Clinical Endoscopy

Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis: Talia F. Malik, Vaishnavi Sabesan, Babu P. Mohan, Asad Ur Rahman, Mohamed O. Othman, Peter V. Draganov, Gursimran S. Kochhar; Clin Endosc 2024;57(3):317-328. Published online February 29, 2024; DOI: https://doi.org/10.5946/ce.2023.205

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD).
Methods
Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity.
Results
Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%–95.4%; I2=0%), 81.5% (95% CI, 72.5%–88%; I2=43%), and 48.9% (95% CI, 32.1%–65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%–7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%–13%; I2=10%) and 5.3% (95% CI, 3.1%–8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%–18.2%; I2=55%) and 13% (95% CI, 8.5%–19.3%; I2=54%), respectively.
Conclusions
ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection.

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The pattern of metachronous recurrence after endoscopic submucosal dissection for gastric adenocarcinoma and dysplasias: Sunah Suk, Yeon Joo Seo, Dae Young Cheung, Han Hee Lee, Jin Il Kim, Soo-Heon Park; Clin Endosc 2023;56(4):470-478. Published online April 18, 2023; DOI: https://doi.org/10.5946/ce.2022.259

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Metachronous recurrence incidences and risk factors following endoscopic submucosal dissection (ESD) for gastric adenocarcinoma and dysplasias were investigated.
Methods
Retrospective review of electronic medical records of patients who underwent gastric ESD at The Catholic University of Korea, Yeouido St. Mary’s Hospital.
Results
A total of 190 subjects were enrolled for analysis during the study period. The mean age was 64.4 years-old and the male sex occupied 73.7%. The mean observation period following ESD was 3.45 years. The annual incidence rate of metachronous gastric neoplasms (MGN) was about 3.96%. The annual incidence rate was 5.36% for the low-grade dysplasia group, 6.47% for the high-grade dysplasia group, and 2.74% for the EGC group. MGN was more frequent in the dysplasia group than in the EGC group (p<0.05). For those with MGN development, the mean time interval from ESD to MGN was 4.1 (±1.8) years. By using the Kaplan–Meier model, the estimated mean MGN free survival time was 9.97 years (95% confidence interval, 8.53–11.40) The histological types of MGN were not related to the primary histology types.
Conclusions
MGN following ESD developed in 3.96% annually and MGN was more frequent in the dysplasia group. The histological types of MGN did not correlate with those of primary neoplasm.

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Research Progress in ESD Treatment of Early Gastric Cancer
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Advances in Clinical Medicine.2024; 14(02): 4201. CrossRef

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Recent advances in surveillance colonoscopy for dysplasia in inflammatory bowel disease: Soo-Young Na, Won Moon; Clin Endosc 2022;55(6):726-735. Published online November 18, 2022; DOI: https://doi.org/10.5946/ce.2022.132

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Inflammatory bowel disease (IBD) has a global presence with rapidly increasing incidence and prevalence. Patients with IBD including those with ulcerative colitis and Crohn’s disease have a higher risk of developing colorectal cancer (CRC) compared to the general population. Risk factors for CRC in patients with IBD include long disease duration, extensive colitis, primary sclerosing cholangitis, family history of CRC, stricture, and prior dysplasia. Surveillance colonoscopy for CRC in patients with IBD should be tailored to individualized risk factors and requires careful monitoring every year to every five years. The current surveillance techniques are based on several guidelines. Chromoendoscopy with targeted biopsy is being recommended increasingly, and high-definition colonoscopy is gradually replacing standard-definition colonoscopy. However, it remains unclear whether chromoendoscopy, virtual chromoendoscopy, or white-light endoscopy has better efficiency when a high-definition scope is used. With the development of new endoscopic instruments and techniques, the paradigm of surveillance strategy has gradually changed. In this review, we discuss cutting-edge surveillance colonoscopy in patients with IBD including a review of literature.

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Inflammatory bowel disease and primary sclerosing cholangitis: One disease or two?
Kim N. van Munster, Annika Bergquist, Cyriel Y. Ponsioen
Journal of Hepatology.2024; 80(1): 155. CrossRef
Extrachromosomal Circular DNA: An Emerging Potential Biomarker for Inflammatory Bowel Diseases?
Valentina Petito, Federica Di Vincenzo, Lorenza Putignani, Maria T. Abreu, Birgitte Regenberg, Antonio Gasbarrini, Franco Scaldaferri
Genes.2024; 15(4): 414. CrossRef
A Review of Colonoscopy in Intestinal Diseases
Seung Hong, Dong Baek
Diagnostics.2023; 13(7): 1262. CrossRef
Potential Oral Microbial Markers for Differential Diagnosis of Crohn’s Disease and Ulcerative Colitis Using Machine Learning Models
Sang-Bum Kang, Hyeonwoo Kim, Sangsoo Kim, Jiwon Kim, Soo-Kyung Park, Chil-Woo Lee, Kyeong Ok Kim, Geom-Seog Seo, Min Suk Kim, Jae Myung Cha, Ja Seol Koo, Dong-Il Park
Microorganisms.2023; 11(7): 1665. CrossRef
Update on Endoscopic Dysplasia Surveillance in Inflammatory Bowel Disease
Nayantara Coelho-Prabhu, James D. Lewis
American Journal of Gastroenterology.2023;[Epub] CrossRef

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Clinical Features and Predictors of Dysplasia in Proximal Sessile Serrated Lesions: Yi Yuan Tan, Gary Sei Kiat Tay, Yu Jun Wong, James Weiquan Li, Andrew Boon Eu Kwek, Tiing Leong Ang, Lai Mun Wang, Malcolm Teck Kiang Tan; Clin Endosc 2021;54(4):578-588. Published online April 29, 2021; DOI: https://doi.org/10.5946/ce.2020.198

