Clinical Endoscopy

Review

A practical approach for small bowel bleeding: Sung Eun Kim, Hyun Jin Kim, Myeongseok Koh, Min Cheol Kim, Joon Sung Kim, Ji Hyung Nam, Young Kwan Cho, A Reum Choe, The Research Group for Capsule Endoscopy and Enteroscopy of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2023;56(3):283-289. Published online May 11, 2023; DOI: https://doi.org/10.5946/ce.2022.302

Gastrointestinal (GI) bleeding is one of the most common conditions among patients visiting emergency departments in Korea. GI bleeding is divided into upper and lower GI bleeding, according to the bleeding site. GI bleeding is also divided into overt and occult GI bleeding based on bleeding characteristics. In addition, obscure GI bleeding refers to recurrent or persistent GI bleeding from a source that cannot be identified after esophagogastroduodenoscopy or colonoscopy. The small intestine is the largest part of the alimentary tract. It extends from the pylorus to the cecum. The small intestine is difficult to access owing to its long length. Moreover, it is not fixed to the abdominal cavity. When hemorrhage occurs in the small intestine, the source cannot be found in many cases because of the characteristics of the small intestine. In practice, small-intestinal bleeding accounts for most of the obscure GI bleeding. Therefore, in this review, we introduce and describe systemic approaches and examination methods, including video capsule endoscopy and balloon enteroscopy, that can be performed in patients with suspected small bowel bleeding in clinical practice.

Citations

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Abdulkreem Al-Juhani, Amirah A Alzaki, Esraa F Maghrabi, Reem Rambo, Azzah AlGhamdi , Nada A Alanazi, Rodan Desoky , Mahmoud S Desoky
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Original Article

Diode Laser—Can It Replace the Electrical Current Used in Endoscopic Submucosal Dissection?: Yunho Jung, Gwang Ho Baik, Weon Jin Ko, Bong Min Ko, Seong Hwan Kim, Jin Seok Jang, Jae-Young Jang, Wan-Sik Lee, Young Kwan Cho, Sun Gyo Lim, Hee Seok Moon, In Kyung Yoo, Joo Young Cho; Clin Endosc 2021;54(4):555-562. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.229

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model.
Methods
In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed.
Results
The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group.
Conclusions
The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.

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Hira Imad Cheema, Benjamin Tharian, Sumant Inamdar, Mauricio Garcia-Saenz-de-Sicilia, Cem Cengiz
World Journal of Gastrointestinal Endoscopy.2023; 15(5): 319. CrossRef
Safety and efficacy of dual emission endoscopic laser treatment in patients with upper or lower gastrointestinal vascular lesions causing chronic anemia: results from the first multicenter cohort study
Gian Eugenio Tontini, Lorenzo Dioscoridi, Alessandro Rimondi, Paolo Cantù, Flaminia Cavallaro, Aurora Giannetti, Luca Elli, Luca Pastorelli, Francesco Pugliese, Massimiliano Mutignani, Maurizio Vecchi
Endoscopy International Open.2022; 10(04): E386. CrossRef

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Focused Review Series: Updates on Capsule Endoscopy from Esophagus to Colon

Current and Future Use of Esophageal Capsule Endoscopy: Junseok Park, Young Kwan Cho, Ji Hyun Kim; Clin Endosc 2018;51(4):317-322. Published online July 31, 2018; DOI: https://doi.org/10.5946/ce.2018.101

Abstract PDF PubReader ePub

Capsule endoscopy can be a diagnostic option for patients with esophageal diseases who cannot tolerate esophagogastroduodenoscopy.Functional modifications of the capsule allow for thorough examination of the esophagus. Esophageal capsule endoscopy has so farfailed to show sufficient performance to justify the replacement of traditional endoscopy for the diagnosis of esophageal diseasesbecause the esophagus has a short transit time and common pathologies appear near the esophagogastric junction. However,technological improvements are being introduced to overcome the limitations of capsule endoscopy, which is expected to become agood alternative to conventional endoscopy.

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Focused Review Series: The New Era of Therapeutic Endoscopy - Endoscopic Submucosal Surgery

Current Status of Peroral Endoscopic Myotomy: Young Kwan Cho, Seong Hwan Kim; Clin Endosc 2018;51(1):13-18. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2017.165

Abstract PDF PubReader ePub

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

Citations

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Case Reports

Hybrid Natural Orifice Transluminal Endoscopic Surgery with Sentinel Lymph Node Navigation for Deep Early Gastric Cancer in the Fundic Region: Yoon Suk Park, Seong Hwan Kim, Hee Yun Ryu, Young Kwan Cho, Yun Ju Jo, Tae il Son, Young Ok Hong; Clin Endosc 2016;49(3):298-302. Published online March 29, 2016; DOI: https://doi.org/10.5946/ce.2015.114

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For patients refusing surgical treatment for deep early gastric cancer, hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation is a potential treatment option, particularly when the anatomic location of the cancer has low probability of lymph node metastasis. We report a case of deep early gastric cancer of the fundus beyond the endoscopic submucosal dissection indication that was treated by hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation. In a conventional approach, a total gastrectomy would have been needed; however, the patient refused surgical intervention. In this case, since the patient showed no positivity of the sentinel lymph node on intraoperative navigation, laparoscopic basin lymph node dissection was not performed. Hybrid natural orifice transluminal endoscopic surgery might be considered for specific regions such as the safety zone where lymph node metastases are less likely to occur.

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A Case Report of Primary Duodenal Tuberculosis Mimicking a Malignant Tumor: Ji Hye Jung, Seong Hwan Kim, Min Jeong Kim, Young Kwan Cho, Sang Bong Ahn, Byoung Kwan Son, Yun Ju Jo, Young Sook Park; Clin Endosc 2014;47(4):346-349. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.346

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Tuberculosis remains a serious infectious disease with primary features of pulmonary manifestation in Korea. However, duodenal tuberculosis is rare in gastrointestinal cases of extrapulmonary tuberculosis. Here, we report a case of primary duodenal tuberculosis mistaken as a malignant tumor and diagnosed with QuantiFERON-TB GOLD (Cellestis Ltd.) in an immunocompetent male patient.

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