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Original Article
Current status and clinical outcome of endoscopic hemostatic powder in gastrointestinal bleeding: a retrospective multicenter study
Zie Hae Lim, Seung In Seo, Dae-Seong Myung, Seung Han Kim, Han Hee Lee, Selen Kim, Bo-In Lee
Received July 14, 2023  Accepted October 12, 2023  Published online March 8, 2024  
DOI: https://doi.org/10.5946/ce.2023.179    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Background
/Aims: Few multicenter studies have investigated the efficacy of hemostatic powders in gastrointestinal (GI) bleeding. We aimed to investigate the clinical outcomes of hemostatic powder therapy and the independent factors affecting rebleeding rates.
Methods
We retrospectively recruited patients who underwent a new hemostatic adhesive powder (UI-EWD; Next-Biomedical) treatment for upper and lower GI bleeding between January 1, 2020 and March 1, 2023. We collected patients’ medical records and bleeding lesions. The primary outcomes were clinical and technical success rates, and the secondary outcomes were early, delayed, and refractory bleeding, mortality, and factors affecting early rebleeding rates.
Results
This study enrolled 135 patients (age: 67.7±13.6 years, male: 74.1%) from five hospitals. Indications for UI-EWD were peptic ulcers (51.1%), post-procedure-related bleeding (23.0%), and tumor bleeding (19.3%). The clinical and technical success rates were both 97%. The early, delayed, and refractory rebleeding rates were 19.3%, 11.1%, and 12.8%, respectively. Initially elevated blood urea nitrogen (BUN) levels (p=0.014) and Forrest classification IA or IB compared with IIA or IIB (p=0.036) were factors affecting early rebleeding.
Conclusions
UI-EWD showed high clinical and technical success rates; however, rebleeding after UI-EWD therapy in patients with initially high BUN levels and active bleeding, according to the Forrest classification, should be considered.
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Review
Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment
Giuseppe Galloro, Angelo Zullo, Gaetano Luglio, Alessia Chini, Donato Alessandro Telesca, Rosa Maione, Matteo Pollastro, Giovanni Domenico De Palma, Raffaele Manta
Clin Endosc 2022;55(3):339-346.   Published online April 28, 2022
DOI: https://doi.org/10.5946/ce.2021.249
AbstractAbstract PDFPubReaderePub
Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

Citations

Citations to this article as recorded by  
  • Adverse Events of Endoscopic Clip Placement
    Daryl Ramai, Smit S. Deliwala, Daniel Mozell, Antonio Facciorusso, Saurabh Chandan, Alana Persaud, Kelita Singh, Andrea Anderloni, Monique T. Barakat
    Journal of Clinical Gastroenterology.2024; 58(1): 76.     CrossRef
  • Right tool for the right bleeder
    Ding Ek Toh, Sheng Wei Lo, Andrew Tsoi, Jonathan P Segal, Joshua Butt
    Gut.2024; 73(1): 206.     CrossRef
  • Could a bleeding-sensor device be established as a new paradigm for detecting upper gastrointestinal bleeding before performing endoscopy?
    Sun Gyo Lim
    Clinical Endoscopy.2024; 57(2): 191.     CrossRef
  • Sustained Hemostasis With the Padlock™ Over-the-scope Clip for Gastric Fundus Dieulafoy’s Lesion in the Setting of Anticoagulation Following Hemorrhagic Shock From Two Dieulafoy’s Lesions
    Jonathan J Cho, Chelsea M Forbes, Benjamin D Fiore, Joshua D McCarron, Leybelis Padilla
    Military Medicine.2023; 188(9-10): e3265.     CrossRef
  • Management of complications related to colorectal endoscopic submucosal dissection
    Tae-Geun Gweon, Dong-Hoon Yang
    Clinical Endoscopy.2023; 56(4): 423.     CrossRef
  • Novel removable endoscopic clip: Usefulness in failure of traction method during endoscopic submucosal dissection
    Nobukazu Agatsuma, Takahiro Utsumi, Hirokazu Higuchi, Takahiro Inoue, Yukari Tanaka, Yuki Nakanishi, Hiroshi Seno
    Endoscopy.2023; 55(S 01): E1031.     CrossRef
  • 4,993 View
  • 320 Download
  • 7 Web of Science
  • 6 Crossref
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Original Articles
Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis
Umair Iqbal, Hafsa Anwar, Hafiz Umair Siddiqui, Muhammad Ali Khan, Faisal Kamal, Bradley D. Confer, Harshit S. Khara
Clin Endosc 2021;54(4):534-541.   Published online June 25, 2021
DOI: https://doi.org/10.5946/ce.2021.071
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB).
Methods
A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB.
Results
Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%).
Conclusions
The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

