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Systematic Review and Meta-analysis
- 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]
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Graphical Abstract
Abstract
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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.
- 542 View
- 73 Download
Original Article
- White spots around colorectal tumors are cancer-related findings and may aid endoscopic diagnosis: a prospective study in Japan
- Kai Korekawa, Yusuke Shimoyama, Fumiyoshi Fujishima, Hiroshi Nagai, Takeo Naito, Rintaro Moroi, Hisashi Shiga, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune
- Clin Endosc 2024;57(5):637-646. Published online June 21, 2024
- DOI: https://doi.org/10.5946/ce.2024.027
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Graphical Abstract
Abstract
PDFPubReaderePub
- Background
/Aims: During endoscopy, white spots (WS) are sometimes observed around benign or malignant colorectal tumors; however, few reports have investigated WS, and their significance remains unknown. Therefore, we investigated the significance of WS from clinical and pathological viewpoints and evaluated its usefulness in endoscopic diagnosis.
Methods
Clinical data of patients with lesions diagnosed as epithelial tumors from January 1, 2019, to December 31, 2020, were analyzed (n=3,869). We also performed a clinicopathological analysis of adenomas or carcinomas treated with endoscopic resection (n=759). Subsequently, detailed pathological observations of the WS were performed.
Results
The positivity rates for WS were 9.3% (3,869 lesions including advanced cancer and non-adenoma/carcinoma) and 25% (759 lesions limited to adenoma and early carcinoma). Analysis of 759 lesions showed that the WS-positive lesion group had a higher proportion of cancer cases and larger tumor diameters than the WS-negative group. Multiple logistic analysis revealed the following three statistically significant risk factors for carcinogenesis: positive WS, flat lesions, and tumor diameter ≥5 mm. Pathological analysis revealed that WS were macrophages that phagocytosed fat and mucus and were white primarily because of fat.
Conclusions
WS are cancer-related findings and can become a new criterion for endoscopic resection in the future.
- 5,264 View
- 284 Download
Reviews
- Current status of image-enhanced endoscopy in inflammatory bowel disease
- Young Joo Yang
- Clin Endosc 2023;56(5):563-577. Published online September 26, 2023
- DOI: https://doi.org/10.5946/ce.2023.070
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Abstract
PDFPubReaderePub
- In inflammatory bowel disease (IBD), chronic inflammation leads to unfavorable clinical outcomes and increases the risk of developing colorectal neoplasm (CRN); thereby highlighting the importance of endoscopically evaluating disease activity as well as detecting and characterizing CRN in patients with IBD. With recent advances in image-enhanced endoscopic (IEE) technologies, especially virtual chromoendoscopy (VCE) platforms, this review discusses state-of-the-art IEE techniques and their applicability in assessing disease activity and surveillance colonoscopy in patients with IBD. Among various IEE, VCE demonstrated the capacity to identify quiescent disease activity. And endoscopic remission defined by the new scoring system using VCE platform better predicted clinical outcomes, which may benefit the tailoring of therapeutic strategies in patients with IBD. High-definition dye-chromoendoscopy (HD-DCE) is numerically superior to high-definition white light endoscopy (HD-WLE) in detecting CRN in IBD; however, discrepancy is observed in the statistical significance. VCE showed comparable performance in detecting dysplasia to HD-WLE or DCE and potential for optical diagnosis to differentiate neoplastic from nonneoplastic lesions during surveillance colonoscopy. Applying these novel advanced IEE technologies would provide opportunities for personalized medicine in IBD and optimal treatment of CRN in patients with IBD.
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Citations
Citations to this article as recorded by
- 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 - The application of the combination between artificial intelligence and endoscopy in gastrointestinal tumors
Shen Li, Maosen Xu, Yuanling Meng, Haozhen Sun, Tao Zhang, Hanle Yang, Yueyi Li, Xuelei Ma
MedComm – Oncology.2024;[Epub] CrossRef
- Advanced Endoscopic Imaging for Detection of Dysplasia in Inflammatory Bowel Disease
- 3,094 View
- 144 Download
- 1 Web of Science
- 2 Crossref
- Management of complications related to colorectal endoscopic submucosal dissection
- Tae-Geun Gweon, Dong-Hoon Yang
- Clin Endosc 2023;56(4):423-432. Published online July 27, 2023
- DOI: https://doi.org/10.5946/ce.2023.104
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Abstract
PDFPubReaderePub
- Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.
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Citations
Citations to this article as recorded by- 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
Clinical Endoscopy.2024; 57(2): 141. CrossRef - Is there a best choice of equipment for colorectal endoscopic submucosal dissection?
Francesco Cocomazzi, Sonia Carparelli, Nunzia Labarile, Antonio Capogreco, Marco Gentile, Roberta Maselli, Jahnvi Dhar, Jayanta Samanta, Alessandro Repici, Cesare Hassan, Francesco Perri, Antonio Facciorusso
Expert Review of Medical Devices.2024; 21(7): 561. CrossRef - IDEN Consensus on 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 Journal of Gastroenterology.2024; 83(6): 217. 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 - Clinical meaning of sarcopenia in patients undergoing endoscopic treatment
Hiroyuki Hisada, Yosuke Tsuji, Hikaru Kuribara, Ryohei Miyata, Kaori Oshio, Satoru Mizutani, Hideki Nakagawa, Rina Cho, Nobuyuki Sakuma, Yuko Miura, Hiroya Mizutani, Daisuke Ohki, Seiichi Yakabi, Yu Takahashi, Yoshiki Sakaguchi, Naomi Kakushima, Nobutake
Clinical Endoscopy.2024; 57(4): 446. CrossRef - Endoscopic approaches for the management of giant colonic polyps
Yunho Jung
Clinical Endoscopy.2024; 57(4): 468. CrossRef - Outcome and predictive factors for perforation in orthodontic rubber band-assisted endoscopic submucosal dissection of fibrotic colorectal lesions
Linfu Zheng, Binbin Xu, Fuqiang Wang, Longping Chen, Baoxiang Luo, Zhilin Liu, Xingjie Gao, Linxin Zhou, Rong Wang, Chuanshen Jiang, Dazhou Li, Wen Wang
Scientific Reports.2024;[Epub] CrossRef - Rhabdomyolysis following colorectal endoscopic submucosal dissection: A case report
Ying Chen, Wenxuan Zhang, Junqiang Cai, Min Zhong
Clinical Case Reports.2024;[Epub] CrossRef - 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
Gut and Liver.2024; 18(5): 764. CrossRef - Knives Out: Does the Choice of Endoscopic Knife Influence the Outcome of Colorectal Endoscopic Submucosal Dissection?
