 2452. CrossRef
A novel intubation discomfort score to predict painful unsedated colonoscopy
Limei Wang, Hui Jia, Hui Luo, Xiaoyu Kang, Linhui Zhang, Xiangping Wang, Shaowei Yao, Qin Tao, Yanglin Pan, Xuegang Guo
Medicine.2021; 100(10): e24907. CrossRef
Effects of intravenous lidocaine on alfentanil consumption during procedural sedation for colonoscopy in patients with inflammatory bowel disease: a randomized controlled trial
T.T.J. Aalbers, S.A.S. van den Heuvel, E.M. Bronkhorst, A.A.J. van Esch, G.J. Scheffer, M Vaneker
Acta Anaesthesiologica Belgica.2021; 72(3): 115. CrossRef
Robotic colonoscopy: efficacy, tolerability and safety. Preliminary clinical results from a pilot study
Antonello Trecca, Filippo Catalano, Antonino Bella, Raffaele Borghini
Surgical Endoscopy.2020; 34(3): 1442. CrossRef
Evaluación del dolor y distensión abdominal según agente insuflante (CO₂ versus aire) en una unidad de endoscopia digestiva avanzada en Manizales, Colombia.
Carlos Andrés Caicedo, Lázaro Antonio Arango Molano
Revista Colombiana de Gastroenterología.2020; 35(1): 18. CrossRef
Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation
Israel Grilo-Bensusan, Pablo Herrera Martín, Remedios Jiménez-Mesa, Valle Aguado Álvarez
Revista Española de Enfermedades Digestivas.2018;[Epub] CrossRef
Painless Colonoscopy
You-Lin Yang, Shan-Shan Li, Xiao-Bing Wang, Ji-Neng Li
Chinese Medical Journal.2018; 131(7): 857. CrossRef

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Original Article

Feedback Survey of the Effect, Burden, and Cost of the National Endoscopic Quality Assessment Program during the Past 5 Years in Korea: Yu Kyung Cho, Jeong Seop Moon, Dong Su Han, Yong Chan Lee, Yeol Kim, Bo Young Park, Il-Kwun Chung, Jin-Oh Kim, Jong Pil Im, Jae Myung Cha, Hyun Gun Kim, Sang Kil Lee, Hang Lak Lee, Jae Young Jang, Eun Sun Kim, Yunho Jung, Chang Mo Moon, Ethics and Quality Control Committee of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2016;49(6):542-547. Published online March 2, 2016; DOI: https://doi.org/10.5946/ce.2015.113

Abstract PDF PubReader ePub

Background
/Aims: In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions.
Methods
We surveyed the staff of institutional endoscopic units via e-mail.
Results
Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program.
Conclusions
Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.

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Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5‐year experience in an endoscopy center
Shu‐Hui Chen, Theophile Liu, Huei‐Wen Lai, Hui‐Lan Chang, Hsu‐Heng Yen
Advances in Digestive Medicine.2022; 9(2): 103. CrossRef
A nationwide survey on the effectiveness of training on endoscope reprocessing within the national cancer screening program in Korea
Hye Young Shin, Da Hun Jang, Jae Kwan Jun
American Journal of Infection Control.2021; 49(8): 1031. CrossRef
Polyp missing rate and its associated risk factors of referring hospitals for endoscopic resection of advanced colorectal neoplasia
Jae Gyu Shin, Hyung Wook Kim, Su Bum Park, Cheol Woong Choi, Dae Hwan Kang, Su Jin Kim, Hyeong Seok Nam, Dae Gon Ryu
Medicine.2017; 96(19): e6742. CrossRef
Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy
Hee Seok Moon, Eun Kwang Choi, Ji Hyun Seo, Jeong Seop Moon, Ho June Song, Kyoung Oh Kim, Jong Jin Hyun, Sung Kwan Shin, Beom Jae Lee, Sang Heon Lee
Clinical Endoscopy.2017; 50(4): 345. CrossRef
How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program
Yu Kyung Cho
Clinical Endoscopy.2016; 49(4): 312. CrossRef
How Can We Propagate the National Endoscopy Quality Improvement Program and Improve the Quality of Endoscopic Screening?
Dong-Hoon Yang
Gut and Liver.2016; 10(5): 657. CrossRef
The Importance of an Endoscopic Quality Assessment Program Reflecting Real Practice
In Kyung Yoo, Yoon Tae Jeen
Clinical Endoscopy.2016; 49(6): 495. CrossRef

