Clinical Endoscopy

One-day low-residue diet is equally effective as the multiple-day low-residue diet in achieving adequate bowel cleansing: a meta-analysis of randomized controlled trials: Raeni Dwi Putri, Fiki Amalia, Festy Aldina Utami, Yunisa Pamela, Mas Rizky A.A. Syamsunarno; Received March 11, 2024 Accepted August 8, 2024 Published online December 12, 2024; DOI: https://doi.org/10.5946/ce.2024.061 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colonoscopy is widely used as a diagnostic and preventive procedure for colorectal diseases. The most recent guidelines advocate the use of a low-residue diet (LRD) for bowel preparation before colonoscopy. LRD duration varies considerably, with recommended 1-day and multiple-day regimens in clinical practice.
Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched multiple databases for randomized controlled trials (RCTs) and analyzed the outcomes using a fixed-effects model.
Results
Six RCTs with 2,469 subjects were included in this study. The rates of adequate bowel preparation for 1-day and >1-day were 87.2% and 87.1%, respectively. No statistically significant differences were observed between the 1-day and >1-day LRD in adequate bowel preparation (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.76–1.41; p=0.84; I2=0%), polyp detection rate (OR, 0.91; 95% CI, 0.76–1.09; p=0.29; I2=16%), adenoma detection rate (OR, 0.87; 95% CI, 0.71–1.08; p=0.21; I2=0%), and withdrawal time (mean difference, –0.01; 95% CI, –0.25 to 0.24; p=0.97; I2=63%).
Conclusions
The efficacy of 1-day and multiple-day LRD is comparable in achieving satisfactory bowel preparation, highlighting their similar impact on the detection of polyps and adenomas during colonoscopy.

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Post-polypectomy colorectal bleeding: current strategies and the way forward: Nilanga Nishad, Mo Hameed Thoufeeq; Received September 3, 2024 Accepted September 23, 2024 Published online November 27, 2024; DOI: https://doi.org/10.5946/ce.2024.241 [Epub ahead of print]

Abstract PDF PubReader ePub: Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.

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The impact of linked color imaging on adenoma detection rate in colonoscopy: a systematic review and meta-analysis: Bruna Haueisen Figueiredo Zwetkoff, Luiz Ronaldo Alberti, Fábio Gontijo Rodrigues, Nelson Carvas Junior, José Celso Ardengh, Otavio Micelli Neto, Fernando Rodrigues Guzman, Marcelo Morganti Ferreira Dias, Guilherme Camarotti de Oliveira Canejo, Carlos Eduardo Oliveira dos Santos; Received March 26, 2024 Accepted May 16, 2024 Published online October 24, 2024; DOI: https://doi.org/10.5946/ce.2024.072 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Colorectal cancer prevention relies on surveillance colonoscopy, with the adenoma detection rate as a key factor in examination quality. Linked color imaging (LCI) enhances lesion contrast and improves the examination performance. This systematic review and meta-analysis aimed to evaluate the effect of LCI on adenoma detection rate in adults who underwent colonoscopy.
Methods
We searched the Medline, PubMed, BIREME, LILACS, and Scientific Electronic Library Online databases for randomized controlled trials comparing the use of LCI versus white light (WL), published up to March 2023. The outcomes included lesion characteristics, number of adenomas per patient, and the additional polyp detection rate.
Results
Sixteen studies were included in the analysis, which showed that LCI was more accurate than WL in detecting adenomas, with an increased number of adenomas detected per patient. Although LCI performed well in terms of lesion size, morphology, and location, the subgroup analyses did not reveal any statistically significant differences between LCI and WL. The addition of LCI did not result in significant improvements in the detection of serrated lesions, and there were no differences in the withdrawal time between groups.
Conclusions
LCI has been shown to be effective in detecting colonic lesions, improving the number of adenomas detected per patient and improving polyp detection rate without negatively affecting other quality criteria in colonoscopy.

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Novel regimen for colonoscopy bowel preparation with oral lactulose: a prospective comparative study: Josué Aliaga Ramos, Danilo Carvalho, Vitor N. Arantes; Clin Endosc 2024;57(6):775-782. Published online October 22, 2024; DOI: https://doi.org/10.5946/ce.2024.056

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Polyethylene glycol (PEG) is considered the gold standard regimen for bowel preparation; however, due to the necessity of a large volume, patient tolerance is impaired. Therefore, lactulose is a novel alternative for colonoscopy preparation. This study aimed to investigate the efficacy and safety of lactulose-based bowel preparations in comparison with PEG for colonoscopy.
Methods
This is a prospective, non-blinded, comparative study. Outpatients were randomly divided into two groups: group 1 (111 patients), PEG; and group 2 (111 patients), lactulose. The following clinical outcomes were assessed in each group: degree of bowel clearance using the Boston bowel preparation score, colorectal polyp detection rate, adenoma detection rate, tolerability, and side effects.
Results
The rate of inadequate bowel preparation was 8.1% and 1.8% for the PEG and lactulose groups, respectively (p=0.030). The Boston bowel preparation score for the entire colon was 7.34±1.17 and 8.36±1.09 for the PEG and lactulose groups, respectively (p<0.001). The satisfactory overall experience rates were 27.9% and 62.2% for the PEG and lactulose groups, respectively (p<0.001).
Conclusions
The novel bowel preparation with oral lactulose was superior to that with PEG in terms of colon cleansing, adenoma detection rate, tolerance, and patient experience.