Yunho Jung
Digestive Diseases and Sciences.2024; 69(11): 4014. CrossRef - Safety and Efficacy of Endoscopic Submucosal Dissection for Rectal Neoplasms Extending to the Dentate Line
Harishankar Gopakumar, Dushyant Singh Dahiya, Peter V. Draganov, Mohamed O. Othman, Neil R. Sharma
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
- International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
- 2,739 View
- 177 Download
- 10 Web of Science
- 11 Crossref
Original Article
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Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum
- Nobuaki Ikezawa, Takashi Toyonaga, Shinwa Tanaka, Tetsuya Yoshizaki, Toshitatsu Takao, Hirofumi Abe, Hiroya Sakaguchi, Kazunori Tsuda, Satoshi Urakami, Tatsuya Nakai, Taku Harada, Kou Miura, Takahisa Yamasaki, Stuart Kostalas, Yoshinori Morita, Yuzo Kodama
- Clin Endosc 2022;55(3):417-425. Published online May 12, 2022
- DOI: https://doi.org/10.5946/ce.2021.245
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Abstract
PDF
Supplementary MaterialPubReaderePub - Background
/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD.
Methods
D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed.
Results
The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively.
Conclusions
D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques. -
Citations
Citations to this article as recorded by- Endoscopic submucosal dissection for diverticulum using combination of countertraction and circumferential-inversion method
Hiroshi Takayama, Yoshinori Morita, Toshitatsu Takao, Douglas Motomura, Madoka Takao, Takashi Toyonaga, Yuzo Kodama
Endoscopy.2024; 56(S 01): E91. CrossRef - Traction-assisted endoscopic submucosal dissection for resection of ileocecal valve neoplasia: a French retrospective multicenter case series
Clara Yzet, Timothée Wallenhorst, Jérémie Jacques, Mariana Figueiredo Ferreira, Jérôme Rivory, Florian Rostain, Louis-Jean Masgnaux, Jean Grimaldi, Romain Legros, Pierre Lafeuille, Jérémie Albouys, Fabien Subtil, Marion Schaefer, Mathieu Pioche
Endoscopy.2024; 56(10): 790. CrossRef - The role of cap-assisted endoscopy and its future implications
Sol Kim, Bo-In Lee
Clinical Endoscopy.2024; 57(3): 293. CrossRef - Strategies to successfully complete complex ESD in the colon
David Barquero Declara, Alex Blasco Pelicano, Claudia Berbel Comas, Alfredo Mata Bilbao
Endoscopy International Open.2024; 12(07): E914. CrossRef - Novel technique “short myotomy” during endoscopic submucosal dissection for a diverticulum‐associated colonic lesion
Ryosuke Kobayashi, Kingo Hirasawa, Shin Maeda
Digestive Endoscopy.2024;[Epub] CrossRef - Successful planned piecemeal endoscopic resection using gel immersion and an over-the-scope clip for a lesion extensively extended into the colonic diverticulum
Tomoaki Tashima, Takahiro Muramatsu, Tomonori Kawasaki, Tsubasa Ishikawa, Shomei Ryozawa
VideoGIE.2023; 8(4): 167. CrossRef - Future therapeutic implications of new molecular mechanism of colorectal cancer
Sen Lu, Cheng-You Jia, Jian-She Yang
World Journal of Gastroenterology.2023; 29(16): 2359. CrossRef - Iatrogenic colorectal perforation caused by a clip
Hirotaka Oura, Yasuki Hatayama, Erika Nomura, Harutoshi Sugiyama, Daisuke Murakami, Makoto Arai, Takayoshi Nishino
Endoscopy.2023; 55(S 01): E1091. CrossRef
- Endoscopic submucosal dissection for diverticulum using combination of countertraction and circumferential-inversion method
- 4,482 View
- 187 Download
- 7 Web of Science
- 8 Crossref
Systematic Review and Meta-Analysis
- 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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Abstract
PDFPubReaderePub
- 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. -
Citations
Citations to this article as recorded by- 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
Clinical Endoscopy.2024; 57(3): 302. CrossRef - 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
Digestive Endoscopy.2023; 35(3): 314. CrossRef - Artificial intelligence and the push for small adenomas: all we need?
Katharina Zimmermann-Fraedrich, Thomas Rösch
Endoscopy.2023; 55(04): 320. CrossRef - Recent advances in devices and technologies that might prove revolutionary for colonoscopy procedures
Jonathan S. Galati, Kevin Lin, Seth A. Gross
Expert Review of Medical Devices.2023; 20(12): 1087. CrossRef - 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
Clinical Endoscopy.2023; 56(5): 553. CrossRef - KI-Werkzeuge als smarte Helfer in Klinik und Forschung
Zeitschrift für Gastroenterologie.2023; 61(11): 1544. 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 - The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization
Edward Young, Louisa Edwards, Rajvinder Singh
Cancers.2023; 15(21): 5126. CrossRef - Artificial intelligence for colorectal neoplasia detection during colonoscopy: a systematic review and meta-analysis of randomized clinical trials
Shenghan Lou, Fenqi Du, Wenjie Song, Yixiu Xia, Xinyu Yue, Da Yang, Binbin Cui, Yanlong Liu, Peng Han
eClinicalMedicine.2023; 66: 102341. CrossRef - Pouring some water into the wine—Poor performance of endoscopists in artificial intelligence studies
Jochen Weigt
United European Gastroenterology Journal.2022; 10(8): 793. CrossRef
- 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?
- 4,454 View
- 168 Download
- 12 Web of Science
- 12 Crossref
Review
- Radiation Proctitis and Management Strategies
- Dushyant Singh Dahiya, Asim Kichloo, Faiz Tuma, Michael Albosta, Farah Wani
- Clin Endosc 2022;55(1):22-32. Published online November 18, 2021
- DOI: https://doi.org/10.5946/ce.2020.288
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Abstract
PDFPubReaderePub
- Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation against rapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of the pathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor for greater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most common being radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based on the onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severity and complication rates. The treatment options available for RP are limited, with most of the data on treatment available from case reports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. We have primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, and prognosis of RP.