Citations

Citations to this article as recorded by  
  • Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis
    Sawai Singh Rathore, Zario Shai Wint, Aman Goyal, Bijay Mukesh Jeswani, Ameer Mustafa Farrukh, María Alejandra Nieto‐Salazar, Thanmai Reddy Thugu, Snigdha Erva, Raafay Mehmood, Adriana Carolina Toro‐velandia, Hamam Aneis, Sunny Ratnani, Ibrahim Marouf Yas
    Reviews in Medical Virology.2024;[Epub]     CrossRef
  • Inpatient outcomes of inflammatory bowel disease in hospitalized patients with COVID-19: analysis of a nationally representative sample
    Mohammad Aldiabat, Saqr Alsakarneh, Tyrell Daniel, Muhammad Ali Butt, Balaji Jagdish, James Rock, Aarushi Sudan, Majd Al-Ahmad, Ahmad Jabri, Yassine Kilani, Tarek Odah, Laith Alhuneafat, Mir Zulqarnain, Jana G. Hashash, Hassan Ghoz
    Baylor University Medical Center Proceedings.2024; 37(2): 239.     CrossRef
  • Increasing inpatient mortality of nonvariceal upper gastrointestinal bleeding during the COVID-19 pandemic: a nationwide retrospective cohort study
    Waqas Rasheed, Gnanashree Dharmarpandi, Ola Al-Jobory, Anass Dweik, Muhammad Anil, Sameer Islam
    Baylor University Medical Center Proceedings.2023; 36(3): 286.     CrossRef
  • Outcomes in Patients Admitted for Upper Gastrointestinal Bleeding and COVID-19 Infection: A Study of Two Years of the Pandemic
    Sergiu Cazacu, Daniela Burtea, Vlad Iovănescu, Dan Florescu, Sevastița Iordache, Adina Turcu-Stiolica, Victor Sacerdotianu, Bogdan Ungureanu
    Life.2023; 13(4): 890.     CrossRef
  • Prevalence, causes, medical interventions, and mortality outcome of acute gastrointestinal bleeding among COVID-19 inpatients
    Mai N. Luu, Thinh P. Dang, Minh-Cong H. Vo, Duc T. Quach
    Current Medical Research and Opinion.2023; 39(5): 731.     CrossRef
  • Gastrointestinal Bleeding in Patients With New Coronavirus Infection COVID-19
    V. D. Anosov, S. A. Domrachev, S. V. Ovchinnikov, N. O. Solovyov
    Russian Sklifosovsky Journal "Emergency Medical Care".2023; 12(3): 458.     CrossRef
  • Clinical and Endoscopic Outcomes in COVID-19 Patients With Gastrointestinal Bleeding
    Hassan Ashktorab, Tiziano Russo, Gholamreza Oskrochi, Giovanni Latella, Sara Massironi, Martina Luca, Lakshmi G. Chirumamilla, Adeyinka O. Laiyemo, Hassan Brim
    Gastro Hep Advances.2022; 1(4): 487.     CrossRef
  • Clinical Characteristics of Hospitalized COVID-19 Patients Who Have Gastrointestinal Bleeds Requiring Intervention: A Case-Control Study
    Ahmad Abulawi, Ali Al-Tarbsheh, Annie Leamon, Paul Feustel, Amit Chopra, Asra Batool
    Cureus.2022;[Epub]     CrossRef
  • Clinical features of thrombosis and bleeding in COVID-19
    Mari R. Thomas, Marie Scully
    Blood.2022; 140(3): 184.     CrossRef
  • Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic
    Petrica Popa, Sevastita Iordache, Dan Nicolae Florescu, Vlad Florin Iovanescu, Alexandru Vieru, Valentin Barbu, Maria-Cristina Bezna, Dragos Ovidiu Alexandru, Bogdan Silviu Ungureanu, Sergiu Marian Cazacu
    Journal of Multidisciplinary Healthcare.2022; Volume 15: 2679.     CrossRef
  • Coronavirus Disease in the Abdomen
    Mark A. Anderson, Mark A. Khauli, Reece J. Goiffon, Avinash Kambadakone
    Advances in Clinical Radiology.2022; 4(1): 25.     CrossRef
  • Сauses, risk factors, diagnostics and treatment of gastrointestinal bleeding in patients with a novel coronavirus infection (COVID-19)
    A. A. Sheptulin, S. S. Kardasheva, A. A. Kurbatova
    Clinical Medicine (Russian Journal).2022; 100(7-8): 341.     CrossRef
  • The frequency of ulcerative-erosive defects and ulcerative bleeding of the gastroduodenal zone in patients with coronavirus infection COVID-19
    N. N. Butorin, V. V. Tsukanov, R. V. Asyayev, M. N. Butorina, A. V. Vasyutin, J. L. Tonkikh
    Experimental and Clinical Gastroenterology.2022; (5): 5.     CrossRef
  • 6,258 View
  • 191 Download
  • 7 Web of Science
  • 13 Crossref
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The Additive Effect of Platelet-Rich Plasma in the Treatment of Actively Bleeding Peptic Ulcer
Waseem M. Seleem, Amr Shaaban Hanafy
Clin Endosc 2021;54(6):864-871.   Published online May 25, 2021
DOI: https://doi.org/10.5946/ce.2021.004
AbstractAbstract PDFPubReaderePub
Background
/Aims: Peptic ulcer bleeding is the most common cause of upper gastrointestinal tract bleeding. Platelet-rich plasma (PRP) enhances tissue repair, and is therefore used in various medical treatments. A combination of mechanical or electrothermal hemostasis has been recommended for upper gastrointestinal tract bleeding treatment. This study evaluated the additive efficacy of PRP in bleeding peptic ulcer hemostasis and recovery.
Methods
Eighty patients with peptic ulcer bleeding were initially treated by hemoclipping, and were randomly chosen for either additional PRP (n=40) or additional epinephrine (n=40) injections. Both groups were compared with regard to achieving hemostasis and the frequency of complications.
Results
Hemostasis was immediately achieved in both groups. Two patients (5%) in the PRP group and 8 (20%) patients in the epinephrine group experienced rebleeding after 15.9±2.8 and 12.3±3.7 days, respectively. They were managed by PRP injection in addition to proton pump inhibitor infusion. Hemoglobin was substantially increased in the PRP-treated group with full recovery occurring in 60.5% compared to 31.3% of patients in the epinephrine group (p=0.001). There was no recurrent bleeding in the PRP group, but 4/32 (12.5%) patients in the epinephrine group exhibited rebleeding.
Conclusions
PRP showed additional benefit in reducing peptic ulcer bleeding with no reported significant complications. Clinical trial (NCT03733171).