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Bowel Preparation Agents: Balancing Efficacy for Colon Cleansing and Safety for Stomach Safety
Gwang Ha Kim
The Korean Journal of Gastroenterology.2024; 84(6): 293. CrossRef

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Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea: Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee; Clin Endosc 2024;57(6):790-797. Published online September 23, 2024; DOI: https://doi.org/10.5946/ce.2024.110

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement.
Methods
All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings.
Results
The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved.
Conclusions
This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.

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Alteration in gut microbiota after colonoscopy: proposed mechanisms and the role of probiotic interventions: Hyeong Ho Jo, Moon Young Lee, Se Eun Ha, Dong Han Yeom, Yong Sung Kim; Received June 6, 2024 Accepted July 13, 2024 Published online September 2, 2024; DOI: https://doi.org/10.5946/ce.2024.147 [Epub ahead of print]

Abstract PDF PubReader ePub

Colonoscopy, a widely used procedure for diagnosing and treating colonic diseases, induces transient gastrointestinal symptoms and alterations in the gut microbiota. This review comprehensively examines the evidence on alterations in the gut microbiota following colonoscopy and their possible mechanisms. Factors such as rapid colonic evacuation, increased osmolality, and mucus thinning caused by bowel preparation and exposure to oxygen during the procedure contribute to these alterations. Typically, the alterations revert to the baseline within a short time. However, their long-term implications remain unclear, necessitating further investigation. Split-dose bowel preparation and CO2 insufflation during the procedure result in fewer alterations in the gut microbiota. Probiotic administration immediately after colonoscopy shows promise in reducing alterations and gastrointestinal symptoms. However, the widespread use of probiotics remains controversial due to the transient nature of both the symptoms and gut microbial alterations following a colonoscopy. Probiotics may offer greater benefits to individuals with preexisting gastrointestinal symptoms. Thus, probiotic administration may be a viable option for selected patients.

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Efficacy of Fecal Microbial Transplantation for Improving Symptoms of Irritable Bowel Syndrome - A Pilot Study for Voluntary Participants in Korea
Jung Won Lee, Nayoung Kim
The Korean Journal of Gastroenterology.2024; 84(4): 168. CrossRef

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Assessing the potential of artificial intelligence to enhance colonoscopy adenoma detection in clinical practice: a prospective observational trial: Søren Nicolaj Rønborg, Suresh Ujjal, Rasmus Kroijer, Magnus Ploug; Clin Endosc 2024;57(6):783-789. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.038

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: This study aimed to evaluate the effectiveness of the GI Genius (Medtronic) module in clinical practice, focusing on the adenoma detection rate (ADR) during colonoscopy. Computer-aided polyp detection (CADe) systems using artificial intelligence have been shown to improve adenoma detection in controlled trials. However, the effectiveness of these systems in clinical practice has recently been questioned.
Methods
This single-center prospective observational study was conducted at the University Hospital of Southern Denmark and included all individuals referred for colonoscopy between November 2020 and January 2021. The primary outcome was ADR, comparing patients examined with CADe to those examined without it. The selection of patients to be examined with the CADe module was completely random.
Results
A total of 502 patients were analyzed (318 in the control group and 184 in the CADe group). The overall ADR was 32.1% with a slight increase in the CADe group (34.7% vs. 30.5%). Multivariable analysis showed a very modest and statistically insignificant increase in ADR (risk ratio, 1.12; 95% confidence interval, 0.88–1.43).
Conclusions
The use of CADe in clinical practice did not increase ADR with statistical significance when compared to colonoscopy without CADe. These findings suggest that the impact of CADe systems in everyday clinical practice are modest.

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Understanding the discrepancy in the effectiveness of artificial intelligence-assisted colonoscopy: from randomized controlled trials to clinical reality
Jung Ho Bae
Clinical Endoscopy.2024; 57(6): 765. CrossRef
Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
Biomimetics.2024; 9(12): 783. CrossRef