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Citations
Citations to this article as recorded by- Management of gastrointestinal bleed in the intensive care setting, an updated literature review
Vignesh K Nagesh, Sai Priyanka Pulipaka, Ruchi Bhuju, Emelyn Martinez, Shruthi Badam, Gomathy Aarthy Nageswaran, Hadrian Hoang-Vu Tran, Daniel Elias, Charlene Mansour, Jaber Musalli, Sanket Bhattarai, Lokeash Subramani Shobana, Tannishtha Sethi, Ritvik Se
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Tahmineh Tahouri, Sahand Hedayati Omami, Maryam Hosseini, Ehsanollah Rahimi-Movaghar
International Journal of Surgery Case Reports.2024; 116: 109337. CrossRef - Endoscopic resection of residual rectal neoplasia after definitive chemoradiotherapy for rectal cancer
Robert Klimkowski, Jakub Krzyzkowiak, Nastazja Dagny Pilonis, Krzysztof Bujko, Michal F. Kaminski
Best Practice & Research Clinical Gastroenterology.2024; 68: 101896. CrossRef - Radiation injuries of organs and tissues: mechanisms of occurrence, methods of prevention and treatment: A review
Daiana A. Balaeva, Denis S. Romanov, Oxana P. Trofimova, Zarina Z. Gadzhibabaeva, Yury Yu. Gorchak, Garia A. Gariaev
Journal of Modern Oncology.2024; 25(4): 504. CrossRef - Interventions for Managing Late Gastrointestinal Symptoms Following Pelvic Radiotherapy: a Systematic Review and Meta-analysis
H. Berntsson, A. Thien, D. Hind, L. Stewart, M. Mahzabin, W.S. Tung, M. Bradburn, M. Kurien
Clinical Oncology.2024; 36(5): 318. CrossRef - Intestinal microecological transplantation for a patient with chronic radiation enteritis: A case report
Lin Wang, Yan Li, Yu-Jing Zhang, Li-Hua Peng
World Journal of Gastroenterology.2024; 30(19): 2603. CrossRef - Intrarectal formalin treatment for haemorrhagic radiation‐induced proctopathy: efficacy and safety
Darina Kohoutova, Ana Wilson, Caroline Gee, Ramy Elhusseiny, Linda Wanders, David Cunningham
Colorectal Disease.2024; 26(5): 932. CrossRef - Emodin ameliorates acute radiation proctitis in mice by regulating AKT/MAPK/NF-κB/VEGF pathways
Jinsheng Gao, Yousong Li, Jiaohua Chen, Wen Feng, Jianchen Bu, Zixuan Lu, Jiandong Wang
International Immunopharmacology.2024; 132: 111945. CrossRef - Protocolo diagnóstico de la rectitis (proctitis)
C. Iniesta Cavero, L. Menchén-Viso
Medicine - Programa de Formación Médica Continuada Acreditado.2024; 14(8): 468. CrossRef - Feel the Burn: RFA for Chronic Radiation Proctitis
Gabriele De Sena, Federico Maria Mongardini, Danilo Porpora, Maria Mauro, Davide Bentivoglio, Davide Centore, Luigi Brusciano, Claudio Gambardella, Augusto Lauro, Ludovico Docimo, Vincenzo Napolitano
Digestive Diseases and Sciences.2024; 69(9): 3147. CrossRef - Pelvic Radiation Therapy Increases Risk of Pouch Failure in Patients with Inflammatory Bowel Disease and Ileal Pouch
Karthik Gnanapandithan, Laura G. Stuessel, Bo Shen, Fadi H. Mourad, Zhongwei Peng, Francis A. Farraye, Jana G. Hashash
Digestive Diseases and Sciences.2024; 69(9): 3392. CrossRef - Acute toxicity patterns and their management after moderate and ultra- hypofractionated radiotherapy for prostate cancer: A prospective cohort study
F. Sinzabakira, L. Incrocci, K. de Vries, M.E.M.C. Christianen, M. Franckena, F.E. Froklage, H. Westerveld, W.D. Heemsbergen
Clinical and Translational Radiation Oncology.2024; 48: 100842. CrossRef - Prevention and management of radiotherapy-related toxicities in gynecological malignancies. Position paper on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology)
Elisabetta Perrucci, Gabriella Macchia, Annamaria Cerrotta, Angela Damiana Andrulli, Rosa Autorino, Amelia Barcellini, Maura Campitelli, Giulia Corrao, Sara Costantini, Vitaliana De Sanctis, Jacopo Di Muzio, Valeria Epifani, Patrizia Ferrazza, Andrei Fodo
La radiologia medica.2024; 129(9): 1329. CrossRef - Radiation-Induced Intestinal Injury: Molecular Mechanisms and Therapeutic Status
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DNA and Cell Biology.2024; 43(11): 537. CrossRef - Preventive efficacy of hydrocortisone enema for radiation proctitis in rectal cancer patients undergoing short-course radiotherapy: a phase II randomized placebo-controlled clinical trial
Mohammad Mohammadianpanah, Maryam Tazang, Nam Phong Nguyen, Niloofar Ahmadloo, Shapour Omidvari, Ahmad Mosalaei, Mansour Ansari, Hamid Nasrollahi, Behnam Kadkhodaei, Nezhat Khanjani, Seyed Vahid Hosseini
Annals of Coloproctology.2024; 40(5): 506. CrossRef - Utility of Endoscopic Full-Thickness Resection for Refractory Rectal Bleeding in Chronic Radiation Proctitis
Benjamin I. Richter, Yazan Abboud, Ben Flikshteyn, Kaveh Hajifathalian
ACG Case Reports Journal.2024; 11(11): e01556. CrossRef - Navigating the Complexities of Radiation Injuries: Therapeutic Principles and Reconstructive Strategies
Andreea Grosu-Bularda, Flavia-Francesca Lita, Florin-Vlad Hodea, Eliza-Maria Bordeanu-Diaconescu, Andrei Cretu, Catalina-Stefania Dumitru, Stefan Cacior, Bogdan-Mihai Marinescu, Ioan Lascar, Cristian-Sorin Hariga
Journal of Personalized Medicine.2024; 14(11): 1100. CrossRef - Management of radiation-induced proctitis using submucosal endoscopic injections of autologous adipose-derived stromal vascular fraction: a case report
A. V. Smirnov, V. I. Sychev, S. M. Kuznetsova, V. A. Kalsin, V. S. Vasilyev, Yu. V. Ivanov, V. R. Stankevich, D. V. Sazonov, F. G. Zabozlaev, M. A. Konoplyannikov, V. P. Baklaushev, A. V. Troitsky
Stem Cell Research & Therapy.2024;[Epub] CrossRef - Dickdarmschädigung durch Chemotherapie und Bestrahlung
Karin Steidl
Journal für Gastroenterologische und Hepatologische Erkrankungen.2024; 22(4): 108. CrossRef - Administration of modified Gegen Qinlian decoction for hemorrhagic chronic radiation proctitis: A case report and review of literature
Shao-Yong Liu, Liu-Ling Hu, Shi-Jun Wang, Zhong-Li Liao
World Journal of Clinical Cases.2023; 11(5): 1129. CrossRef - A Retrospective Single-Arm Cohort Study in a Single Center of Radiofrequency Ablation in Treatment of Chronic Radiation Proctitis
Chien-En Tang, Kung-Chuan Cheng, Kuen-Lin Wu, Hong-Hwa Chen, Ko-Chao Lee
Life.2023; 13(2): 566. CrossRef - Survivorship in Early-Stage Rectal Cancer Patients Who Have Received Combined Modality Therapy
Saboor E. Randhawa, Laura Tenner
Clinical Colorectal Cancer.2023; 22(4): 375. CrossRef - A Systematic Review of Population-Based Studies of Chronic Bowel Symptoms in Cancer Survivors following Pelvic Radiotherapy
Adam Biran, Iakov Bolnykh, Ben Rimmer, Anthony Cunliffe, Lisa Durrant, John Hancock, Helen Ludlow, Ian Pedley, Colin Rees, Linda Sharp
Cancers.2023; 15(16): 4037. CrossRef - The effectiveness of hyperbaric oxygen therapy for managing radiation-induced proctitis – results of a 10-year retrospective cohort study
António Moreira Monteiro, Diogo Alpuim Costa, Virgínia Mareco, Carla Espiney Amaro