Citations

Citations to this article as recorded by  
  • The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial
    Konstantina Dinaki, Nikolaos Grigoriadis, Ioannis S. Vizirianakis, Jannis Constantinidis, Stefanos Triaridis, Petros Karkos
    European Archives of Oto-Rhino-Laryngology.2024; 281(7): 3587.     CrossRef
  • 3,766 View
  • 90 Download
  • 1 Web of Science
  • 1 Crossref
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Positive Fecal Occult Blood Test is a Predictive Factor for Gastrointestinal Bleeding after Capsule Endoscopy in Patients with Unexplained Iron Deficiency Anemia: A Korean Multicenter CAPENTRY Study
Ji Young Chang, Chang Mo Moon, Ki-Nam Shim, Dae Young Cheung, Hyun Seok Lee, Yun Jeong Lim, Seong Ran Jeon, Soo Jung Park, Kyeong Ok Kim, Hyun Joo Song, Hyun Joo Jang, Ji Hyun Kim
Clin Endosc 2020;53(6):719-726.   Published online November 6, 2020
DOI: https://doi.org/10.5946/ce.2019.149
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Capsule endoscopy (CE) is recommended as the primary method for the evaluation of unexplained anemia. This study aimed to assess the diagnostic yield of CE in patients with unexplained iron deficiency anemia (IDA) without overt bleeding, and to evaluate their long-term outcomes and related clinical factors.
Methods
Data of patients who underwent CE for the evaluation of IDA were reviewed from a CE registry in Korea. Additional clinical data were collected by the involved investigators of each hospital through a review of medical records.
Results
Among a total of 144 patients, the diagnostic yield of CE was 34%. Gastrointestinal (GI) bleeding was found in 6.3% (n=9) of the patients (occult bleeding in four patients and overt bleeding in five patients) during a mean follow-up of 17.8 months. Patients with a positive fecal occult blood test (FOBT) result at the initial diagnosis had a higher rate of GI bleeding after CE (p=0.004). In addition, a positive FOBT result was the only independent predictive factor for GI bleeding (hazard ratio, 5.30; 95% confidence interval, 1.41–19.85; p=0.013).
Conclusions
Positive FOBT is a predictive factor for GI bleeding during follow-up after CE in patients with unexplained IDA without overt bleeding. Thus, patients with positive FOBT need to be more closely followed up.