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Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea: Jung-Bin Park, Jung Ho Bae; Received June 24, 2024 Accepted July 21, 2024 Published online August 5, 2024; DOI: https://doi.org/10.5946/ce.2024.168 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: The real-world effectiveness of computer-aided detection (CADe) systems during colonoscopies remains uncertain. We assessed the effectiveness of the novel CADe system, ENdoscopy as AI-powered Device (ENAD), in enhancing the adenoma detection rate (ADR) and other quality indicators in real-world clinical practice.
Methods
We enrolled patients who underwent elective colonoscopies between May 2022 and October 2022 at a tertiary healthcare center. Standard colonoscopy (SC) was compared to ENAD-assisted colonoscopy. Eight experienced endoscopists performed the procedures in randomly assigned CADe- and non-CADe-assisted rooms. The primary outcome was a comparison of ADR between the ENAD and SC groups.
Results
A total of 1,758 sex- and age-matched patients were included and evenly distributed into two groups. The ENAD group had a significantly higher ADR (45.1% vs. 38.8%, p=0.010), higher sessile serrated lesion detection rate (SSLDR) (5.7% vs. 2.5%, p=0.001), higher mean number of adenomas per colonoscopy (APC) (0.78±1.17 vs. 0.61±0.99; incidence risk ratio, 1.27; 95% confidence interval, 1.13–1.42), and longer withdrawal time (9.0±3.4 vs. 8.3±3.1, p<0.001) than the SC group. However, the mean withdrawal times were not significantly different between the two groups in cases where no polyps were detected (6.9±1.7 vs. 6.7±1.7, p=0.058).
Conclusions
ENAD-assisted colonoscopy significantly improved the ADR, APC, and SSLDR in real-world clinical practice, particularly for smaller and nonpolypoid adenomas.

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Impact of Artificial Intelligence on Polyp Size and Surveillance Colonoscopy: A Phantom Study
Muhammad N Yousaf, Neal Sharma, Michelle L Matteson-Kome, Srinivas Puli, Douglas Nguyen, Matthew L Bechtold
Cureus.2024;[Epub] CrossRef
Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
Biomimetics.2024; 9(12): 783. CrossRef

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Painless colonoscopy: fact or fiction?: Pieter Sinonquel, Alexander Jans, Raf Bisschops; Clin Endosc 2024;57(5):581-587. Published online June 27, 2024; DOI: https://doi.org/10.5946/ce.2024.001

Abstract PDF PubReader ePub

Although colonoscopy is a routinely performed procedure, it is not devoid of challenges, such as the potential for perforation and considerable patient discomfort, leading to patients postponing the procedure with several healthcare risks. This review delves into preprocedural and procedural solutions, and emerging technologies aimed at addressing the drawbacks of colonoscopies. Insufflation and sedation techniques, together with various other methods, have been explored to increase patient satisfaction, and thereby, the quality of endoscopy. Recent advances in this field include the prevention of loop formation, encompassing the use of variable-stiffness endoscopes, computer-guided scopes, magnetic endoscopic imaging, robotics, and capsule endoscopy. An autonomous endoscope that relies on self-propulsion to completely avoid looping is a potentially groundbreaking technology for the next generation of endoscopes. Nevertheless, critical techniques need to be refined to ensure the development of effective and efficient endoscopes.

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Polyp Matching in Colon Capsule Endoscopy: Pioneering CCE-Colonoscopy Integration Towards an AI-Driven Future
Ian Io Lei, Ramesh Arasaradnam, Anastasios Koulaouzidis
Journal of Clinical Medicine.2024; 13(23): 7034. CrossRef

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Performance comparison between two computer-aided detection colonoscopy models by trainees using different false positive thresholds: a cross-sectional study in Thailand: Kasenee Tiankanon, Julalak Karuehardsuwan, Satimai Aniwan, Parit Mekaroonkamol, Panukorn Sunthornwechapong, Huttakan Navadurong, Kittithat Tantitanawat, Krittaya Mekritthikrai, Salin Samutrangsi, Peerapon Vateekul, Rungsun Rerknimitr; Clin Endosc 2024;57(2):217-225. Published online February 7, 2024; DOI: https://doi.org/10.5946/ce.2023.145

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: This study aims to compare polyp detection performance of “Deep-GI,” a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model.
Methods
Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen.
Results
In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p<0.01) and the lowest PMR (0.6% vs. 14.6% vs. 33.3%, p<0.01) when compared to CADe and trainees, respectively. Compared to CADe, Deep-GI demonstrated lower FPR at FP thresholds of ≥0.5 (12.1 vs. 22.4) and ≥1 second (4.4 vs. 6.8) (both p<0.05). However, when the threshold was raised to ≥1.5 seconds, the FPR became comparable (2 vs. 2.4, p=0.3), while the PMR increased from 2% to 10%.
Conclusions
Compared to CADe, Deep-GI demonstrated a higher PDS with significantly lower FPR at ≥0.5- and ≥1-second thresholds. At the ≥1.5-second threshold, both systems showed comparable FPR with increased PMR.

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Understanding the discrepancy in the effectiveness of artificial intelligence-assisted colonoscopy: from randomized controlled trials to clinical reality
Jung Ho Bae
Clinical Endoscopy.2024; 57(6): 765. CrossRef
Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
Biomimetics.2024; 9(12): 783. CrossRef

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Computer-aided polyp characterization in colonoscopy: sufficient performance or not?: Natalie Halvorsen, Yuichi Mori; Clin Endosc 2024;57(1):18-23. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.092

Abstract PDF PubReader ePub

Computer-assisted polyp characterization (computer-aided diagnosis, CADx) facilitates optical diagnosis during colonoscopy. Several studies have demonstrated high sensitivity and specificity of CADx tools in identifying neoplastic changes in colorectal polyps. To implement CADx tools in colonoscopy, there is a need to confirm whether these tools satisfy the threshold levels that are required to introduce optical diagnosis strategies such as “diagnose-and-leave,” “resect-and-discard” or “DISCARD-lite.” In this article, we review the available data from prospective trials regarding the effect of multiple CADx tools and discuss whether they meet these thresholds.