Frontiers in Oncology.2023;[Epub] CrossRef - Chinese clinical practice guidelines for the prevention and treatment of radiation‐induced rectal injury
Hui Zhang, Zhen Zhang, Shuanghu Yuan
Precision Radiation Oncology.2023; 7(4): 237. CrossRef - Progress in multidisciplinary treatment of hemorrhagic radiation proctitis
Qiulian Li, Guangjie Liao
Annals of Oncology Research and Therapy.2022; 2(1): 10. CrossRef
- Management of gastrointestinal bleed in the intensive care setting, an updated literature review
- 9,654 View
- 638 Download
- 22 Web of Science
- 26 Crossref
Special Article: Celebrating the 10th Anniversary of Clinical Endoscopy
- 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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Abstract
PDFSupplementary MaterialPubReaderePub
- 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. -
Citations
Citations to this article as recorded by- Research Progress in Land Consolidation and Rural Revitalization: Current Status, Characteristics, Regional Differences, and Evolution Laws
Shuchang Li, Wei Song
Land.2023; 12(1): 210. CrossRef - Journal metrics, document network, and conceptual and social structures of the Korean Journal of Anesthesiology from 2017 to July 2022: a bibliometric study
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
Annals of Laboratory Medicine.2022; 42(3): 321. CrossRef - Research trends on endoscopic mucosal resection: A bibliometric analysis from 1991 to 2021
Yihan Yang, Xuan Xu, Menghui Wang, Yang Zhang, Pinglang Zhou, Sifan Yang, Xu Shu, Chuan Xie
Frontiers in Surgery.2022;[Epub] CrossRef - Riesgo de sangrado gastrointestinal por uso de anticoagulantes directos orales: ¿cuál es más seguro?
Ivan David Lozada Martinez, Luis Carlos Solano Díaz, Marcela Barbosa Pérez, Víctor Andrés Rueda Oviedo, Brainerd Lenin Caicedo Moncada, Gustavo Andrés Diaz Cruz, Adriana cristina Ceballos Espitia, David Esteban Diaz Gómez, Daiana Andrea Rojas Ramí
Revista Cuarzo.2022; 28(2): 31. CrossRef
- Research Progress in Land Consolidation and Rural Revitalization: Current Status, Characteristics, Regional Differences, and Evolution Laws
- 3,937 View
- 82 Download
- 4 Web of Science
- 5 Crossref
Case Report
- Colorectal carcinoma and chronic inflammatory demyelinating polyneuropathy: is there a possible paraneoplastic association?
- Adnan Malik, Faisal Inayat, Muhammad Hassan Naeem Goraya, Gul Nawaz, Ahmad Mehran, Atif Aziz, Saad Saleem
- Clin Endosc 2023;56(2):245-251. Published online July 28, 2021
- DOI: https://doi.org/10.5946/ce.2021.076
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Abstract
PDFPubReaderePub
- A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management.
- 4,608 View
- 330 Download
Original Articles
- 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
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Abstract
PDFPubReaderePub
- 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.
- 6,467 View
- 223 Download
- 1 Web of Science
- White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms
- Kazutomo Yamasaki, Takashi Hisabe, Kenshi Yao, Hiroshi Ishihara, Kentaro Imamura, Tatsuhisa Yasaka, Hiroshi Tanabe, Akinori Iwashita, Toshiharu Ueki
- Clin Endosc 2021;54(4):570-577. Published online January 13, 2021
- DOI: https://doi.org/10.5946/ce.2020.205
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Abstract
PDFPubReaderePub
- Background
/Aims: A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma.
Methods
A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma.
Results
The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%.
Conclusions
This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms. -
Citations
Citations to this article as recorded by- Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?
Han Hee Lee
Clinical Endoscopy.2022; 55(2): 315. CrossRef
- Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?
- 4,665 View
- 132 Download
- 2 Web of Science
- 1 Crossref
- 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
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Abstract
PDFPubReaderePub
- 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. -
Citations
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Nalini Kanta Ghosh, Ashok Kumar
Artificial Intelligence in Gastrointestinal Endoscopy.2024;[Epub] CrossRef - The Utility of Narrow-Band Imaging International Colorectal Endoscopic Classification in Predicting the Histologies of Diminutive Colorectal Polyps Using I-Scan Optical Enhancement: A Prospective Study
Yeo Wool Kang, Jong Hoon Lee, Jong Yoon Lee
Diagnostics.2023; 13(16): 2720. CrossRef - 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
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 - Usefulness of optical enhancement endoscopy combined with magnification to improve detection of intestinal metaplasia in the stomach
Sergio Sobrino-Cossío, Oscar Teramoto-Matsubara, Fabian Emura, Raúl Araya, Vítor Arantes, Elymir S. Galvis-García, Marisi Meza-Caballero, Blanca Sinahi García-Aguilar, Arturo Reding-Bernal, Noriya Uedo
Endoscopy International Open.2022; 10(04): E441. CrossRef - Interventions to improve adenoma detection rates for colonoscopy
Aasma Shaukat, Anne Tuskey, Vijaya L. Rao, Jason A. Dominitz, M. Hassan Murad, Rajesh N. Keswani, Fateh Bazerbachi, Lukejohn W. Day
Gastrointestinal Endoscopy.2022; 96(2): 171. CrossRef - A modified fujinon intelligent color enhancement (FICE) in the diagnostics of superficial epithelial neoplasms of the colon
V. A. Duvanskiy, A. V. Belkov
Experimental and Clinical Gastroenterology.2022; (5): 154. CrossRef - Mucosal imaging in colon polyps: New advances and what the future may hold
Edward John Young, Arvinf Rajandran, Hamish Lachlan Philpott, Dharshan Sathananthan, Sophie Fenella Hoile, Rajvinder Singh
World Journal of Gastroenterology.2022; 28(47): 6632. CrossRef - Commentary on “Comparative Study of Narrow-Band Imaging and i-scan for Predicting the Histology of Intermediate-to-Large Colorectal Polyps: A Prospective, Randomized Pilot Study”
Yunho Jung, Masayuki Kato
Clinical Endoscopy.2021; 54(6): 781. CrossRef
- Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future
- 5,047 View
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- 8 Web of Science
- 9 Crossref
Focused Review Series: Endoscopic Submucosal Dissection for Colorectal Tumorses
- Management of Complications of Colorectal Submucosal Dissection
- Eun Ran Kim, Dong Kyung Chang
- Clin Endosc 2019;52(2):114-119. Published online March 29, 2019
- DOI: https://doi.org/10.5946/ce.2019.063
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Abstract
PDFPubReaderePub
- Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure- related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication.