Citations

Citations to this article as recorded by  
  • Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022
    Marco Pennazio, Emanuele Rondonotti, Edward J. Despott, Xavier Dray, Martin Keuchel, Tom Moreels, David S. Sanders, Cristiano Spada, Cristina Carretero, Pablo Cortegoso Valdivia, Luca Elli, Lorenzo Fuccio, Begona Gonzalez Suarez, Anastasios Koulaouzidis,
    Endoscopy.2023; 55(01): 58.     CrossRef
  • Predictive Model for Positive Video Capsule Endoscopy in Iron Deficiency Anemia
    Shadi Hamdeh, Jihan Fathallah, Hui Zhang, Amber Charoen, Barakat Aburajab Altamimi, Florence-Damilola Odufalu, Devashree Dave, Amer El Sayed, Laura R. Glick, Scott Grisolano, Christine Hachem, Muhammad Bader Hammami, Khaldoun Haj Mahmoud, Alexander N. Lev
    Digestive Diseases and Sciences.2023; 68(7): 3083.     CrossRef
  • Predictors of Positive Video Capsule Endoscopy Findings for Chronic Unexplained Abdominal Pain: Single-Center Retrospective Study and Meta-Analysis
    Wonshik Kim, Beomjae Lee, Ahyoung Yoo, Seunghan Kim, Moonkyung Joo, Jong-Jae Park
    Diagnostics.2021; 11(11): 2123.     CrossRef
  • 5,726 View
  • 117 Download
  • 4 Web of Science
  • 3 Crossref
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Prospective Comparison of the AIMS65 Score, Glasgow-Blatchford Score, and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding
Arunchai Chang, Chokethawee Ouejiaraphant, Keerati Akarapatima, Attapon Rattanasupa, Varayu Prachayakul
Clin Endosc 2021;54(2):211-221.   Published online July 16, 2020
DOI: https://doi.org/10.5946/ce.2020.068
AbstractAbstract PDFPubReaderePub
Background
/Aims: This study aimed to determine the performance of the AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), and Rockall score (RS) in predicting outcomes in patients with upper gastrointestinal bleeding (UGIB), and to compare the results between patients with nonvariceal UGIB (NVUGIB) and those with variceal UGIB (VUGIB).
Methods
We conducted a prospective observational study between March 2016 and December 2017. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. The associations of all three scores with mortality were evaluated using multivariate logistic regression analysis.
Results
Of the total of 337 patients with UGIB, 267 patients (79.2%) had NVUGIB. AIMS65 was significantly associated (odds ratio [OR], 1.735; 95% confidence interval [CI], 1.148–2.620), RS was marginally associated (OR, 1.225; 95% CI, 0.973–1.543), but GBS was not associated (OR, 1.017; 95% CI, 0.890–1.163) with mortality risk in patients with UGIB. However, all three scores accurately predicted all other outcomes (all p<0.05) except rebleeding (p>0.05). Only AIMS65 precisely predicted mortality, the need for blood transfusion and the composite endpoint (all p<0.05) in patients with VUGIB.
Conclusions
AIMS65 is superior to GBS and RS in predicting mortality in patients with UGIB, and also precisely predicts the need for blood transfusion and the composite endpoint in patients with VUGIB. No scoring system could satisfactorily predict rebleeding in all patients with UGIB.