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Building Machine Learning Models in Gastrointestinal Endoscopy
Giulio Antonelli, Tom Eelbode, Touka Elsaman, Mrigya Sharma, Raf Bisschops, Cesare Hassan
Gastrointestinal Endoscopy Clinics of North America.2024;[Epub] CrossRef
Cost-Effectiveness for Artificial Intelligence in Colonoscopy
Natalie Halvorsen, Yuichi Mori
Gastrointestinal Endoscopy Clinics of North America.2024;[Epub] CrossRef
Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
Biomimetics.2024; 9(12): 783. CrossRef

2,943 View
178 Download
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Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials: Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita; Clin Endosc 2023;56(5):553-562. Published online July 26, 2023; DOI: https://doi.org/10.5946/ce.2023.055

Abstract PDF PubReader ePub

Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.

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Advanced Endoscopic Imaging for Detection of Dysplasia in Inflammatory Bowel Disease
Laura Alexandra Lucaciu, Edward John Despott
Gastrointestinal Endoscopy Clinics of North America.2025; 35(1): 141. 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
Practical utility of linked color imaging in colonoscopy: Updated literature review
Fumiaki Ishibashi, Sho Suzuki
Digestive Endoscopy.2024;[Epub] CrossRef
The Past, Present and Future of Imaging Enhanced Endoscopy in Colon Tumor
Kyueng-Whan Min, One-Zoong Kim
Journal of Digestive Cancer Research.2024; 12(2): 90. CrossRef
Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
Yong Soo Kwon, Su Young Kim
Journal of the Korean Medical Association.2023; 66(11): 652. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef

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Use of abdominal compression device in colonoscopy: a systematic review and meta-analysis: Yousaf Zafar, Ahmed Mustafa Rashid, Syed Sarmad Javaid, Ahmed Kamal Siddiqi, Adnan Zafar, Arsalan Zafar Iqbal, Jagpal Singh Klair, Rajesh Krishnamoorthi; Clin Endosc 2023;56(4):446-452. Published online May 26, 2023; DOI: https://doi.org/10.5946/ce.2022.304

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes.
Methods
We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated.
Results
Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device.
Conclusions
Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.

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Simulator-based training method in gastrointestinal endoscopy training and currently available simulators: Yuri Kim, Jeong Hoon Lee, Gin Hyug Lee, Ga Hee Kim, Gunn Huh, Seung Wook Hong, Hwoon-Yong Jung; Clin Endosc 2023;56(1):1-13. Published online January 6, 2023; DOI: https://doi.org/10.5946/ce.2022.191

Abstract PDF PubReader ePub

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM’s advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator’s validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

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Impact and assessment of training models in interventional endoscopic ultrasound
Bogdan Miutescu, Vinay Dhir
Digestive Endoscopy.2024; 36(1): 59. CrossRef
A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions
Jun Woo Park, Tae Gyun Kim, Kwang Bum Cho, Jeong Seok Kim, Jin Woong Cho, Jung Won Jeon, Sun Gyo Lim, Chan Gyoo Kim, Hong Jun Park, Tae Jun Kim, Eun Sun Kim, Su Jin Jeong, Yong Hwan Kwon
Gut and Liver.2024; 18(1): 77. CrossRef
Exploring Endoscopic Competence in Gastroenterology Training: A Simulation-Based Comparative Analysis of GAGES, DOPS, and ACE Assessment Tools
Faisal Wasim Ismail, Azam Afzal, Rafia Durrani, Rayyan Qureshi, Safia Awan, Michelle R Brown
Advances in Medical Education and Practice.2024; Volume 15: 75. CrossRef
Assemblage of a functional and versatile endoscopy trainer reusing medical waste: Step‐by‐step video tutorial
Riccardo Vasapolli, Jörg Schirra, Christian Schulz
Digestive Endoscopy.2024; 36(5): 634. CrossRef
Navigating the learning landscape: Comprehensive training in third space endoscopy - training, techniques, and practical recommendations
D. Roser, S. Nagl, A. Ebigbo
Best Practice & Research Clinical Gastroenterology.2024; 71: 101918. CrossRef
Systematic review of subjective validation methods for computerized colonoscopy simulators
Adrián Lugilde-López, Manuel Caeiro-Rodríguez, Fernando A. Mikic-Fonte, Martín Llamas-Nistal
Health Informatics Journal.2024;[Epub] CrossRef
Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea
Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee
Clinical Endoscopy.2024; 57(6): 790. CrossRef
EUS and ERCP training in Europe: Time for simulation, optimization, and standardization
Selma J. Lekkerkerker, Rogier P. Voermans
United European Gastroenterology Journal.2023; 11(5): 407. CrossRef
There is no royal road: a shortcut for endoscopic submucosal dissection training
Seong Woo Jeon
Clinical Endoscopy.2023; 56(5): 590. CrossRef
Enhancing the Quality of Upper Gastrointestinal Endoscopy: Current Indicators and Future Trends
Caesar Ferrari, Micheal Tadros
Gastroenterology Insights.2023; 15(1): 1. CrossRef