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Background
/Aims: Proximal colorectal cancers (CRCs) account for up to half of CRCs. Sessile serrated lesions (SSLs) are precursors to CRC. Proximal location and presence of dysplasia in SSLs predict higher risks of progression to cancer. The prevalence of dysplasia in proximal SSLs (pSSLs) and clinical characteristics of dysplastic pSSLs are not well studied.
Methods
Endoscopically resected colonic polyps at our center between January 2016 and December 2017 were screened for pSSLs. Data of patients with at least one pSSL were retrieved and clinicopathological features of pSSLs were analysed. pSSLs with and without dysplasia were compared for associations.
Results
Ninety pSSLs were identified, 45 of which had dysplasia giving a prevalence of 50.0%. Older age (65.9 years vs. 60.1 years, p=0.034) was associated with the presence of dysplasia. Twelve pSSLs were 10 mm or larger. After adjusting for age, pSSLs ≥10 mm had an adjusted odds ratio of 5.98 (95% confidence interval, 1.21–29.6) of having dysplasia compared with smaller pSSLs.
Conclusions
In our cohort of pSSLs, the prevalence of dysplasia is high at 50.0% and is associated with lesion size ≥10 mm. Endoscopic resection for all proximal serrated lesions should be en-bloc to facilitate accurate histopathological examination for dysplasia as its presence warrants shorter surveillance intervals.

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Clinical and endoscopic characteristics of colorectal sessile serrated lesions with or without dysplasia/carcinoma: A systematic review and meta‐analysis
Qing Qing Zhang, Jian Di Wu, Xue Yan Li, Fei Fei Fang, Gang Ping Li, Tao Bai, Jun Song
Journal of Digestive Diseases.2024;[Epub] CrossRef
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
Intestinal Research.2023; 21(1): 20. CrossRef
Microvesicular hyperplastic polyp and sessile serrated lesion of the large intestine: a biological continuum or separate entities?
Adrian C Bateman, Adam L Booth, Raul S Gonzalez, Neil A Shepherd
Journal of Clinical Pathology.2023; 76(7): 429. CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. 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
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
The Korean Journal of Gastroenterology.2022; 80(3): 115. CrossRef
Impact of looping on premalignant polyp detection during colonoscopy
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Tatsuya Matsuno, Toru Arano, Ryo Kondo, Kazunori Kinoshita, Yuki Yasumi, Yosuke Tsuji, Mitsuhiro Fujishiro
World Journal of Gastrointestinal Endoscopy.2022; 14(11): 694. CrossRef
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
Clinical Endoscopy.2022; 55(6): 703. CrossRef

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Endoscopic Submucosal Dissection for Colitis-Associated Dysplasia: Dong-Hoon Yang, Imelda Rey; Clin Endosc 2019;52(2):120-128. Published online March 27, 2019; DOI: https://doi.org/10.5946/ce.2019.047

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Dysplasia is a precancerous lesion of colorectal cancer in patients with long-standing inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn’s disease. Recent guidelines suggest endoscopic resection as a key modality for the treatment of endoscopically resectable dysplasia in patients with colitis. Endoscopic submucosal dissection (ESD) has been suggested as one of the therapeutic options for dysplasia that is potentially resectable but not suitable for the conventional endoscopic mucosal resection technique. Several recent studies supported the feasibility of ESD for the treatment of colitis-associated dysplasia in terms of the en bloc and complete resection rates and the risk of procedure-related complications. However, these studies were performed exclusively in expert centers. Moreover, the local and metachronous recurrence rates were relatively high, and long-term outcome data are still lacking. Endoscopists should be highly skilled in colorectal ESD and have an intensive understanding of not only the lesions but also the conditions of patients with IBDs. Therefore, the decision to perform ESD for colitis-associated dysplasia should be made scrupulously after careful discussion with patients, in collaboration with a multidisciplinary IBD team including physicians, surgeons, and pathologists specialized in IBDs.

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Characteristics of flat‐type ulcerative colitis‐associated neoplasia on chromoendoscopic imaging with indigo carmine dye spraying
Kaoru Takabayashi, Shinya Sugimoto, Kosaku Nanki, Yusuke Yoshimatsu, Hiroki Kiyohara, Yohei Mikami, Tomohisa Sujino, Motohiko Kato, Naoki Hosoe, Masayuki Shimoda, Naohisa Yahagi, Haruhiko Ogata, Yasushi Iwao, Takanori Kanai
Digestive Endoscopy.2024; 36(4): 446. CrossRef
Colorectal endoscopic submucosal dissection: a review on patient selection and indications
M Bronswijk, G Rasschaert, Y Hayashi, H Yamamoto
Acta Gastro Enterologica Belgica.2023; 86(1): 36. CrossRef
Current Screening and Management Strategies for Dysplasia in IBD
Dania Hudhud, Angela Wu, Raymond K. Cross
Current Treatment Options in Gastroenterology.2023; 21(2): 218. CrossRef
Beyond the SCENIC route: updates in chromoendoscopy and dysplasia screening in patients with inflammatory bowel disease
Loren Galler Rabinowitz, Nikhil A. Kumta, James F. Marion
Gastrointestinal Endoscopy.2022; 95(1): 30. CrossRef
Colorectal Cancer in Inflammatory Bowel Disease: Mechanisms and Management
Shailja C. Shah, Steven H. Itzkowitz
Gastroenterology.2022; 162(3): 715. CrossRef
Efficacy and Safety of Endoscopic Submucosal Dissection for Dysplasia in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis
Qi-Shan Zeng, Zhi-Jing Zhao, Jiao Nie, Min Zou, Jia-Hui Yang, Jin-Zhi Zhang, Hua-Tian Gan, Fabiana Andréa Moura
Gastroenterology Research and Practice.2022; 2022: 1. CrossRef
Endoscopic Management of Colitis-Associated Neoplasia
Nathaniel A. Cohen, David T. Rubin
Gastrointestinal Endoscopy Clinics of North America.2022; 32(4): 863. CrossRef
Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India
Partha Pal, Mohan Ramchandani, Rupa Banerjee, Pradev Inavolu, Zaheer Nabi, Hardik Rughwani, Aniruddha Pratap Haripal Singh, Rajendra Patel, Polina Vijayalaxmi, Jagdeesh Rampal Singh, Pradeep Rebala, Guduru Venkat Rao, D Nageshwar Reddy, Manu Tandan
Journal of Digestive Endoscopy.2022; 13(04): 207. CrossRef
An endoscopic treatment strategy for superficial tumors in patients with ulcerative colitis
Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato, Reiko Kunisaki, Shin Maeda
Journal of Gastroenterology and Hepatology.2021; 36(2): 498. CrossRef
Endoscopic molecular imaging in inflammatory bowel disease
Nam Seok Ham, Seung-Jae Myung
Intestinal Research.2021; 19(1): 33. CrossRef
AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review
Sanjay K. Murthy, Joseph D. Feuerstein, Geoffrey C. Nguyen, Fernando S. Velayos
Gastroenterology.2021; 161(3): 1043. CrossRef
Recent Advance in the Management of Dysplasia in the Ulcerative Colitis
Dong-Hoon Yang
Journal of Digestive Cancer Reports.2021; 9(2): 50. CrossRef
Elevating the Technique: Resecting Complex Dysplastic Lesions of the Colon in Patients with Inflammatory Bowel Disease
Eshandeep S. Boparai, Fernando S. Velayos, Abhik Roy, Carolyn Li, Ahmed S. Alkoraishi, Craig A. Munroe
Digestive Diseases and Sciences.2020; 65(1): 78. CrossRef