Citations

Citations to this article as recorded by  
  • Similar Effect of Vonoprazan and Oral Proton Pump Inhibitors for Preventing Rebleeding in Cases of Upper Gastrointestinal Bleeding
    Hiroko Abe, Kunio Tarasawa, Waku Hatta, Tomoyuki Koike, Isao Sato, Yoshitaka Ono, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune
    Internal Medicine.2024; 63(7): 911.     CrossRef
  • Comparison of scoring systems for predicting clinical outcomes of acute lower gastrointestinal bleeding: A prospective cohort study
    Kamales Prasitvarakul, Nawawich Attanath, Arunchai Chang
    World Journal of Surgery.2024; 48(2): 474.     CrossRef
  • Lactate level as a predictor of outcomes in patients with acute upper gastrointestinal bleeding: A systematic review and meta‑analysis
    Fanshu Zeng, Li Du, Ling Ling
    Experimental and Therapeutic Medicine.2024;[Epub]     CrossRef
  • The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review
    María Isabel Murillo Pineda, Tania Siu Xiao, Edgar J Sanabria Herrera, Alberto Ayala Aguilar, David Arriaga Escamilla, Alejandra M Aleman Reyes, Andreina D Rojas Marron, Roberto R Fabila Lievano, Jessica J de Jesús Correa Gomez, Marily Martinez Ramirez
    Cureus.2024;[Epub]     CrossRef
  • Mortality Risk Scoring System in Patients after Bleeding from Cancers in the Upper Gastrointestinal Tract
    Hyun Min Kim, Donghoon Kang, Jun Young Park, Yu Kyung Cho, Myung-Gyu Choi, Jae Myung Park
    Gut and Liver.2024; 18(2): 222.     CrossRef
  • Could a bleeding-sensor device be established as a new paradigm for detecting upper gastrointestinal bleeding before performing endoscopy?
    Sun Gyo Lim
    Clinical Endoscopy.2024; 57(2): 191.     CrossRef
  • ASSESSMENT OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING USING AIMS65 SCORE
    Farahnaz Joukar, Raheleh Sadat Hosseini Basti, Fakhrieh Sadat Hosseini Basti, Fatemeh Mosafer, Hoorieh Sadat Hosseini Basti, Zahra Hedayatzadeh, Afshin Shafaghi
    Studies in Medical Sciences.2024; 35(1): 51.     CrossRef
  • External validation and comparison of the Glasgow-Blatchford score, modified Glasgow-Blatchford score, Rockall score and AIMS65 score in patients with upper gastrointestinal bleeding: a cross-sectional observational study in Western Switzerland
    Sirio Rivieri, Pierre-Nicolas Carron, Alain Schoepfer, Francois-Xavier Ageron
    European Journal of Emergency Medicine.2023; 30(1): 32.     CrossRef
  • Comparison of Glasgow Blatchford and New Risk Scores to Predict Outcomes in Patients with Acute Upper GI Bleeding
    Bahadır TAŞLIDERE, Elmas BİBERCİ KESKİN, Serdar ÖZDEMİR, Ahmet ATSIZ, Ertan SÖNMEZ
    Bezmialem Science.2023; 11(1): 100.     CrossRef
  • Comparative Evaluation of the ABC Score to Other Risk Stratification Scales in Managing High-risk Patients Presenting With Acute Upper Gastrointestinal Bleeding
    Omar Kherad, Sophie Restellini, Majid Almadi, Myriam Martel, Alan N. Barkun
    Journal of Clinical Gastroenterology.2023; 57(5): 479.     CrossRef
  • Progress in the Evaluation of Acute Upper Gastrointestinal Bleeding with AIMS65 Scoring System
    莉 王
    Advances in Clinical Medicine.2023; 13(05): 8163.     CrossRef
  • Risk analysis of 30-day rebleeding in acute non-variceal upper gastrointestinal bleeding
    Xu Wang, Meiling Yang, Jianhua Xu, Yaxian Kuai, Bin Sun
    Arab Journal of Gastroenterology.2023; 24(2): 136.     CrossRef
  • Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding
    Bianca-Codrina Morarasu, Victorita Sorodoc, Anca Haisan, Stefan Morarasu, Cristina Bologa, Raluca Ecaterina Haliga, Catalina Lionte, Emilia Adriana Marciuc, Mohammed Elsiddig, Diana Cimpoesu, Gabriel Mihail Dimofte, Laurenţiu Sorodoc
    World Journal of Clinical Cases.2023; 11(19): 4513.     CrossRef
  • Strengths and limitations of risk stratification tools for patients with upper gastrointestinal bleeding: a narrative review
    Ali A. Alali, Antoine Boustany, Myriam Martel, Alan N. Barkun
    Expert Review of Gastroenterology & Hepatology.2023; 17(8): 795.     CrossRef
  • A nomogram to predict in-hospital mortality of gastrointestinal bleeding patients in the intensive care unit
    Xueyan Zhang, Jianfang Ni, Hongwei Zhang, Mengyuan Diao
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Research Status of Pre-Endoscopic Scoring System for Upper Gastrointestinal Bleeding
    莎 吴
    Advances in Clinical Medicine.2023; 13(11): 17097.     CrossRef
  • Recurrent Non-Variceal Upper Gastrointestinal Bleeding among Patients Receiving Dual Antiplatelet Therapy
    Ah Young Yoo, Moon Kyung Joo, Jong-Jae Park, Beom Jae Lee, Seung Han Kim, Won Shik Kim, Hoon Jai Chun
    Diagnostics.2023; 13(22): 3444.     CrossRef
  • Modified N score is helpful for identifying patients who need endoscopic intervention among those with black stools without hematemesis
    Nobuhito Ito, Kohei Funasaka, Toshihisa Fujiyoshi, Kazuhiro Furukawa, Naomi Kakushima, Satoshi Furune, Eri Ishikawa, Yasuyuki Mizutani, Tsunaki Sawada, Keiko Maeda, Takuya Ishikawa, Takeshi Yamamura, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Ryoj
    Digestive Endoscopy.2022; 34(6): 1157.     CrossRef
  • Usefulness of the d-dimer to albumin ratio for risk assessment in patients with acute variceal bleeding at the emergency department: retrospective observational study
    Jun Seok Seo, Yongwon Kim, Yoonsuk Lee, Ho Young Chung, Tae Youn Kim
    BMC Emergency Medicine.2022;[Epub]     CrossRef
  • Effect of holiday admission on clinical outcome of patients with upper gastrointestinal bleeding: A real-world report from Thailand
    Arunchai Chang, Chokethawee Ouejiaraphant, Nuttanit Pungpipattrakul, Keerati Akarapatima, Attapon Rattanasupar, Varayu Prachayakul
    Heliyon.2022; 8(8): e10344.     CrossRef
  • The Value of Risk Scores to Predict Clinical Outcomes in Patients with Variceal and Non-Variceal Upper Gastrointestinal Bleeding
    James Yun-wong Lau
    Clinical Endoscopy.2021; 54(2): 145.     CrossRef
  • Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial
    Attapon Rattanasupar, Arunchai Chang, Keerati Akarapatima, Thanongsak Chaojin, Teerha Piratvisuth
    Indian Journal of Gastroenterology.2021; 40(6): 621.     CrossRef
  • Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study
    Basak Toptas Firat, Muge Gulen, Salim Satar, Ahmet Firat, Selen Acehan, Cem Isikber, Adem Kaya, Gonca Koksaldi Sahin, Haldun Akoglu
    Sao Paulo Medical Journal.2021; 139(6): 583.     CrossRef
  • Systematic review and meta-analysis of risk scores in prediction for the clinical outcomes in patients with acute variceal bleeding
    Ling Yang, Rui Sun, Ning Wei, Hong Chen
    Annals of Medicine.2021; 53(1): 1806.     CrossRef
  • 7,206 View
  • 349 Download
  • 27 Web of Science
  • 24 Crossref
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Clinical Usefulness of Dual Red Imaging in Gastric Endoscopic Submucosal Dissection: A Pilot Study
Naoki Yorita, Shiro Oka, Shinji Tanaka, Takahiro Kotachi, Naoko Nagasaki, Kosaku Hata, Kazutaka Kuroki, Kazuhiko Masuda, Mio Kurihara, Mariko Kiso, Tomoyuki Boda, Masanori Ito, Kazuaki Chayama
Clin Endosc 2020;53(1):54-59.   Published online September 3, 2019
DOI: https://doi.org/10.5946/ce.2019.065
AbstractAbstract PDFPubReaderePub
Background
/Aims: Dual red imaging (DRI) is a new, image-enhanced endoscopy technique. There are few reports about the usefulness of DRI during gastric endoscopic submucosal dissection (ESD). We aimed to examine the usefulness of DRI in endoscopic hemostasis during gastric ESD.
Methods
We enrolled a total of 20 consecutive patients who underwent gastric ESD. Five endoscopists compared DRI with white light imaging (WLI) for the visibility of blood vessels and bleeding points while performing endoscopic hemostasis.
Results
The visibility of blood vessels was increased in 56% (19/34) of the cases, and the visibility of bleeding points was improved in 55% (11/20) of the cases with the use of DRI compared with the use of WLI.
Conclusions
DRI improved the visibility of blood vessels and bleeding points in cases with oozing bleeding, blood pooling around the bleeding points, and multiple bleeding points.