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Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition: Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases; Clin Endosc 2022;55(6):703-725. Published online October 13, 2022; DOI: https://doi.org/10.5946/ce.2022.136

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Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index
Jung Ho Lee, Hyunseok Cho, Sang Hoon Lee, Sung Joon Lee, Chang Don Kang, Dae Hee Choi, Jin Myung Park, Seung-Joo Nam, Tae Suk Kim, Ji Hyun Kim, Sung Chul Park
The Korean Journal of Gastroenterology.2024; 83(4): 143. CrossRef
A survey of current practices in post-polypectomy surveillance in Korea
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
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Hye Kyung Hyun, Ji Soo Park, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim
Journal of Gastroenterology and Hepatology.2024;[Epub] CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
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Journal of the Korean Medical Association.2023; 66(11): 626. CrossRef
Classification and endoscopic diagnosis of colorectal polyps
Ji Hyun Kim, Sung Chul Park
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Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
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Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
Yong Soo Kwon, Su Young Kim
Journal of the Korean Medical Association.2023; 66(11): 652. CrossRef

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Factors influencing endoscopic estimation of colon polyp size in a colon model: Koen Robert Beukema, Jaimy A. Simmering, Marjolein Brusse-Keizer, Sneha John, Rutger Quispel, Peter B. Mensink; Clin Endosc 2022;55(4):540-548. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2022.017

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Background
/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation.
Methods
Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope’s tip. Participants were asked to estimate the diameter and volume of each polyp.
Results
Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62–0.71) for diameter and 0.56 (95% CI, 0.50–0.62) for volume. Polyp size estimated at 3 cm from the colonoscope’s tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size.
Conclusions
Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.

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Usefulness and Educational Benefit of a Virtual Scale Endoscope in Measuring Colorectal Polyp Size
Yudai Takehara, Ken Yamashita, Shin Morimoto, Fumiaki Tanino, Noriko Yamamoto, Yuki Kamigaichi, Hidenori Tanaka, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Shiro Oka
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Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study
Ioana Popescu Crainic, Roupen Djinbachian, Douglas K. Rex, Alan Barkun, Aasma Shaukat, James East, Cesare Hassan, Yuichi Mori, Heiko Pohl, Amit Rastogi, Prateek Sharma, Joseph C. Anderson, Mahsa Taghiakbari, Edgard Medawar, Daniel von Renteln
Scandinavian Journal of Gastroenterology.2024; 59(5): 608. CrossRef

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Post-polypectomy surveillance: the present and the future: Masau Sekiguchi, Takahisa Matsuda, Kinichi Hotta, Yutaka Saito; Clin Endosc 2022;55(4):489-495. Published online July 11, 2022; DOI: https://doi.org/10.5946/ce.2022.097

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An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

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S. Redondo Evangelista, M. Sierra Morales, I. Bartolomé Oterino, P. García Centeno, A. Santos Rodríguez
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Jiwon Chang, Yoosoo Chang, Yoosun Cho, Hyun‐Suk Jung, Dong‐Il Park, Soo‐Kyung Park, Soo‐Youn Ham, Sarah H. Wild, Christopher D. Byrne, Seungho Ryu
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Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
Yong Soo Kwon, Su Young Kim
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Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef
Understanding colorectal polyps to prevent colorectal cancer
Dong-Hoon Yang
Journal of the Korean Medical Association.2023; 66(11): 626. CrossRef

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Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis: Arun Sivananthan, Scarlet Nazarian, Lakshmana Ayaru, Kinesh Patel, Hutan Ashrafian, Ara Darzi, Nisha Patel; Clin Endosc 2022;55(3):355-364. Published online May 12, 2022; DOI: https://doi.org/10.5946/ce.2021.228

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Background
/Aims: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.
Methods
A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.
Results
Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09–0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02–0.07).
Conclusions
CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.

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Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth?
James Weiquan Li, Lai Mun Wang, Katsuro Ichimasa, Kenneth Weicong Lin, James Chi-Yong Ngu, Tiing Leong Ang
Clinical Endoscopy.2024; 57(1): 24. CrossRef
As how artificial intelligence is revolutionizing endoscopy
Jean-Francois Rey
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Understanding the discrepancy in the effectiveness of artificial intelligence-assisted colonoscopy: from randomized controlled trials to clinical reality
Jung Ho Bae
Clinical Endoscopy.2024; 57(6): 765. CrossRef
Eye tracking technology in endoscopy: Looking to the future
Arun Sivananthan, Jabed Ahmed, Alexandros Kogkas, George Mylonas, Ara Darzi, Nisha Patel
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The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization
Edward Young, Louisa Edwards, Rajvinder Singh
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Quality indicators in colonoscopy: the chasm between ideal and reality: Su Bee Park, Jae Myung Cha; Clin Endosc 2022;55(3):332-338. Published online April 4, 2022; DOI: https://doi.org/10.5946/ce.2022.037

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Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice.