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Endoscopic Therapeutic Approach for Dysplasia in Inflammatory Bowel Disease: Sung Noh Hong; Clin Endosc 2017;50(5):437-445. Published online September 29, 2017; DOI: https://doi.org/10.5946/ce.2017.132

Abstract PDF PubReader ePub

Long-standing intestinal inflammation in patients with inflammatory bowel disease (IBD) induces dysplastic change in the intestinal mucosa and increases the risk of subsequent colorectal cancer. The evolving endoscopic techniques and technologies, including dye spraying methods and high-definition images, have been replacing random biopsies and have been revealed as more practical and efficient for detection of dysplasia in IBD patients. In addition, they have potential usefulness in detailed characterization of lesions and in the assessment of endoscopic resectability. Most dysplastic lesions without an unclear margin, definite ulceration, non-lifting sign, and high index of malignant change with suspicion for lymph node or distant metastases can be removed endoscopically. However, endoscopic resection of dysplasia in chronic IBD patients is usually difficult because it is often complicated by submucosal fibrosis. In patients with dysplasias that demonstrate submucosa fibrosis or a large size (≥20 mm), endoscopic submucosal dissection (ESD) or ESD with snaring (simplified or hybrid ESD) is an alternative option and may avoid a colectomy. However, a standardized endoscopic therapeutic approach for dysplasia in IBD has not been established yet, and dedicated specialized endoscopists with interest in IBD are needed to fully investigate recent emerging techniques and technologies.

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Considerations for Colorectal Neoplasia Detection in Inflammatory Bowel Disease Clinical Trials
Mira M. Yang, Keith Usiskin, Harris A. Ahmad, Shabana Ather, Antoine Sreih, James B. Canavan, Francis A. Farraye, Christopher Ma
Digestive Diseases.2024; 42(1): 12. CrossRef
Beyond the SCENIC route: updates in chromoendoscopy and dysplasia screening in patients with inflammatory bowel disease
Loren Galler Rabinowitz, Nikhil A. Kumta, James F. Marion
Gastrointestinal Endoscopy.2022; 95(1): 30. CrossRef
Elevating the Technique: Resecting Complex Dysplastic Lesions of the Colon in Patients with Inflammatory Bowel Disease
Eshandeep S. Boparai, Fernando S. Velayos, Abhik Roy, Carolyn Li, Ahmed S. Alkoraishi, Craig A. Munroe
Digestive Diseases and Sciences.2020; 65(1): 78. CrossRef
Role of interventional inflammatory bowel disease in the era of biologic therapy: a position statement from the Global Interventional IBD Group
Bo Shen, Gursimran Kochhar, Udayakumar Navaneethan, Xiuli Liu, Francis A. Farraye, Yago Gonzalez-Lama, David Bruining, Darrell S. Pardi, Martin Lukas, Martin Bortlik, Kaicun Wu, Ajit Sood, David A. Schwartz, William J. Sandborn, Roger Charles, Yan Chen, M
Gastrointestinal Endoscopy.2019; 89(2): 215. CrossRef
Management of Inflammatory Bowel Disease–Associated Dysplasia in the Modern Era
Shailja C. Shah, Steven H. Itzkowitz
Gastrointestinal Endoscopy Clinics of North America.2019; 29(3): 531. CrossRef

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Multiple Polypoid Angiodysplasia with Obscure Overt Bleeding: Jooyoung Lee, Sung Wook Hwang, Jihye Kim, Jinwoo Kang, Gyeong Hoon Kang, Kyu Joo Park, Jong Pil Im, Joo Sung Kim; Clin Endosc 2016;49(1):91-96. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.91

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Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.

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Intraoperative Endoscopic-Guided Bowel Resection for Persistent Gastrointestinal Bleeding Caused by Angiodysplasia: A Case Report and Literature Review
Emily Fellows, Joy Harris, Tania Kibble, Nicholas M. McDonald, Nabeel Azeem, James V. Harmon
The Surgery Journal.2023; 09(04): e112. CrossRef
Ileal angiodysplasia presentation as a bowel obstruction: A case report
Ons Ghdes, Ali Gaja, Ahlem Blel, Hichem Jarraya, Najla Mnif
International Journal of Surgery Case Reports.2017; 39: 301. CrossRef
Solitary Polypoid Angiodysplastic Lesion Mimicking a Tumor in the Jejunum
Abhishek D. Polavarapu, Mayurathan Kesavan, Vivek V. Gumaste, Monika Wrzolek, Elias Purow
ACG Case Reports Journal.2017; 4(1): e83. CrossRef

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A Case of Endoscopic Full-Thickness Resection in a Patient with Gastric High-Grade Dysplasia Unsuitable for Endoscopic Submucosal Dissection: Jung Min Chae, Jae Young Jang, Seonghun Hong, Jung Wook Kim, Young Woon Chang; Clin Endosc 2014;47(4):353-357. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.353

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Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8×0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.