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Satsuki Takahashi, Kenichiro Okimoto, Tomoaki Matsumura, Yuhei Oyama, Hayato Nakazawa, Yukiyo Mamiya, Chihiro Goto, Ryosuke Horio, Akane Kurosugi, Michiko Sonoda, Tatsuya Kaneko, Naoki Akizue, Yuki Ohta, Takashi Taida, Keiko Saito, Jun Kato, Naoya Kato
Gastrointestinal Endoscopy.2024; 100(4): 718. CrossRef - Response
Satsuki Takahashi, Kenichiro Okimoto, Tomoaki Matsumura
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- 35 Web of Science
- 35 Crossref
- Estimation of Invasion Depth: The First Key to Successful Colorectal ESD
- Bo-In Lee, Takahisa Matsuda
- Clin Endosc 2019;52(2):100-106. Published online March 27, 2019
- DOI: https://doi.org/10.5946/ce.2019.012
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Abstract
PDFPubReaderePub
- Colorectal tumors with superficial submucosal invasion, which cannot be removed by snaring, are one of the most optimal indications for colorectal endoscopic submucosal dissection (ESD). Therefore, estimation of the invasion depth is the first key to successful colorectal ESD. Although estimation of the invasion depth based on the gross morphology may be useful in selected cases, its diagnostic accuracy could not reach the clinical requirement. The Japan Narrow-band Imaging (NBI) Expert Team (JNET) classification of NBI magnifying endoscopy findings is a useful method for histologic prediction and invasion depth estimation. However, magnifying chromoendoscopy is still necessary for JNET type 2B lesions to reach a satisfactory diagnostic accuracy. Endocytoscopy with artificial intelligence is a promising technology in invasion depth estimation; however, more data are needed for its clinical application.
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Citations
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- Advanced Treatment and Imaging in Colonoscopy: The Pocket-Creation Method for Complete Resection and Linked Color Imaging for Better Detection of Early Neoplastic Lesions by Colonoscopy
- Hironori Yamamoto, Satoshi Shinozaki, Yoshikazu Hayashi, Yoshimasa Miura, Tsevelnorov Khurelbaatar, Hiroyuki Osawa, Alan Kawarai Lefor
- Clin Endosc 2019;52(2):107-113. Published online January 10, 2019
- DOI: https://doi.org/10.5946/ce.2018.189
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Abstract
PDFPubReaderePub
- Early detection and resection of neoplastic lesions are key objectives to diminish colorectal cancer mortality. Resection of superficial colorectal neoplasms, cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection have all been developed and used worldwide. The pocket-creation method facilitates the resection of tumors in difficult and routine locations. Early detection is the most important first step to maximize the benefits of recent advancements in endoscopic techniques. However, the detection of small, flat-shaped, or faded color lesions remains difficult. Linked color imaging, a novel multi-light technology, facilitates the recognition of minor differences in tissue by enhancing the color contrast between early colorectal neoplasms and surrounding normal mucosa in a bright field of view. The most striking feature of linked color imaging is its ability to display the color of early neoplastic lesions as distinct from inflammatory changes, both of which have similar “redness” when viewed using white light imaging. To increase the detection rate of neoplasms, linked color imaging should be used from the outset for endoscopic observation. Early detection of superficial colorectal tumors can result in decreased mortality from colorectal cancer and maintain a good quality of life for patients.
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Citations
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Review
- Screening Relevance of Sessile Serrated Polyps
- Charles J. Kahi
- Clin Endosc 2019;52(3):235-238. Published online January 8, 2019
- DOI: https://doi.org/10.5946/ce.2018.112
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Abstract
PDFPubReaderePub
- Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursor lesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulate incremental genetic alterations over time, leading eventually to malignancy. However, it is now recognized that this “conventional” pathway accounts for only about two-thirds of CRCs. The serrated pathway is responsible for most of the remainder, and is a disproportionate contributor to postcolonoscopy CRC. Hallmarks of the serrated pathway are mutations in the BRAF gene, high levels of methylation of promoter CpG islands, and the sessile serrated polyp (SSP). Accumulating evidence shows that SSPs can be considered adenoma-equivalent from the standpoint of CRC screening. SSPs have a higher prevalence than previously thought, and appear to have a relatively long dwell time similar to that of conventional adenomas. In addition, SSPs, whether sporadic or as part of the serrated polyposis syndrome, are associated with increased risk of synchronous and metachronous neoplasia. These features collectively support that SSPs are highly relevant to CRC prevention.
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Citations
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Original Article
- Endoscopic Features of Mucous Cap Polyps: A Way to Predict Serrated Polyps
- Brian T. Moy, Faripour Forouhar, Chia-Ling Kuo, Thomas J. Devers
- Clin Endosc 2018;51(4):368-374. Published online April 27, 2018
- DOI: https://doi.org/10.5946/ce.2017.155
-
Abstract
PDFPubReaderePub
- Background
/Aims: The aims of the study were to identify whether a mucous-cap predicts the presence of serrated polyps, and to determine whether additional endoscopic findings predict the presence of a sessile serrated adenomas/polyp (SSA/P).
Methods
We analyzed 147 mucous-capped polyps with corresponding histology, during 2011–2014. Eight endoscopic features (presence of borders, elevation, rim of debris, location in the colon, size ≥10 mm, varicose vessels, nodularity, and alteration in mucosal folds) of mucous-capped polyps were examined to see if they can predict SSA/Ps.
Results
A total of 86% (n=126) of mucous-capped polyps were from the right sided serrated pathway (right-sided hyperplastic [n=83], SSA/Ps [n=43], traditional serrated adenoma [n=1]), 10% (n=15) were left-sided hyperplastic polyps, and 3% (n=5) were from the adenoma-carcinoma sequence. The presence of a mucous cap combined with varicose vessels was the only significant predictor for SSA/Ps. The other seven characteristics were not found to be statistically significant for SSA/Ps, although location in the colon and the presence of nodularity trended towards significance.
Conclusions
Our study suggests that mucous-capped polyps have high predictability for being a part of the serrated pathway. Gastroenterologists should be alert for a mucous-capped polyp with varicose veins, as these lesions have a higher risk of SSA/P. -
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Review
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Abstract
PDFPubReaderePub
- Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant, latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screening guidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50–75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%–33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.