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Case Reports

Endoscopic Ultrasound-Guided Sampling of a Metastatic Mucinous Adenocarcinoma Mimicking a Gastric Subepithelial Tumor: Dae Chul Seo, Tae Hee Lee, Yoon Mi Jeen, Hyun Gun Kim, Eui Bae Kim, Sang Cheol Lee; Clin Endosc 2014;47(5):460-463. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.460

Abstract PDF PubReader ePub: Metastatic mucinous adenocarcinoma of appendix origin and mimicking a gastric subepithelial tumor (SET) is very rare. Endoscopic ultrasound (EUS)-guided sampling is a useful diagnostic method for SETs. However, the cytologic findings of metastatic mucinous adenocarcinoma are unfamiliar to many pathologists and gastroenterologists. These findings present a diagnostic challenge because the introduction of gastric epithelium and mucin into the specimen during the procedure can be misleading. This is the first reported experience of an EUS-guided sampling of a gastric SET in a patient with suspected appendiceal tumor, to make the diagnosis of a mucinous adenocarcinoma.

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Endoscopic Treatment of Various Gastrointestinal Tract Defects with an Over-the-Scope Clip: Case Series from a Tertiary Referral Hospital: Woong Cheul Lee, Weon Jin Ko, Jun-Hyung Cho, Tae Hee Lee, Seong Ran Jeon, Hyun Gun Kim, Joo Young Cho; Clin Endosc 2014;47(2):178-182. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.178

Abstract PDF PubReader ePub

Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.

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Experimental Evaluation of the Optimal Suture Pattern With a Flexible Endoscopic Suturing System
Peter Halvax, Michele Diana, Yoshihiro Nagao, Jacques Marescaux, Lee Swanström
Surgical Innovation.2017; 24(3): 201. CrossRef
Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience
Joshua S. Winder, Afif N. Kulaylat, Jane R. Schubart, Hassan M. Hal, Eric M. Pauli
Surgical Endoscopy.2016; 30(6): 2251. CrossRef
Early endoscopic closure of colocutaneous fistula adjacent to unmatured low colorectal anastomosis with the Over-The-Scope Clip (OTSC)
Constantinos Avgoustou, K. Paraskeva
Hellenic Journal of Surgery.2016; 88(3): 193. CrossRef
Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations
Nobuyoshi Takeshita, Khek Yu Ho
Clinical Endoscopy.2016; 49(5): 438. CrossRef

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Endoscopic Resection of Hypopharyngeal Squamous Cell Carcinoma: Gene Hyun Bok, Won Young Cho, Joo Young Cho, So Young Jin, Ji Ho Ahn, Chang Gyun Chun, Tae Hee Lee, Hyun Gun Kim; Clin Endosc 2013;46(2):189-192. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.189

Abstract PDF PubReader ePub

Hypopharyngeal cancers are often diagnosed at an advanced stage and have a poor prognosis. Even when they are diagnosed at an operable stage, surgery often results in substantial morbidity and decreased patients' quality of life. Although the endoscopic diagnosis of early hypopharyngeal cancer is difficult, recent developments in advanced imaging endoscopy have enabled easier diagnosis of these lesions. Endoscopic resection of early hypopharyngeal cancer is a potential minimally invasive treatment that can preserve the function and quality of life of patients. Reports of this procedure are limited, however. We report a case of hypopharygeal cancer treated with endoscopic resection.

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