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Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold
Edward Young, Hamish Philpott, Rajvinder Singh
World Journal of Gastroenterology.2021; 27(31): 5126. CrossRef
Identification and preparation of lesions suitable for endoscopic full-thickness resection
Jeffrey Fiorenza, Pavlos Kaimakliotis
Techniques in Gastrointestinal Endoscopy.2015; 17(3): 108. CrossRef

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Treatment of Dysplasia in Barrett Esophagus: Javier Aranda-Hernandez, Maria Cirocco, Norman Marcon; Clin Endosc 2014;47(1):55-64. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.55

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Barrett esophagus is recognized as a risk factor for the development of dysplasia and adenocarcinoma of the esophagus. Cancer is usually diagnosed at an advanced stage with a 5-year survival rate of 15%. Most of these patients present de novo and are not part of a surveillance program. Endoscopic screening with improvement in recognition of early lesions may change this pattern. In the past, patients diagnosed with dysplasia and mucosal cancer were best managed by esophagectomy. Endoscopic techniques such as endoscopic mucosal resection and radiofrequency ablation have resulted in high curative rates and a shift away from esophagectomy. This pathway is supported by the literature review of esophagectomies performed for mucosal disease, as well as pathologists' interpretation of endoscopic mucosal specimens, which document the low risk of lymph node metastasis. The role of endoscopic therapy for superficial submucosal disease continues to be a challenge.

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Determination of regional lymph node status using18F-FDG PET/CT parameters in oesophageal cancer patients: comparison of SUV, volumetric parameters and intratumoral heterogeneity
Seong-Jang Kim, Kyoungjune Pak, Samuel Chang
The British Journal of Radiology.2016; 89(1058): 20150673. CrossRef
Management of high grade dysplasia in Barrett's oesophagus with underlying oesophageal varices: A retrospective study
William C. Palmer, Milena Di Leo, Manol Jovani, Michael G. Heckman, Nancy N. Diehl, Prasad G. Iyer, Herbert C. Wolfsen, Michael B. Wallace
Digestive and Liver Disease.2015; 47(9): 763. CrossRef
Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer
Ru Tan, Shu-Zhan Yao, Zhao-Qin Huang, Jun Li, Xin Li, Hai-Hua Tan, Qing-Wei Liu
Asian Pacific Journal of Cancer Prevention.2014; 15(18): 7719. CrossRef

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81 Download
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Histopathology in Barrett Esophagus and Barrett Esophagus-Related Dysplasia: Andrea Grin, Catherine J. Streutker; Clin Endosc 2014;47(1):31-39. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.31

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Pathologic specimens, both biopsies and endoscopic mucosal resections, for Barrett esophagus and Barrett-associated dysplasia and malignancy are common for pathologists in North America, and the incidence in South Asian countries seems to be increasing. Dysplasia and malignancy arising in intestinalized gastric-type mucosa raises issues in the interpretation of dysplasia and the evaluation of the depth of invasion of malignancies that are not seen in squamous dysplasia and squamous cell carcinoma. We review the North American approach to these lesions.

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Complete circumferential endoscopic submucosal dissection for early Barrett’s neoplasia
Douglas Motomura, Robert Bechara
Gastrointestinal Endoscopy.2024; 99(3): 337. CrossRef
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Ksenia S. Maslyonkina, Alexandra K. Konyukova, Darya Y. Alexeeva, Mikhail Y. Sinelnikov, Liudmila M. Mikhaleva
Cancer Medicine.2022; 11(2): 447. CrossRef
Matrix metalloproteinase (MMP)-7 in Barrett's esophagus and esophageal adenocarcinoma: expression, metabolism, and functional significance
Hanan M. Garalla, Nantaporn Lertkowit, Laszlo Tiszlavicz, Zita Reisz, Chris Holmberg, Rob Beynon, Deborah Simpson, Akos Varga, Jothi Dinesh Kumar, Steven Dodd, David Mark Pritchard, Andrew R. Moore, András I. Rosztóczy, Tibor Wittman, Alec Simpson, Graham
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A Comparison Study of Esophageal Findings on 18F-FDG PET/CT and Esophagogastroduodenoscopy
KwanHyeong Jo, Soyoung Kim, Jongtae Cha, Sang Hyun Hwang, Narae Lee, Mijin Yun, Won Jun Kang
Nuclear Medicine and Molecular Imaging.2016; 50(2): 123. CrossRef

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145 Download
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Confocal Microscopy in the Esophagus and Stomach: Adam Templeton, Joo Ha Hwang; Clin Endosc 2013;46(5):445-449. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.445

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

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Probe‐based confocal laser endomicroscopy versus biopsies in the diagnostics of oesophageal and gastric lesions: A prospective, pathologist‐blinded study
Marek Kollar, Jana Krajciova, Lucia Prefertusova, Eva Sticova, Jana Maluskova, Zuzana Vackova, Jan Martinek
United European Gastroenterology Journal.2020; 8(4): 436. CrossRef
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Mu-Ni Hu, Shu-Hui Hu, Xing-Wei Zhang, Shu-Min Xiong, Huan Deng
Tumori Journal.2020; 106(5): 346. CrossRef
Role of endoscopy in the management of hereditary diffuse gastric cancer syndrome
Shria Kumar, Jessica M Long, Gregory G Ginsberg, Bryson W Katona
World Journal of Gastroenterology.2019; 25(23): 2878. CrossRef
Diagnosis and Management of Gastric Intestinal Metaplasia: Current Status and Future Directions
Robert J. Huang, Alyssa Y. Choi, Camtu D. Truong, Matthew M. Yeh, Joo Ha Hwang
Gut and Liver.2019; 13(6): 596. CrossRef
Probe-based confocal laser endomicroscopy (pCLE): a preclinical investigation of the male genital tract
Matthias Trottmann, Ronald Sroka, Herbert Stepp, Bernhard Liedl, Armin J. Becker, Christian G. Stief, Sabine Kölle
Lasers in Medical Science.2016; 31(1): 57. CrossRef
How to manage gastric polyps
Gandhi Lanke, Atin Agarwal, Jeffrey H. Lee
International Journal of Gastrointestinal Intervention.2016; 5(3): 159. CrossRef
Prevención, escrutinio y seguimiento endoscópico de lesiones premalignas del tracto digestivo superior y medio
Daniel Ruiz-Romero, Félix Ignacio Téllez-Ávila, Rafael Barreto-Zúñiga, Luis Eduardo Zamora-Nava.
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Colonoscopic Cancer Surveillance in Inflammatory Bowel Disease: What's New Beyond Random Biopsy?: James E. East; Clin Endosc 2012;45(3):274-277. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.274