Citations

Citations to this article as recorded by  
  • Red Dichromatic Imaging Improves the Recognition of Bleeding Points During Endoscopic Submucosal Dissection
    Yosuke Mori, Taro Iwatsubo, Akitoshi Hakoda, Shin Kameishi, Kazuki Takayama, Shun Sasaki, Ryoji Koshiba, Shinya Nishida, Satoshi Harada, Hironori Tanaka, Noriaki Sugawara, Kazuhiro Ota, Shinpei Kawaguchi, Yuichi Kojima, Toshihisa Takeuchi, Kazuhide Higuch
    Digestive Diseases and Sciences.2024; 69(1): 216.     CrossRef
  • Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies
    Louis Jean Masgnaux, Jean Grimaldi, Jérémie Jacques, Jérôme Rivory, Mathieu Pioche
    Visceral Medicine.2024; 40(3): 128.     CrossRef
  • Red dichromatic imaging: going deeper with electronic chromoendoscopy
    Joshua Melson
    Gastrointestinal Endoscopy.2024; 100(2): 305.     CrossRef
  • Efficacy of using red dichromatic imaging throughout endoscopic submucosal dissection procedure
    Aoi Kita, Shiko Kuribayashi, Yuki Itoi, Keigo Sato, Yu Hashimoto, Kengo Kasuga, Hirohito Tanaka, Hiroko Hosaka, Kazue Nagai, Hemchand Ramberan, Toshio Uraoka
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Case Report
Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel
Chung-Jo Choi, Hyun Lim, Dong-Suk Kim, Yong-Seol Jeong, Sang-Young Park, Jeong-Eun Kim
Clin Endosc 2019;52(6):612-615.   Published online May 20, 2019
DOI: https://doi.org/10.5946/ce.2019.020
AbstractAbstract PDFPubReaderePub
Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%–15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.

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Focused Review Series: Endoscopic Submucosal Dissection for Colorectal Tumors
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
AbstractAbstract 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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Case Report
Giant Brunner’s Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction
Ju Hyoung Lee, Kyeong Min Jo, Tae Oh Kim, Jong Ha Park, Seung Hyun Park, Jae Won Jung, So Chong Hur, Sung Yeun Yang
Clin Endosc 2016;49(6):570-574.   Published online October 13, 2016
DOI: https://doi.org/10.5946/ce.2016.022
AbstractAbstract PDFPubReaderePub
Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

Citations

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    Lizhi Yi, Zhengyu Cheng, Huarong Qiu, Jianjun Yang, Tao Wang, Ke Liu
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  • 152 Download
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Review
Diagnosis of Obscure Gastrointestinal Bleeding
Satoshi Tanabe
Clin Endosc 2016;49(6):539-541.   Published online February 11, 2016
DOI: https://doi.org/10.5946/ce.2016.004
AbstractAbstract PDFPubReaderePub
Obscure gastrointestinal bleeding (OGIB) is defined as gastrointestinal bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy. OGIB is considered an important indication for capsule endoscopy (CE). CE is particularly useful for the detection of vascular and small ulcerative lesions, conditions frequently associated with OGIB, particularly in Western countries. On the other hand, balloon enteroscopy (BE) can facilitate the diagnosis of lesions presenting with minimal changes of the mucosal surface, such as submucosal tumors, and can be used not only for diagnosis, but also for treatment, including endoscopic hemostasis. In other words, the complementary use of both CE and BE enables OGIB to be more efficiently diagnosed and treated. However, rebleeding can occur even in patients with negative results of CE, and such patients require repeat CE or BE. It is essential to effectively use both CE and BE based on a thorough understanding of the strong points and weak points of these procedures. Further advances and developments in virtual endoscopy incorporating computed tomography and magnetic resonance imaging are expected in the future.