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Kasenee Tiankanon, Satimai Aniwan
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Clinical Endoscopy.2023; 56(5): 553. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef

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Can Computed Tomography Colonography Replace Optical Colonoscopy in Detecting Colorectal Lesions?: State of the Art: Alessia Chini, Michele Manigrasso, Grazia Cantore, Rosa Maione, Marco Milone, Francesco Maione, Giovanni Domenico De Palma; Clin Endosc 2022;55(2):183-190. Published online February 24, 2022; DOI: https://doi.org/10.5946/ce.2021.254

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Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions <5 mm or flat lesions, which, although rarely, can have a malignant potential.

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Multi-view orientational attention network combining point-based affinity for polyp segmentation
Yan Liu, Yan Yang, Yongquan Jiang, Zhuyang Xie
Expert Systems with Applications.2024; 249: 123663. CrossRef
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Diagnostics.2023; 13(21): 3355. CrossRef

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Comparison of conventional and new endoscopic band ligation devices for colonic diverticular bleeding: Ayaka Takasu, Takashi Ikeya, Yasutoshi Shiratori; Clin Endosc 2022;55(3):408-416. Published online February 18, 2022; DOI: https://doi.org/10.5946/ce.2021.200

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Background
/Aims: Endoscopic band ligation (EBL) is used to treat colonic diverticular bleeding (CDB). An endoscopic variceal ligation device for esophageal varices is used as a conventional EBL device (C-EBL). A new EBL device (N-EBL) was developed by Sumitomo Bakelite Co. in August 2018. We aimed to evaluate the clinical outcomes of N-EBL compared with those of C-EBL.
Methods
Seventy-nine patients who underwent EBL for CDB at St. Luke’s International Hospital, Japan, between 2017 and 2020 were included in this retrospective study. Patients were divided into the C-EBL and N-EBL groups. Their clinical outcomes, including achieving initial hemostasis, early rebleeding, procedure time, and EBL-associated adverse events, were evaluated.
Results
Of the 79 patients, 36 (45.6%) were in the C-EBL group and 43 (54.4%) were in the N-EBL group. The rate of achieving initial hemostasis was 100% in the C-EBL group and 93.0% in the N-EBL group. No significant difference was noted in the early rebleeding rate between the groups (p=0.24). The N-EBL group achieved a shorter median EBL procedure time than the C-EBL group (18.2 minutes vs. 14.2 minutes, p=0.02). No adverse events were observed in either group.
Conclusions
The N-EBL device is safe and useful and may reduce EBL procedure time.

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Advances in endoscopic management of colonic diverticular bleeding
Yasutoshi Shiratori, Syed Matthew Kodilinye, Ahmed E. Salem
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Document Network and Conceptual and Social Structures of Clinical Endoscopy from 2015 to July 2021 Based on the Web of Science Core Collection: A Bibliometric Study: Sun Huh; Clin Endosc 2021;54(5):641-650. Published online September 30, 2021; DOI: https://doi.org/10.5946/ce.2021.207

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Background
/Aims: The present study investigated the relevance and network of institutions, keywords, and authors’ countries of the articles in Clinical Endoscopy published from 2015 to May 2021 based on the Web of Science Core Collection.
Methods
The Web of Science Core Collection was searched with the term Clinical Endoscopy as the publication title on July 12, 2021. All 776 citations published from 2015 to May 2021 and 2,964 articles citing those 776 articles were analyzed using Biblioshiny.
Results
The corresponding authors were from 73 countries. Document coupling showed that the colorectal cancer-colonoscopyrandomized controlled trial cluster had the most significant impact and highest centrality. There were 442 articles with corresponding authors from Korea (57.0%). The number of collaborative works by Korean authors with the authors of other countries was 33 (7.5%). The articles were cited 2,964 times by corresponding authors from 37 countries.
Conclusions
The above results show that Clinical Endoscopy has published several studies on gastrointestinal endoscopy. A large proportion of citations (84.7 %) were from outside Korea, indicating that the journal content is useful for global physicians. Collaborative work between authors from Korea and other countries should be encouraged to promote the journal.

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Sun Huh
Korean Journal of Anesthesiology.2023; 76(1): 3. CrossRef
Promotion to Top-Tier Journal and Development Strategy of the Annals of Laboratory Medicine for Strengthening its Leadership in the Medical Laboratory Technology Category: A Bibliometric Study
Sun Huh
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Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan: Jandos Amankulov, Dilyara Kaidarova, Zhamilya Zholdybay, Marianna Zagurovskaya, Nurlan Baltabekov, Madina Gabdullina, Akmaral Ainakulova, Dias Toleshbayev, Alexandra Panina, Elvira Satbayeva, Zhansaya Kalieva; Clin Endosc 2022;55(1):101-112. Published online July 15, 2021; DOI: https://doi.org/10.5946/ce.2021.066

Abstract PDF PubReader ePub: Background
/Aims: The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods
A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results
Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions
Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.