Abstract PDF PubReader ePub

Colonoscopy based colitis surveillance is widely accepted to try to prevent development of and ensure early detection of colitis-associated colorectal cancer. Traditionally this has been performed with quadrantic random biopsies throughout the colon. Chromoendoscopy "dye-spray" with targeted biopsies only has been shown to increase dysplasia detection 4 to 5 fold on a per lesion basis. It has therefore been suggested that random biopsies should be abandoned as they do not increase dysplasia detection nor change patient clinical course. Recent British guidelines for colitis surveillance have strongly endorsed chromoendoscopy. This short review summarizes current international guidelines and looks at how to optimize white light colonoscopy in colitis considering: bowel preparation, withdrawal time, high definition, and structure enhancement. Data for advanced imaging techniques are reviewed including positive evidence in favor of chromoendoscopy, and limited data suggesting autofluoresence imaging may be promising. Narrow band imaging does not increase dysplasia detection in colitis. Confocal endomicroscopy might potentially reduce biopsies beyond that of chromoendoscopy but does not offer a clear detection advantage. Pan-colonic chromoendoscopy with targeted biopsies increases dysplasia detection and is the standard of care in the United Kingdom. It is likely that the use of chromoendoscopy for colitis surveillance will become widely accepted internationally.

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A Case of Bleeding on the Ampulla of Vater Due to Angiodysplasia in a Patient with End Stage Renal Disease: Sang Bae Kim, M.D., Bu Sug Jun, M.D., Hae Bin Jung, M.D., Hyung Keun Kim, M.D., Young Suk Cho, M.D., Hyun Suk Chae, M.D., Chang Don Lee, M.D. and Sung Soo Kim, M.D.; Korean J Gastrointest Endosc 2010;40(1):41-44. Published online January 30, 2010

Abstract PDF: Gastrointestinal angiodysplasia is one of the causes of acute and chronic gastrointestinal bleeding, and gastrointestinal angiodysplasia makes up 2∼6% of all the cases of upper gastrointestinal bleeding. Bleeding from the ampulla of Vater is very rare. We report here on an unusual case of bleeding from angiodysplasia at the ampulla of Vater in a 58-aged woman with end stage renal failure. This lesion was successfully treated with endoscopic argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:41-44)

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Colonic Carcinoma and Tubular Adenoma with High Grade Dysplasia Resembling Submucosal Tumor: Eun Ran Kim, M.D., Dong Kyung Chang, M.D., Kyoung-Mee Kim, M.D.*, Jin Yong Kim, M.D., Young-Ho Kim, M.D., Jae Jun Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2009;38(4):229-233. Published online April 30, 2009

Abstract PDF: Colorectal carcinoma arises from the epithelium of the colorectal mucosa, and so it displays various macroscopic appearances with abnormal mucosal changes. But submucosal tumor-like colorectal carcinoma is very rare. We report here on two such cases along with a review of the relevant literature. The first case was submucosal tumor-like colorectal carcinoma that was initially diagnosed as rectal submucosal tumor, but the follow-up endoscopic exam revealed ulceroinfiltrative type adenocarcinoma. The second case was an endoscopically determined polypoid lesion combined with submucosal tumor, but it was found to be tubular adenoma with high grade dysplasia combined with a mucin pool collection in the submucosa after surgical resection. (Korean J Gastrointest Endosc 2009;38:229- 233)

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A Clinical Analysis of Patients with Active Small Bowel Bleeding as Detected on Double Balloon Enteroscopy: Tae Hee Lee, M.D., Jin Oh Kim, M.D., Soo Hoon Eun, M.D., Bong Min Ko, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., So Young Jin, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2008;37(5):321-327. Published online November 30, 2008

Abstract PDF: Background/Aims: There are few studies that have evaluated active small bowel bleeding. The aim of this study was to evaluate patients with active small bowel bleeding that had been considered as obscure gastrointestinal bleeding an was confirmed by the use of double balloon enteroscopy (DBE). Methods: We retrospectively reviewed the medical records of 12 patients with active small bowel bleeding as detected on DBE from January 2005 to September 2007. Results: The mean patient age was 63 years (age range, 45∼80 years) and the patients consisted of seven men and five women. The mean hemoglobin level at admission was 7.6 g/dL (range, 5.8∼9.0 g/dL). The mean transfusion volume was 4.4 pints (range, 0∼7 pints). Angiodysplasia was the most common cause of bleeding (n=6, 50%), followed by small bowel tumors (n=4, 33%). Other causes included diverticula and a nonspecific ulcer. The most common location of bleeding was the jejunum. Diagnostic yields of capsule endoscopy, a ^99mTc RBC scan, an abdomen CT scan, angiography and a small bowel series were 40%, 33%, 25%, 0% and 0%, respectively. Endoscopic treatment was performed successfully in eight patients (67%). Conclusions: The most common etiology for active small bowel bleeding is angiodysplasia followed by a small bowel tumor. Other diagnostic methods for the small bowel showed low diagnostic yields. Further investigation of active small bowel bleeding is needed to confirm our results. (Korean J Gastrointest Endosc 2008;37:321-327)