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Case Report
- Full-Thickness Resection Device for Complex Colorectal Lesions in High-Risk Patients as a Last-Resort Endoscopic Treatment: Initial Clinical Experience and Review of the Current Literature
- Edris Wedi, Beatrice Orlandini, Mark Gromski, Carlo Felix Maria Jung, Irina Tchoumak, Stephanie Boucher, Volker Ellenrieder, Jürgen Hochberger
- Clin Endosc 2018;51(1):103-108. Published online January 31, 2018
- DOI: https://doi.org/10.5946/ce.2017.093
-
Abstract
PDFPubReaderePub
- The full-thickness resection device (FTRD) is a novel endoscopic device approved for the resection of colorectal lesions. This case-series describes the device and its use in high-risk patients with colorectal lesions and provides an overview of the potential indications in recently published data.
Between December 2014 and September 2015, 3 patients underwent endoscopic full thickness resection using the FTRD for colorectal lesions: 1 case for a T1 adenocarcinoma in the region of a surgical anastomosis after recto-sigmoidectomy, 1 case for a non-lifting colonic adenoma with low-grade dysplasia in an 89-year old patient and 1 for a recurrent adenoma with high-grade dysplasia in a young patient with ulcerative rectocolitis who was under immunosuppression after renal transplantation. Both technical and clinical success rates were achieved in all cases. The size of removed lesions ranged from 9 to 30 mm.
Overall, the most frequent indication in the literature has been for lifting or non-lifting adenoma, submucosal tumors, neuroendocrin tumors, incomplete endoscopic resection (R1) or T1 carcinoma.
Colorectal FTRD is a feasible technique for the treatment of colorectal lesions and represents a minimally invasive alternative for either surgical or conventional endoscopic resection strategies. -
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Original Article
- External Validation of the Endoscopic Features of Sessile Serrated Adenomas in Expert and Trainee Colonoscopists
- Hyo-Joon Yang, Jeong In Lee, Soo-Kyung Park, Yoon Suk Jung, Jin Hee Sohn, Kyu Yong Choi, Dong Il Park
- Clin Endosc 2017;50(3):279-286. Published online September 13, 2016
- DOI: https://doi.org/10.5946/ce.2016.107
-
Abstract
PDFSupplementary MaterialPubReaderePub
- Background
/Aims: It is unclear whether the endoscopic features of sessile serrated adenomas (SSAs) would be useful to trainee colonoscopists to predict SSA. Therefore, the present study aimed to identify features that expert and trainee colonoscopists can use to independently and reliably predict SSA by using high-resolution white-light endoscopy.
Methods
Endoscopic images of 81 polyps (39 SSAs, 22 hyperplastic polyps, and 20 tubular adenomas) from 43 patients were retrospectively evaluated by 10 colonoscopists (four experts and six trainees). Eight endoscopic features of SSAs were assessed for each polyp.
Results
According to multivariable analysis, a mucous cap (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.72 to 19.07), indistinctive borders (OR, 4.21; 95% CI, 2.74 to 7.16), dark spots (OR, 3.64; 95% CI, 1.89 to 7.00), and cloud-like surface (OR, 2.43; 95% CI, 1.27 to 4.668) were independent predictors of SSAs. Among these, a mucous cap, indistinctive borders, and cloud-like surface showed moderate interobserver agreement (mean κ >0.40) among experts and trainees. When ≥1 of the three predictors was observed, the sensitivity and specificity for diagnosing SSAs were 79.0% and 81.4%, respectively.
Conclusions
Colonoscopy trainees and experts can use several specific endoscopic features to independently and reliably predict SSAs. -
Citations
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Review
- Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Large Polyps: A Western Colonoscopist’s View
- Ian Holmes, Shai Friedland
- Clin Endosc 2016;49(5):454-456. Published online August 26, 2016
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-
Abstract
PDFPubReaderePub
- To discuss the rationale for the widespread application of endoscopic mucosal resection (EMR) rather than endoscopic submucosal dissection (ESD) in Western centers. In Western centers, EMR is the treatment of choice for most non-pedunculated colorectal adenomas >2 cm in size. EMR is sufficiently effective and safe to be performed without post-procedure hospitalization. Advances in EMR have led to reduced recurrence rates, and recent studies have demonstrated excellent outcomes with endoscopic treatment of recurrent adenomas. While studies from Asia have demonstrated lower recurrence rates with ESD, concern about the higher perforation risk and lengthy procedure time of ESD are two of the barriers preventing widespread adoption of ESD in the West. EMR is likely to continue as the dominant method for the treatment of large colorectal adenomas in Western centers until the limitations of ESD are overcome.
-
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Kan Wang, Jihao Shi, Linna Ye
Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41. CrossRef - Using Endoscopic Submucosal Dissection as a Routine Component of the Standard Treatment Strategy for Large and Complex Colorectal Lesions in a Western Tertiary Referral Unit
Andrew Emmanuel, Shraddha Gulati, Margaret Burt, Bu’Hussain Hayee, Amyn Haji
Diseases of the Colon & Rectum.2018; 61(6): 743. CrossRef - Endoscopic resection of large colorectal adenomas – clinical experience of a tertiary referral centre
L. Mlynarsky, S. Zelber‐Sagi, E. Miller, R. Kariv
Colorectal Disease.2018; 20(5): 391. CrossRef - Implementation of mentor-assisted colorectal endoscopic submucosal dissection in Sweden; learning curve and clinical outcomes
Shunsuke Yamamoto, Tomasz Radomski, Morteza Shafazand
Scandinavian Journal of Gastroenterology.2018; 53(9): 1146. CrossRef
- Outcome after colorectal full-thickness resection and management of recurrence
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Case Report
- Unusual Local Recurrence with Distant Metastasis after Successful Endoscopic Submucosal Dissection for Colorectal Mucosal Cancer
- Hyo Jeong Lee, Byong Duk Ye, Jeong-Sik Byeon, Jihun Kim, Young Soo Park, Yong Sang Hong, Yong Sik Yoon, Dong-Hoon Yang
- Clin Endosc 2017;50(1):91-95. Published online August 22, 2016
- DOI: https://doi.org/10.5946/ce.2016.054
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Abstract
PDFPubReaderePub
- Intramucosal colorectal cancer (CRC) is thought not to metastasize because the colonic lamina propria lacks lymphatics. Only a few recent case reports have suggested lymph node metastasis from intramucosal CRC, but there is no clear evidence supporting the metastatic potential of intramucosal CRC. Hence, endoscopic resection is regarded as curative treatment for intramucosal CRC. This report describes two cases of unusual local recurrence with distant metastasis in patients who had previously undergone successful endoscopic submucosal dissection for intramucosal CRC. The recurrent colorectal lesions developed at the site of the previous endoscopic submucosal dissection scars in a relatively short-term period, and the pathologic findings showed an “undermining” invasion pattern without surrounding mucosal change. Based on the clinical course and pathological findings, we concluded that the second colorectal lesions were recurrences rather than de novo cancers.