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    Ali Issa
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Original Article
Roles of Capsule Endoscopy and Single-Balloon Enteroscopy in Diagnosing Unexplained Gastrointestinal Bleeding
Shohei Ooka, Kiyonori Kobayashi, Kana Kawagishi, Masaru Kodo, Kaoru Yokoyama, Miwa Sada, Satoshi Tanabe, Wasaburo Koizumi
Clin Endosc 2016;49(1):56-60.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.56
AbstractAbstract PDFPubReaderePub
Background
/Aims: The diagnostic algorithms used for selecting patients with obscure gastrointestinal bleeding (OGIB) for capsule endoscopy (CE) or balloon-assisted enteroscopy (BE) vary among facilities. We aimed to demonstrate the appropriate selection criteria of CE and single balloon-assisted enteroscopy (SBE) for patients with OGIB according to their conditions, by retrospectively comparing the diagnostic performances of CE and BE for detecting the source of the OGIB.
Methods
We investigated 194 patients who underwent CE and/or BE. The rate of positive findings, details of the findings, accidental symptoms, and hemostasis methods were examined and analyzed.
Results
CE and SBE were performed in 103 and 91 patients, respectively, and 26 patients underwent both examinations. The rate of positive findings was significantly higher with SBE (73.6%) than with CE (47.5%, p<0.01). The rate of positive findings was higher in overt bleeding cases than in occult bleeding cases for both BE and SBE. Among the overt bleeding cases, the rate was significantly higher in ongoing bleeding cases than in previous bleeding cases.
Conclusions
Both CE and SBE are useful to diagnose OGIB. For overt bleeding cases and ongoing bleeding cases, SBE may be more appropriate than CE because endoscopic diagnosis and treatment can be completed simultaneously.

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  • The Role of Capsule Endoscopy in the Diagnosis and Management of Small Bowel Tumors: A Narrative Review
    Stefano Fantasia, Pablo Cortegoso Valdivia, Stefano Kayali, George Koulaouzidis, Marco Pennazio, Anastasios Koulaouzidis
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    Marco Pennazio, Emanuele Rondonotti, Edward J. Despott, Xavier Dray, Martin Keuchel, Tom Moreels, David S. Sanders, Cristiano Spada, Cristina Carretero, Pablo Cortegoso Valdivia, Luca Elli, Lorenzo Fuccio, Begona Gonzalez Suarez, Anastasios Koulaouzidis,
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    Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung
    Intestinal Research.2023; 21(1): 3.     CrossRef
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Focused Review Series: Current Issues and Future Directions of Small Bowel Endoscopic Evaluation
The Role of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding
Yang Won Min, Dong Kyung Chang
Clin Endosc 2016;49(1):16-20.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.16
AbstractAbstract PDFPubReaderePub
Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention.

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Original Article
Risk Factors for Dieulafoy Lesions in the Upper Gastrointestinal Tract
Hae Jin Shin, Jong Seok Ju, Ki Dae Kim, Seok Won Kim, Sung Hoon Kang, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
Clin Endosc 2015;48(3):228-233.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.228
AbstractAbstract PDFPubReaderePub
Background/Aims

The purpose of this study is to verify the risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

Methods

A case-control study was performed by reviewing the electronic medical records of 42 patients who were admitted to a tertiary medical center in the Daejeon region for Dieulafoy lesions from September 2008 to October 2013, and the records of 132 patients who were admitted during the same period and who underwent endoscopic examination for reasons other than bleeding. We analyzed clinical and endoscopic findings retrospectively, and searched for risk factors associated with Dieulafoy lesion formation.

Results

All 42 patients diagnosed with Dieulafoy lesion had accompanying bleeding, and the location of the bleeding was proximal in 25 patients (59.5%), the middle portion in seven patients (16.7%), and distal in 10 patients (23.8%). Antiplatelet agents (p=0.022) and alcohol (p=0.001) use showed statistically significant differences between the two groups. The odds ratios (95% confidence intervals) of the two factors were 2.802 (1.263 to 6.217) and 3.938 (1.629 to 9.521), respectively.