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A Case of Capsule Endoscopy in a 42-month-old Girl: Kyung-Jo Kim, M.D., Kyung Mo Kim, M.D.*, Sung Chul Kim, M.D.^†, Young Mi Cho, M.D.^‡ and Eun Jin Rho, M.D.^§; Korean J Gastrointest Endosc 2008;36(2):92-96. Published online February 27, 2008

Abstract PDF: Capsule endoscopy (CE) provides a minimally invasive examination of the entire small intestine, and is the preferred procedure for evaluation of patients with GI bleeding of unknown origin. Even though the FDA approved its use for pediatric patients between 10 and 18 years old in January 2004, little information is available regarding the effectiveness of CE in the younger pediatric population (below 6 years old) because of safety issues. A 42-month child with recurrent melena was referred to evaluate the cause of gastrointestinal bleeding. Despite extensive evaluation, including EGD, colonoscopy, a small bowel series, and Meckel's scan, the bleeding source was not identified. Finally, wireless CE demonstrated angiodysplasia on the mucosa of proximal jejunum. This is the first pediatric case of endoscopy-assisted CE under intravenous sedation without endotracheal intubation in Korea. (Korean J Gastrointest Endosc 2008;36:92-96)

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A Case of Huge Gastric Angiodysplasia Treated with Argon Plasma Coagulation: Sung-Jin Moon, M.D., Jin Il Kim, M.D., Jae Kyu Chung, M.D., Min Kuk Kim, M.D., Dae Young Cheung, M.D., Se Hyun Cho, M.D., Soo-Heon Park, M.D., Joon-Yeol Han, M.D., Jae Kwang Kim, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2006;33(5):289-293. Published online November 30, 2006

Abstract PDF: Gastric angiodysplasia is an uncommon cause of upper gastrointestinal blood loss that may occur in the stomach or duodenum, and is responsible for up to 1∼6% of upper gastrointestinal bleeding. In contrast to colonic angioectasia, gastric lesions are more common in young individuals and originate from developmental causes. On an endoscopic examination, the lesions typically show a spider-shape or coral reef-like pattern of dilated and tortuous vessels and measure approximately 2 to 10 mm in diameter. We encountered a case of huge gastric angiodysplasia that presented with overt bleeding and anemia and was successfully treated with argon plasma coagulation. (Korean J Gastrointest Endosc 2006;33: 289⁣293)

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A Case of Bleeding Due to Angiodysplasia of the Ampulla of Vater: Jong Ryul Eun, M.D. and Byung Ik Jang, M.D.; Korean J Gastrointest Endosc 2006;32(6):405-408. Published online June 30, 2006

Abstract PDF: Although angiodysplasia can be found along the whole gastrointestinal tract, it is extremely rare at the ampulla of Vater. We experienced a case of chronic bleeding due to an angiodysplasia of the major papilla. A 53-year-old man was admitted due to intermittent melena and dyspnea for approximately 4 months. Esophagogastroduodenoscopy revealed bleeding from the ampulla of Vater. A subsequent examination with side-viewing duodenoscopy revealed vascular ectasia around the orifice of the major papilla and blood oozing from this lesion. Hemostasis was successfully performed by endoscopic bipolar electrocoagulation. No further bleeding was observed and the previous vascular abnormality disappeared at the follow-up duodenoscopy. (Korean J Gastrointest Endosc 2006;32: 405⁣408)

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A Case of High Grade Dysplasia in Sporadic Fundic Gland Polyp: Hyung Keun Ha, M.D., Jin Tae Jung, M.D., Young Sup Kim, M.D., Byung Seok Kim, M.D., Kyu Hyun Cho, M.D., Joong Goo Kwon, M.D., Eun Young Kim, M.D., Chang Hyeong Lee, M.D., Ho Gak Kim, M.D. and Chang Ho Cho, M.D.*; Korean J Gastrointest Endosc 2006;32(5):338-341. Published online May 30, 2006

Abstract PDF: Fundic gland polyps (FGP) are the most common type of gastric polyps, with an incidence on endoscopy of 0.8∼1.9%. They have been considered as benign lesions, without the potential for malignant transformation. High grade dysplasia and gastric adenocarcinomas associated with FGP have been described in patients with familial, as well as attenuated adenomatous polyposis (FAP). In contrast, dysplasia associated with FGP in non-FAP patients is extremely rare, and there have been no reports of sporadic FGP with high grade dysplasia in the Korean literature. Herein, we report one case of high grade dysplasia associated with sporadic FGP in a non-FAP patient treated with an endoscopic polypectomy. (Korean J Gastrointest Endosc 2006;32:338⁣341)

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A Case of Polyp with High Grade Dysplasia in Ulcerative Colitis: Han-Hyo Lee, M.D., Sung-Ae Jung, M.D., Seong-Eun Kim, M.D., Yoon-Joo Na, M.D., Hee-Sun Kim, M.D., Jun-Sik Nam, M.D., Moon-Sun Yeoum, M.D., Ki-Nam Shim, M.D., Kwon Yoo, M.D. and Il Hwan Moon, M.D.; Korean J Gastrointest Endosc 2004;29(1):46-49. Published online July 30, 2004

Abstract PDF: Patients with ulcerative colitis (UC) have the increased risk of colorectal cancer. The risk of colorectal cancer development in UC is associated with the extent of colitis and duration of disease. It is generally agreed that there is little or no increased risk associated with proctitis or proctosigmoiditis. A dysplasia-associated lesion or mass (DALM) is difficult to distinguish from sporadic adenoma. The DALM indicate a high association with colon cancer. The presence of DALM as a premalignant lesion has been considered as an indication for colectomy because of the high risk of progression to malignancy within a short period. We report a case of polyp with high grade dysplasia in a 27-year-old man of ulcerative colitis confined to rectum and sigmoid colon. (Korean J Gastrointest Endosc 2004;29: 46⁣49)