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Citations
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Helen J. S. Jones, Issam al‐Najami, Gunnar Baatrup, Chris Cunningham
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Ming-Hao Hsieh, Pei-Tseng Kung, Wen-Yin Kuo, Tao-Wei Ke, Wen-Chen Tsai
Medicine.2020; 99(36): e21688. CrossRef - Recurrence rate of lateral margin-positive cases after en bloc endoscopic submucosal dissection of colorectal neoplasia
Seohyun Lee, Jihun Kim, Jae Seung Soh, Jungho Bae, 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.2018; 33(6): 735. CrossRef
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Reviews
- Optimal Colonoscopy Surveillance Interval after Polypectomy
- Tae Oh Kim
- Clin Endosc 2016;49(4):359-363. Published online July 29, 2016
- DOI: https://doi.org/10.5946/ce.2016.080
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Abstract
PDFPubReaderePub
- The detection and removal of adenomatous polyps and postpolypectomy surveillance are considered important for the control of colorectal cancer (CRC). Surveillance using colonoscopy is an effective tool for preventing CRC after colorectal polypectomy, especially if compliance is good. In current practice, the intervals between colonoscopies after polypectomy are variable. Different recommendations for recognizing at risk groups and defining surveillance intervals after an initial finding of colorectal adenomas have been published. However, high-grade dysplasia and the number and size of adenomas are known major cancer predictors. Based on this, a subgroup of patients that may benefit from intensive surveillance colonoscopy can be identified.
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Citations
Citations to this article as recorded by- Gender disparities in colorectal polyps
A. K. Safiyeva
Klinicheskaia khirurgiia.2021; 88(1-2): 57. CrossRef - Three-year colonoscopy surveillance after polypectomy in Korea: a Korean Association for the Study of Intestinal Diseases (KASID) multicenter prospective study
Won Seok Choi, Dong Soo Han, Chang Soo Eun, Dong Il Park, Jeong-Sik Byeon, Dong-Hoon Yang, Sung-Ae Jung, Sang Kil Lee, Sung Pil Hong, Cheol Hee Park, Suck-Ho Lee, Jeong-Seon Ji, Sung Jae Shin, Bora Keum, Hyun Soo Kim, Jung Hye Choi, Sin-Ho Jung
Intestinal Research.2018; 16(1): 126. CrossRef
- Gender disparities in colorectal polyps
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- Endocuff-Assisted Colonoscopy—A Novel Accessory in Improving Adenoma Detection Rate: A Review of the Literature
- Rashmee Patil, Mel A. Ona, Emmanuel Ofori, Madhavi Reddy
- Clin Endosc 2016;49(6):533-538. Published online May 2, 2016
- DOI: https://doi.org/10.5946/ce.2016.032
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Abstract
PDFPubReaderePub
- Endocuff (Arc Medical Design) is a U.S. Food and Drug Administration-approved device that is attached like a cap to the distal tip of the colonoscope; it is used to improve adenoma detection rates during colonoscopy. The aim of this review was to summarize and evaluate the clinical and technical efficacy of Endocuff in improving adenoma detection rate. A comprehensive literature review was performed to identify studies describing this technique. In this review article, we have summarized case series and reports describing Endocuff use and results. The reported indications, results, limitations, and complications are discussed.
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Rossella Palma, Gianluca Andrisani, Gianfranco Fanello, Augusto Lauro, Cristina Panetta, Chiara Eberspacher, Francesco Di Matteo, Samuele Vaccari, Noemi Zorzetti, Vito D’Andrea, Stefano Pontone
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Original Article
- Factors for Endoscopic Submucosal Dissection in Early Colorectal Neoplasms: A Single Center Clinical Experience in China
- Yu-Qi He, Xin Wang, Ai-Qin Li, Lang Yang, Jian Zhang, Qian Kang, Shan Tang, Peng Jin, Jian-Qiu Sheng
- Clin Endosc 2015;48(5):405-410. Published online September 30, 2015
- DOI: https://doi.org/10.5946/ce.2015.48.5.405
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Abstract
PDFPubReaderePub
Background/Aims Early colorectal (CR) neoplasm can be cured by endoscopic submucosal dissection (ESD), but clinical experience and factors associated with complications from ESD for CR neoplasms in China have not been reported.
Methods Seventy-eight cases of early CR neoplasm treated with endoscopic resection performed between December 2012 and December 2013 at Beijing Military General Hospital were included. Factors associated with ESD complications and procedure times were evaluated.
Results The
en bloc resection rate was 88.5% (69/78), tumor size was 32.1±10.7 mm, and procedure time was 71.8±49.5 minutes. The major complication was perforation, which occurred in 8.97% of the ESD procedures. Multivariate logistic regression analysis indicated that only tumor size (p =0.022) was associated with ESD perforation. Tumor size (p <0.001) and the non-lifting sign (p =0.017) were independent factors for procedure time, and procedure time (p =0.016) was a key factor foren bloc resection. After a median 10 months (range, 4 to 16) of follow-up, no patients had local recurrence.Conclusions This study indicated that ESD is an applicable method for large early CR neoplasm in the colon and rectum. Tumor size and the non-lifting sign might be considerable factors for increased complication rate and procedural time of ESD.
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Citations
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Focused Review Series: Updates on Gastrointestinal and Pancreaticobiliary Stents
- Colorectal Stents: Current Status
- Jeong-Mi Lee, Jeong-Sik Byeon
- Clin Endosc 2015;48(3):194-200. Published online May 29, 2015
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Abstract
PDFPubReaderePub
A self-expandable metal stent (SEMS) is an effective and safe method for the decompression of colon obstruction. Based on recent evidence, colorectal SEMS is now recommended for the palliation of patients with colonic obstruction from incurable colorectal cancer or extracolonic malignancy and also as a bridge to surgery in those who are a high surgical risk. Prophylactic SEMS insertion in patients with no obstruction symptoms is not recommended. Most colorectal SEMS are inserted endoscopically under fluoroscopic guidance. The technical and clinical success rates of colorectal SEMS are high, and the complication rate is acceptable. Advances in this technology will make the insertion of colorectal SEMS better and may expand the indications of colorectal SEMS in the future.
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Review
- Status and Literature Review of Self-Expandable Metallic Stents for Malignant Colorectal Obstruction
- Dae Young Cheung, Yong Kook Lee, Chang Heon Yang
- Clin Endosc 2014;47(1):65-73. Published online January 24, 2014
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Abstract
PDFPubReaderePub
Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review.
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Special Issue Article of IDEN 2013
- Debates on Colorectal Endoscopic Submucosal Dissection - Traction for Effective Dissection: Gravity Is Enough
- Bo-In Lee
- Clin Endosc 2013;46(5):467-471. Published online September 30, 2013
- DOI: https://doi.org/10.5946/ce.2013.46.5.467
-
Abstract
PDFPubReaderePub
Colorectal endoscopic submucosal dissection (ESD) still remains a technically difficult procedure. The maintenance of tissue tension and good submucosal exposure during dissection is one of the most important factors for an effective and safe dissection. Although various traction methods have been developed, traction by gravity is one of the most useful method for colorectal ESD. Traction using adjunctive devices can thus be reserved for extremely difficult cases or for endoscopists in their learning periods for colorectal ESD.
