Clinical Endoscopy

International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy: Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee, The Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines; Clin Endosc 2024;57(2):141-157. Published online March 14, 2024; DOI: https://doi.org/10.5946/ce.2024.002

Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

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Mapping Competence in Gastrointestinal Endoscopy Nursing Practice: An Item Response Theory Analysis of Perceived Skill Acquisition and Maintenance in Italy
Mattia Bozzetti, Gennaro Pascale, Ilaria Marcomini, Alessio Lo Cascio, Fabio Grilli, Caterina Sclapari, Grazia Multari, Nicoletta Orgiana, Mirko Gaggiotti, Giorgio Iori, Luciana Nicola Giordano, Stefano Mancin, Fabio Petrelli, Giovanni Cangelosi, Loris Ri
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Liqi Sun, Jiang Liu
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Medical disputes involving lower gastrointestinal endoscopies: cases from the Korean Medical Dispute Mediation and Arbitration Agency
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The Korean Journal of Internal Medicine.2025; 40(3): 404. CrossRef
Contemporary approaches in the peri-endoscopic management of antithrombotic agents: current paradigms, challenges, and prognostications
Jiaxuan Zuo, Wei Jiang, Lumei Wang, Kaiqi Yang, Peng Li, Shutian Zhang, Rui Cheng
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Prediction of immediate bleeding after cold snare polypectomy: A prospective observational study
Shin Ju Oh, Yunho Jung, Young Hwangbo, Young Sin Cho, Il Kwun Chung, Chang Kyun Lee
Medicine.2024; 103(36): e39597. CrossRef

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Mucosal Incision-Assisted Endoscopic Biopsy as an Alternative to Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy for Gastric Subepithelial Tumor: Cheol Woong Choi, Joo Ha Hwang; Clin Endosc 2020;53(5):505-507. Published online September 29, 2020; DOI: https://doi.org/10.5946/ce.2020.187

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Natural History of Asymptomatic Esophageal Subepithelial Tumors of 30 mm or Less in Size
Seokin Kang, Do Hoon Kim, Yuri Kim, Dongsub Jeon, Hee Kyong Na, Jeong Hoon Lee, Ji Yong Ahn, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef

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Current Status of Endoscopic Ultrasonography in Gastrointestinal Subepithelial Tumors: Sang Gyun Kim, Ji Hyun Song, Joo Ha Hwang; Clin Endosc 2019;52(4):301-305. Published online July 9, 2019; DOI: https://doi.org/10.5946/ce.2019.024

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Gastrointestinal subepithelial tumors (GSTs) are usually detected incidentally on endoscopic or radiologic examinations. In conventional endoscopy, a GST usually presents as a protuberant lesion with an intact mucosal surface. As the lesion is located beneath the mucosal layer of the gastrointestinal tract, conventional biopsy typically does not reveal the pathologic diagnosis. First, a GST should be differentiated from an extrinsic compression through the positional change of the patient during conventional endoscopic examination. In cases of GSTs originating from the gastrointestinal wall, endoscopic ultrasonography (EUS) can be beneficial for narrowing the differential diagnosis through delineation of echo findings and by determining the layer of origin. EUS findings can also help determine the management strategies for GSTs by making a differential diagnosis according to malignant potential.

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Traumatic neuroma of remnant cystic duct mimicking duodenal subepithelial tumor: A case report
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Confocal Microscopy in the Esophagus and Stomach: Adam Templeton, Joo Ha Hwang; Clin Endosc 2013;46(5):445-449. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.445

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Probe-based confocal microscopy (pCLE) is actively being investigated for applications in the esophagus and stomach. The use of pCLE allows real-time in vivo microscopy to evaluate the microarchitecture of the mucosal epithelium. pCLE appears to be particularly useful in identifying mucosal dysplasia and early malignancies that cannot be clearly distinguished using high-definition white light endoscopy, chromoendoscopy, or magnification endoscopy. In addition, the ability to detect dysplastic tissue in real-time may shift the current screening practice from random biopsy to targeted biopsy of esophageal and gastric cancers and their precursor lesions. We will review the use of pCLE for detection and surveillance of upper gastrointestinal early luminal malignancy.

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Endoscopic Ultrasound-Fine Needle Aspiration versus Core Biopsy for the Diagnosis of Subepithelial Tumors: Kevin Webb, Joo Ha Hwang; Clin Endosc 2013;46(5):441-444. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.441

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Subepithelial lesions are frequently encountered and remain a diagnostic challenge. Imaging of subepithelial lesions using endoscopic ultrasound (EUS) can be helpful in narrowing the differential diagnosis of the lesion; however, definitive diagnosis typically requires tissue. Many methods for acquiring tissue exist including EUS-guided fine needle aspiration, Trucut biopsy, and fine needle biopsy. Obtaining adequate tissue is important for cytologic and histologic exams including immunohistochemical stains, thus a great deal of effort has been made to increase tissue acquisition in order to improve diagnostic yield in subepithelial lesions.

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