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A Case of Lower Gastrointestinal Bleeding due to Angiodysplasia in the Terminal Ileum: Anna Kim, M.D., Jong Min Lee, M.D., Jane Oh, M.D. and Gye Sung Lee, M.D.; Korean J Gastrointest Endosc 2004;28(4):197-201. Published online April 30, 2004

Abstract PDF: Angiodysplasia has been recognized as an important cause of lower gastrointestinal bleeding, but it is difficult to confirm the lesions. Angiodysplasia in the small bowel could be the most probable cause of bleeding particularly in the elderly patients when usual methods fail to document the focus. Small bowel angiodysplasias have been diagnosed by angiography and/or surgery at the sites where usual endoscope could not reach, and treated by medical therapy, angiographic embolization or surgery. We experienced a case of a bleeding angiodysplasia in the terminal ileum in a 51-year-old man who was taking anti-platelet agents. The lesion was diagnosed by colonoscopy, and bleeding was easily controlled with hemoclipping. (Korean J Gastrointest Endosc 2004;28:197⁣201)

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59세 남자, 식후 상복부 불쾌감: Korean J Gastrointest Endosc 2003;26(5):352-352. Published online May 30, 2003

PDF

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Endoscopic Photodynamic Diagnosis (PDD) Using Oral 5-aminolevulinic Acid in Gastrointestinal Cancer and Dysplastic Lesions: Young Koog Cheon, M.D., Young Deok Cho, M.D., Jin Oh Kim, M.D., Joo Yong Cho, M.D. Joon Seong Lee, M.D., Yun Soo Kim, M.D., Moon Sung Lee, M.D. and Chan Sup Shim, M.D.; Korean J Gastrointest Endosc 2003;26(2):73-78. Published online February 28, 2003

Abstract PDF: Background
/Aim: Endoscopic screening for the detection of premalignant high-grade dysplasia remains time consuming and is subject to sampling error. We performed this study to determine the clinical usefulness of laser endoscopic spectra analyzer (LESA-7) in gastrointestinal cancer and dysplastic lesions. Methods: Seventeen patients with histologically proven carcinoma or adenoma with or without high-grade dysplasia were treated with oral administration of 5-ALA (20 mg/kg). PDD was performed 4 hours later. The fluorescence was excited by a helium-neon laser with emission at 637 nm. The generated fluorescence light was collected and fed into a multi-channel analyzer and the full spectrum was displayed in real time (LESA-7). Results: In most of malignant tumors, a clear protoporphyrin IX-related dual-peaked fluorescence signal at about 635 and 700 nm was identified in the fluorescence spectra. However, it was not fully identified in bile duct cancers. In PDD of post-EMR in order to detect residual lesions (gastric flat adenoma 1, early gastric cancer 2), a dual spectra was not identified. Conclusion: PDD with 5-ALA might be useful for the detection of dysplasia and carcinoma in the gastrointestinal tract. (Korean J Gastrointest Endosc 2003;26:73⁣78)

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Comparison of Clinicopathologic Findings between Colorectal Adenoma with High Grade Dysplasia and Colorectal Carcinoma with Mucosal Invasion: Myoung Joo Ki, M.D., Hyun Duk Shin, M.D., Jae Duk Kim, M.D.,Jeong Eun Shin, M.D. and Chang Young Lim, M.D.; Korean J Gastrointest Endosc 2002;25(6):438-442. Published online December 30, 2002

Abstract PDF: Background
/Aims: The precancerous lesion of colorectal cancer is adenoma. Adenoma with high grade dysplasia has been known as the lesion having high malignant potentials. The cancer with invasion to mucosa is limted to the mucosa, and it is difficult to pathologically differentiate the adenoma with high grade dysplasia. Methods: Fifty three adenomas with high grade dysplasia (type I group) and 40 cancers with invasion to mucosa (type II group) for 4 years, were analyzed for the colonoscopic findings and pathological findings before and after EMR. Results: Mean ages were 57.0 years old for type I group and 60.4 for type II group. Chief complaint for colonoscopy was rectal bleeding (21.0%) for type I group, and rectal bleeding (35.0%) for type II group. Mean sizes of the lesions were 1.18 cm for type I group, and 1.71 cm for type II group. Locations of the lesion were rectum 43.4%, sigmoid colon 32.1%, proximal colon 24.5% for type I group, and rectum 45.7%, sigmoid colon 42.9%, proximal colon 11.4% for type II group. Shapes of the lesions were Is 46.9%, Ip 30.6%, Isp 18.4%, LST 4.1% for type I group, and Isp 34.2%, Ip 31.6%, Is 18.4%, LST 5%, IIa⁢depression 5%, Is⁢IIc 5% for type II group. Methods for therapy were EMR 60.4%, operation 1.9%, electrocoagulation 11.3%, observation 26.4% for type I group, and EMR 85.0%, operation 15.0% for type II group. Pathological agreement before and after EMR was 57.1% for type I group and 31.3% for type II group. Conclusions: Type II group had more rectal bleeding, larger, more Isp type, more EMR therapy, more pathological disagreement ratio before and after EMR, than type I group. (Korean J Gastrointest Endosc 2002;25:438⁣442)

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종양과의 감별이 어려웠던 원위부 총담관의 감돈 결석 ( An Impacted Distal Common Bile Duct Stone Mimicking a Tumor : An Unusual Manifestation of Gallstone Disease ): Korean J Gastrointest Endosc 2001;22(6):449-453. Published online November 30, 2000

Abstract PDF: Patients with bile duct stones usually present with biliary pain, obstructive jaundice, ascending cholangitis, or pancreatitis, When endoscopic retrograde cholangiopancreatography (ERCP) is performed, bile duct stones are usually movable and thus easily detected. If a stone in the bile duct presents unusually, it may pose some diagnostic challenges. Recently, we experienced a case of an impacted distal common bile duct (CBD) stone mimicking a tumor which resulted in performing a pylorus-preserving pancreaticoduodenectomy in an asymptomatic 56-year-old man. On ERCP, an obstructing distal CBD lesion did not move even by doing brush cytology. Moreover, the result of brush cytology was positive for atypical cells. A major resective surgery performed after recovery from severe post-ERCP pancreatitis confirmed the diagnosis. Interestingly, this stone caused erosion with acute and chronic inflammation and fibrosis containing foci of mild epithelial dysplasia. We herein report an unusual manifestation of gallstone disease with a review of the literature. (Korean J Gastrointest Endosc 2001;22:449-453)