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Surgical Endoscopy.2023; 37(12): 9658. CrossRef - Training program using a traction device improves trainees’ learning curve of colorectal endoscopic submucosal dissection
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Haruka Fujinami, Akira Teramoto, Saeko Takahashi, Takayuki Ando, Shinya Kajiura, Ichiro Yasuda
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- Conventional Versus Traction Endoscopic Submucosal Dissection for Colorectal Tumors
- 6,835 View
- 86 Download
- 22 Crossref
Original Article
- Diagnostic Accuracy and Interobserver Agreement in Predicting the Submucosal Invasion of Colorectal Tumors Using Gross Findings, Pit Patterns, and Microvasculatures
- Hye Jung Choi, Bo-In Lee, Hwang Choi, Kyu Yong Choi, Sang-Woo Kim, Joo Yong Song, Jeong Seon Ji, Byung-Wook Kim
- Clin Endosc 2013;46(2):168-171. Published online March 31, 2013
- DOI: https://doi.org/10.5946/ce.2013.46.2.168
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Abstract
PDFPubReaderePub
Background/Aims Depth of invasion is one of the most important factors for establishing treatment strategy for colorectal tumors.
Methods Three blinded experts reviewed electronic photos and video clips of 33 early colorectal cancer-like lesions. They estimated the depth of invasion based on conventional white light endoscopy (CWE), magnifying chromoendoscopy (MCE), and magnifying narrow band imaging endoscopy (MNE).
Results The lesions included nine mucosal low-grade neoplasias, 16 mucosal high grade neoplasias, and eight carcinomas with invasion to the submucosal layer or beyond. The diagnostic accuracy for submucosal invasion by CWE ranged from 67% to 82%, while those by MCE and MNE ranged from 85% to 88% and 85% to 88%, respectively. The diagnostic accuracy significantly differed between CWE and MCE (
p =0.034) and between CWE and MNE (p =0.039). The kappa values for CWE, MCE, and MNE among the endoscopists were 0.564, 0.673, and 0.673, respectively.Conclusions The estimation of submucosal invasion for early colorectal cancer-like lesions based on MCE or MNE is more accurate than CWE. MCE and MNE were demonstrated to have substantial agreement for predicting submucosal invasion.
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Citations
Citations to this article as recorded by- Estimation of Invasion Depth: The First Key to Successful Colorectal ESD
Bo-In Lee, Takahisa Matsuda
Clinical Endoscopy.2019; 52(2): 100. CrossRef - Comparison of endoscopic ultrasonography and magnifying endoscopy for assessment of the invasion depth of shallow gastrointestinal neoplasms: a systematic review and meta-analysis
Zhang Tao, Chen Yan, He Zhao, Jiawei Tsauo, Xiaowu Zhang, Bing Qiu, Yanqing Zhao, Xiao Li
Surgical Endoscopy.2017; 31(12): 4923. CrossRef - Use of confocal laser endomicroscopy with a fluorescently labeled fatty acid to diagnose colorectal neoplasms
Feihong Deng, Yuan Fang, Zhiyong Shen, Wei Gong, Tao Liu, Jing Wen, Wanling Zhang, Xianjun Zhu, Hui Zhong, Tong Wang, Fachao Zhi, Biao Nie
Oncotarget.2017; 8(35): 58934. CrossRef - Higher net change of index of hemoglobin values between colon polyp and nonpolyp mucosa correlates with the presence of an advanced colon adenoma
Wei‐Chun Cheng, Hsiu‐Chi Cheng, Po‐Jun Chen, Jui‐Wen Kang, Er‐Hsiang Yang, Bor‐Shyang Sheu, Wei‐Ying Chen
Advances in Digestive Medicine.2016; 3(4): 161. CrossRef - Brief Education on Microvasculature and Pit Pattern for Trainees Significantly Improves Estimation of the Invasion Depth of Colorectal Tumors
Joon Sung Kim, Bo-In Lee, Hwang Choi, Bong Koo Kang, Jong In Kim, Hae Mi Lee, Eun-Joo Im, Byung-Wook Kim, Sang-Woo Kim, Myung-Gyu Choi, Kyu Yong Choi
Gastroenterology Research and Practice.2014; 2014: 1. CrossRef - Clinical Usefulness of Magnifying Chromoendoscopy and Magnifying Narrow Band Imaging Endoscopy for Predicting the Submucosal Invasion of Early Colorectal Cancers
Kwang An Kwon, Yang Suh Ku
Clinical Endoscopy.2013; 46(2): 113. CrossRef
- Estimation of Invasion Depth: The First Key to Successful Colorectal ESD
- 7,634 View
- 58 Download
- 6 Crossref
Special Issue Articles of IDEN 2012
- Indications, Knives, and Electric Current: What's the Best?
- Bo-In Lee
- Clin Endosc 2012;45(3):285-287. Published online August 22, 2012
- DOI: https://doi.org/10.5946/ce.2012.45.3.285
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Abstract
PDFPubReaderePub
Endoscopic submucosal dissection (ESD) was developed to overcome the limitations of conventional endoscopic mucosal resection (EMR), and ESD has been also applied for large colorectal neoplasms. Since colorectal ESD is still associated with higher perforation rate, a longer procedure time, and increased technical difficulty, the indications should be strictly considered. Generally, colorectal tumors without deep submucosal invasion or minimal possibility of lymph node metastasis, for which en bloc resection using conventional EMR is difficult, are good candidates for colorectal ESD. The ideal knife for colorectal ESD should avoid making perforations but can make a clean cut of optimal depth at one time. The ideal current for ESD differs depending on the procedure used, the surgical devices used, the tissue to be dissected, and the operator's preference. Application of the optimal indications and improvements in the technical skill and surgical devices are required for easier and safer colorectal ESD.
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Citations
Citations to this article as recorded by- Review on colorectal endoscopic submucosal dissection focusing on the technical aspect
Tak Lit Derek Fung, Chi Woo Samuel Chow, Pak Tat Chan, Kam Hung Kwok
Surgical Endoscopy.2020; 34(9): 3766. CrossRef - International Digestive Endoscopy Network to Strengthen Network for Lower Gastrointestinal Diseases Including Inflammatory Bowel Disease and Colorectal Cancer
Kwang An Kwon
Clinical Endoscopy.2012; 45(3): 251. CrossRef
- Review on colorectal endoscopic submucosal dissection focusing on the technical aspect
- 5,306 View
- 72 Download
- 2 Crossref
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