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Clinical Applications of Linked Color Imaging and Blue Laser/Light Imaging in the Screening, Diagnosis, and Treatment of Superficial Colorectal Tumors: Taku Sakamoto, Hourin Cho, Yutaka Saito; Clin Endosc 2021;54(4):488-493. Published online July 14, 2021; DOI: https://doi.org/10.5946/ce.2021.157

Abstract PDF PubReader ePub

Considering its contribution to reducing colorectal cancer morbidity and mortality, the most important task of colonoscopy is to find all existing polyps. Moreover, the accurate detection of existing polyps determines the risk of colorectal cancer morbidity and is an important factor in deciding the appropriate surveillance program for patients. Image-enhanced endoscopy is an easy-to-use modality with improved lesion detection. Linked color imaging (LCI) and blue laser/light imaging (BLI) are useful modalities for improving colonoscopy quality. Each mode has unique optical features; therefore, their intended use differs. LCI contributes to improved polyp detection due to its brightness and high color contrast between the lesion and normal mucosa, while BLI contributes to the characterization of detected polyps by evaluating the vessel and surface patterns of detected lesions. The proper use of these observation modes allows for more efficient endoscopic diagnosis. Moreover, recent developments in artificial intelligence will soon change the clinical practice of colonoscopy and this system will provide an efficient education modality for novice endoscopists.

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Endoscopic Treatment of Iatrogenic Perforation of Sigmoid Diverticulum: A Case Report of Multidisciplinary Management: Giacomo Emanuele Maria Rizzo, Giuseppina Ferro, Giovanna Rizzo, Giovanni Di Carlo, Alessandro Cantone, Gaetano Giuseppe Di Vita, Carmelo Sciumè; Clin Endosc 2022;55(2):292-296. Published online June 7, 2021; DOI: https://doi.org/10.5946/ce.2021.005

Abstract PDF PubReader ePub: Iatrogenic perforations are severe complications of gastrointestinal endoscopy; therefore, their management should be adequately planned. A 77-year-old man with a history of diverticulosis underwent a colonoscopy for anemia. During the procedure, an iatrogenic perforation occurred suddenly in the sigmoid colon, near a severe angle among the numerous diverticula. Through-the-scope clips were immediately applied to treat it and close mucosal edges. Laboratory tests showed increased levels of inflammation and infection, and although there were no complaints of abdominal pain, the patient had an extremely distended abdomen. A multidisciplinary board began management based on a conservative approach. Pneumoperitoneum was treated with computed tomography-assisted drainage. After 72 hours, his intestinal canalization and laboratory tests were normal. Though this adverse event is rare, a multidisciplinary board should be promptly gathered upon occurrence, even if the patient appears clinically stable, to consider a conservative approach and avoid surgical treatment.

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Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: John Alexander Lata Guacho, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Bruna Furia Buzetti Hourneaux de Moura, Megui Marilia Mansilla Gallegos, Thomas McCarty, Ricardo Katsuya Toma, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(2):242-249. Published online March 25, 2021; DOI: https://doi.org/10.5946/ce.2020.275

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Carbon dioxide is increasingly used in insufflation during colonoscopy in adult patients; however, air insufflation remains the primary practice among pediatric gastroenterologists. This systematic review and meta-analysis aims to evaluate insufflation using CO₂ versus air in colonoscopies in pediatric patients.
Methods
Individualized search strategies were performed using MEDLINE, Cochrane Library, EMBASE, and LILACS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane working methodology. Randomized control trials (RCTs) were selected for the present meta-analysis. Pooled proportions were calculated for outcomes including procedure time and abdominal pain immediately and 24 hours post-procedure.
Results
The initial search yielded 644 records, of which five RCTs with a total of 358 patients (CO₂: n=178 versus air: n=180) were included in the final analysis. The procedure time was not different between the CO₂ and air insufflation groups (mean difference, 10.84; 95% confidence interval [CI], -2.55 to 24.22; p=0.11). Abdominal pain immediately post-procedure was significantly lower in the CO₂ group (risk difference, -0.15; 95% CI; -0.26 to -0.03; p=0.01) while abdominal pain at 24 hours post-procedure was similar (risk difference, -0.05; 95% CI; -0.11 to 0.01; p=0.11).
Conclusions
Based on this systematic review and meta-analysis of RCT data, CO₂ insufflation reduced abdominal pain immediately following the procedure, while pain was similar at 24 hours post-procedure. These results suggest that CO₂ is a preferred insufflation technique when performing colonoscopy in pediatric patients.

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Journal of Pediatric Gastroenterology & Nutrition.2023; 76(5): 660. CrossRef

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Current Status of Colorectal Cancer and Its Public Health Burden in Thailand: Kasenee Tiankanon, Satimai Aniwan, Rungsun Rerknimitr; Clin Endosc 2021;54(4):499-504. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.245-IDEN

Abstract PDF PubReader ePub

Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalent cancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program as a response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, while there are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage of endoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel, reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemical test (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FIT cutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify the priority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies and the current status of the Thailand CRC screening program.