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고도 이형성증을 동반한 식도 편평세포 유두종 1예 ( A Squamous Cell Papilloma of Esophagus Associated with Dysplasia ): Korean J Gastrointest Endosc 2000;21(6):934-937. Published online November 30, 1999

Abstract PDF: A squamous cell papilloma of esophagus is regarded as a rare tumor, and one of the distal esophagus is known to be not changed into a malignant neoplasm although squamous papilloma of the larynx, cervix and the upper esophagus may be associated with squamous cell carcinoma. We report the first case of a squamous papilloma associated with hig grade dysplasia at the lower esophagus. We think this case may have an important implication in the surveillance and management of esophageal papilloma found at endoscopy.

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대량 출혈을 동반한 대장 혈관 이형성증 1 예 ( A Case of Colonic Angiodysplasia in Massive Lower Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1999;19(3):469-472. Published online November 30, 1998

Abstract PDF: Colonic angiodysplasia is important because of the likelihood of lower gastrointestinal tract bleeding, either massively or chronically. A 66-year-old male patient visited our hospital because of hematochezia and lower abdominal discomfort. He underwent colonoscopy, which revealed 0.5 cm sized, cherry red colored, branching, ozzing vessel with fern-like margin on cecum. Although he received endoscopic injection therapy with hypertonic saline and oral estrogen-progesterone therapy, subsequent ileocecal resection was performed due to recurrent bleeding. Histology of the resected specimen showed irregularly dilated, distorted, thin-walled vessels in submucosa. (Korean J Gastrointest Endosc 19: 469∼472, 1999)

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내시경적 결찰요법으로 치유한 위 혈관이형성증 1 예 ( Endoscopic Ligation Therapy for Gastric Angiodysplasia ): Korean J Gastrointest Endosc 1999;19(3):425-429. Published online November 30, 1998

Abstract PDF: Gastric angiodysplasia may be responsible for up to 2% to 6% of upper gastrointestinal bleeding. Moreover, gastric angiodysplasia may be particularly difficult to treat and is usually associated with a high rebleeding rate. Bleeding due to gastric angiodypsplasia is usually treated by various endoscopic approaches, including argon and Nd：YAG laser photocoagulation, monopolar or biopolar electrocoagulation, heater probe, or injection. Associated complications of these methods, however, such as perforation, acute bleeding during the procedure, or delayed massive hemorrhage have been reported. Recently a few reports have been suggested that endoscopic ligation therapy is a safe, effective treatment for gastric angiodysplasia. A 70-year-old man, who had undergone subtotal gastrectomy for perforation of a duodenal ulcer for 20 years, was admitted due to melena and dizziness persisting for 1 week. A gastroscopy revealed a single angiodysplasia with active bleeding just above the anastomotic site of the remnant stomach. Endoscopic ligation therapy was performed successfully and the bleeding stopped immediately after endoscopic ligation. Since then, no recurrence of bleeding has been reported to date. (Korean J Gastrointest Endosc 19: 425∼429, 1999)

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증례 : 식도 위장관 ; 대장의 혈관이형성증과 동반된 십이지장 평활근육종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Leiomyosarcoma in a Patient with Colonic Angioysplasia ): Korean J Gastrointest Endosc 1998;18(3):403-407. Published online November 30, 1997

Abstract PDF: Angiodysplasia is probably responsible for 2.6-6.2% of cases involving of lower gastrointestinal bleeding and 1.2-8.0% of cases involving hemorrhages from the upper GI tract. Small bowel neoplasia is rare, accounting for about 5% of gastrointestinal tumors overall and 2-3% of all malignacies. The third most common malignany of the small bowel is the sarcoma, of which the leiomyosarcoma is the most frequent. A 54-year-old male patient was admitted with the chief complaints of dizziness and headache during 2 months. Laboratory findings revealed iron deficiency anemia. A superior mesenteric arteriography found an intensive vascular stained mass in the hepatic flexure. A celiac artery angiography discovered a irregulary vascular stained lesion in the Ll vertebral level. A colonoscopy located a 10 mm sized angiodysplasia in the right colon. According to these findings, we presumed that these lesions are a colonic angiodysplasia and a suspicious duodenal lesion. The operation was perfomed. The final diagnosis was a colonic angiodysplasia combined with leiomyosarcoma of the duodenum. The rarity of this case is emphasized and the literative reviewed. (Korean J Gastrointest Endosc 18: 403-407, 1998)

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증례 : 식도 위장관 ; Barrett's Esophagus 에서 발생한 식도 선암 - 1예 보고 - ( Case Reports : Esophagus , Stomach & Intestine ; Adenocarcinoma Arising from Barrett's Esophagus - A case report - ): Korean J Gastrointest Endosc 1997;17(2):151-154. Published online November 30, 1996

Abstract PDF: Barrett's esophagus is a metaplastic process in which the squamous epithelium of the lowet esophagus is replaced by columnar epithelium. Most cases are believed to be related to prolonged gastroesophageal reflux. Detection of Barretts esophagus is important in that it results in adenocarcinoma in about 10% of patients. We report a case of adenocarcinoma arising from Barrett's esophagus in a 56 year-old man, diagnosed incidentally at a physical check-up. Grossly, the esophagogastric junction was irregular and there were two small ulcers in the lower esophagus. Microscopically, ihe squamous epithelium of the lower hagus was replaced by specialized intesinal mucosa with a small focus of adenocarcinona confined to the submucosa in one area. Many separate dysplastic foci were also present in the nearby esophageal mucosa. (Korean J Gastrointest Endosc 17: 151-154, 1997)

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