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Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand
Ampornpan Theeranut, Nonglak Methakanjanasak, Sunee Lertsinudom, Pattama Surit, Nichanun Panyaek, Saisamon Leeladapattarakul, Peangtikumporn Nilpetch, Pattapong Kessomboon, Chalongchai Chalermwat, Watcharapong Rintara, Wudipong Khongtong, Pawich Paktipat,
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Cost-Effectiveness of Increasing Access to Colorectal Cancer Diagnosis: Analysis From Thailand
Peeradon Wongseree, Zeynep Hasgul, Mohammad S. Jalali
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Peeradon Wongseree, Zeynep Hasgul, Borwornsom Leerapan, Cherdsak Iramaneerat, Pochamana Phisalprapa, Mohammad S. Jalali
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Artificial Intelligence in Lower Gastrointestinal Endoscopy: The Current Status and Future Perspective: Sebastian Manuel Milluzzo, Paola Cesaro, Leonardo Minelli Grazioli, Nicola Olivari, Cristiano Spada; Clin Endosc 2021;54(3):329-339. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.082

Abstract PDF PubReader ePub

The present manuscript aims to review the history, recent advances, evidence, and challenges of artificial intelligence (AI) in colonoscopy. Although it is mainly focused on polyp detection and characterization, it also considers other potential applications (i.e., inflammatory bowel disease) and future perspectives. Some of the most recent algorithms show promising results that are similar to human expert performance. The integration of AI in routine clinical practice will be challenging, with significant issues to overcome (i.e., regulatory, reimbursement). Medico-legal issues will also need to be addressed. With the exception of an AI system that is already available in selected countries (GI Genius; Medtronic, Minneapolis, MN, USA), the majority of the technology is still in its infancy and has not yet been proven to reach a sufficient diagnostic performance to be adopted in the clinical practice. However, larger players will enter the arena of AI in the next few months.

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Comparative Study of Narrow-Band Imaging and i-scan for Predicting the Histology of Intermediate-to-Large Colorectal Polyps: A Prospective, Randomized Pilot Study: Joon Seop Lee, Seong Woo Jeon, Yong Hwan Kwon; Clin Endosc 2021;54(6):881-887. Published online January 6, 2021; DOI: https://doi.org/10.5946/ce.2020.257

Abstract PDF PubReader ePub

Background
/Aims: To date, no reports have compared the diagnostic efficacy of narrow-band imaging (NBI) and i-scan for the histologic prediction of intermediate-to-large colorectal polyps. We aimed to compare the diagnostic accuracy of NBI and i-scan in predicting histology, and their inter-/intra-observer agreement.
Methods
We performed a prospective, randomized study that included 66 patients (NBI, n=33 vs. i-scan, n=33) with colorectal polyps (size >10 mm but <50 mm) who underwent colonoscopic resection. During the procedure, three endoscopists documented their prediction using the Japan NBI Expert Team (JNET) classification. Two months after study completion, the endoscopists reviewed still images and video clips for analysis.
Results
The overall diagnostic accuracies in the NBI and i-scan groups were 73.7% (73/99) and 75.8% (75/99), respectively, and there was no statistical significance between the two groups (p=0.744). The JNET classification as applied to NBI and i-scan showed substantial inter-observer agreement (NBI κ-value 0.612, p=0.001 vs. i-scan κ-value 0.662, p=0.002). Additionally, the κ-values of intra-observer agreement were in the range of 0.385–0.660 with NBI and 0.364–0.741 with i-scan.
Conclusions
NBI and i-scan have similar diagnostic accuracies for the histologic prediction of intermediate-to-large colorectal polyps. Furthermore, the inter-/intra-observer agreement was acceptable for both modalities when the JNET classification was applied.

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Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future
Nalini Kanta Ghosh, Ashok Kumar
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Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
Classification and endoscopic diagnosis of colorectal polyps
Ji Hyun Kim, Sung Chul Park
Journal of the Korean Medical Association.2023; 66(11): 633. CrossRef
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Yunho Jung, Masayuki Kato
Clinical Endoscopy.2021; 54(6): 781. CrossRef

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Fatal Necrotizing Fasciitis Following Uncomplicated Colonoscopic Polypectomy: A Case Report: Min Kyu Chae, Sang Youn Shin, Min Seob Kwak, Jin Young Yoon, Ha Il Kim, Jae Myung Cha; Clin Endosc 2021;54(2):280-284. Published online December 11, 2020; DOI: https://doi.org/10.5946/ce.2020.117

Abstract PDF PubReader ePub: Necrotizing fasciitis (NF) is a life-threatening infection that can be caused by various procedures or surgery and may develop in healthy elderly patients. Here, we report a case of a 66-year-old man with diabetes mellitus who underwent colonoscopic polypectomy, without complications. However, he visited the emergency department 24 hours after the procedure complaining of abdominal pain. Abdominopelvic computed tomography revealed multiple air bubbles in the right lateral abdominal muscles. After a diagnosis of NF was made, immediate surgical debridement was performed. However, despite three sessions of extensive surgical debridement and best supportive care at the intensive care unit, the patient died because of sepsis and NF-associated multiple-organ failure. In conclusion, physicians should pay special attention to the possibility of NF if a patient with risk factors for NF develops sepsis after colonoscopic polypectomy.

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