Conclusions

This study showed that antiplatelet agents and alcohol consumption were risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

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    金明 张
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Case Report
Esophageal Involvement of Pemphigus Vulgaris Associated with Upper Gastrointestinal Bleeding
Sooyun Chang, Soo Jung Park, Sun Wook Kim, Moo-Nyun Jin, Jung-Hee Lee, Hyun Ju Kim, Sung Pil Hong, Tae Il Kim
Clin Endosc 2014;47(5):452-454.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.452
AbstractAbstract PDFPubReaderePub

Esophageal involvement of pemphigus vulgaris is rare, and when present, the most common presenting symptoms reported in the medical literature are odynophagia and dysphagia. Here, we present two cases of pemphigus vulgaris presenting with upper gastrointestinal hemorrhage because of esophageal involvement of the disease. In case 1, a 41-year-old female patient with a prior diagnosis of pemphigus vulgaris presented with hematemesis. Esophagogastroduodenoscopy showed diffuse mucosal exfoliation and oozing bleeding of the oropharynx and esophagus. The patient recovered after the administration of high-dose corticosteroids and immunosuppressants. In case 2, a 30-year-old female patient with known pemphigus vulgaris also presented with hematemesis, showing similar endoscopic findings to the first case. She also responded to the same treatment. Esophageal involvement of pemphigus vulgaris responds to high-dose corticosteroids and immunosuppressants. Thus, in patients with pemphigus vulgaris with signs or symptoms of upper gastrointestinal bleeding, an early endoscopy for the evaluation of esophageal involvement is beneficial.

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Review
Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding
Ki Bae Kim, Soon Man Yoon, Sei Jin Youn
Clin Endosc 2014;47(4):315-319.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.315
AbstractAbstract PDFPubReaderePub

Endoscopy for acute nonvariceal upper gastrointestinal bleeding plays an important role in primary diagnosis and management, particularly with respect to identification of high-risk stigmata lesions and to providing endoscopic hemostasis to reduce the risk of rebleeding and mortality. Early endoscopy, defined as endoscopy within the first 24 hours after presentation, improves patient outcome and reduces the length of hospitalization when compared with delayed endoscopy. Various endoscopic hemostatic methods are available, including injection therapy, mechanical therapy, and thermal coagulation. Either single treatment with mechanical or thermal therapy or a treatment that combines more than one type of therapy are effective and safe for peptic ulcer bleeding. Newly developed methods, such as Hemospray powder and over-the-scope clips, may provide additional options. Appropriate decisions and specific treatment are needed depending upon the conditions.

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Case Report
Successful Treatment of Duodenal Variceal Bleeding by Endoscopic Clipping
Su Bin Park, Sang Ho Lee, Jin Hee Kim, Hyun Jung Lee, Sung Pil Jang, Jae Nam Lee, Jong Ho Hwang
Clin Endosc 2013;46(4):403-406.   Published online July 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.4.403
AbstractAbstract PDFPubReaderePub

Duodenal varix bleeding is an uncommon cause of gastrointestinal bleeding in patients with portal hypertension but can cause severe and potentially fatal bleeding. However, the incidence is low and a good treatment method has not been well established yet. Duodenal variceal bleeding can be treated surgically or nonsurgically. We have successfully treated a patient with duodenal variceal bleeding secondary to liver cirrhosis using hemoclips to control the bleeding.

Citations

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    Hyun Woo Kim, Jun Sik Yoon, Seung Jung Yu, Tae Heon Kim, Jae Heon Seol, Dan Kim, Jun Young Jung, Pyeong Hwa Jeong, Hoon Kwon, Hong Sub Lee, Sang Heon Lee, Jung Sik Choi, Sung Jae Park, Sam Ryong Jee, Youn Jae Lee, Sang Yong Seol
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    Soon Woo Hwang, Joo Hyun Sohn, Tae Yeob Kim, Ji Yeoun Kim, Jiyoung Yhi, Dong Shin Kwak, Hae Su Kim, Soon-Young Song
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Special Issue Articles of IDEN 2012
New Endoscopic Hemostasis Methods
En-Ling Leung Ki, James Y W Lau
Clin Endosc 2012;45(3):224-229.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.224
AbstractAbstract PDFPubReaderePub

Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension.

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    M. Vincent
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    Young-Il Kim, Il Ju Choi
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Indications for Enteroscopy: Which Patients Should Be Recommended for Enteroscopy?
Hwang Choi, M.D.
Korean J Gastrointest Endosc 2011;42(3):137-142.   Published online March 28, 2011
AbstractAbstract PDF
Balloon-assisted endoscopy (double-balloon or single-balloon endoscopy) is a novel method used to examine the entire small bowel. Enteroscopy has advantages in that tissues can be obtained to get a detailed image, and it is feasible for endoscopic treatments such as hemostasis, dilatation, and polypectomy. Indications for enteroscopy are obscure gastrointestinal bleeding, small bowel involvement due to inflammatory bowel disease, an investigation of a small bowel tumor or polyposis, and difficulty of a colonoscopy. Enteroscopy should be recommended to patients with recurrent mid-gut bleeding of obscure origin, suspected Crohn's disease, suspicious small bowel tumor on abnormal imaging, and surveillance of polyposis syndrome including familial adenomatous polyposis and Peutz-Jeghers syndrome. We may consider enteroscopy in patients with chronic abdominal pain or diarrhea and increased inflammatory markers. We must also understand the contraindications, complications, and limitations of enteroscopy. (Korean J Gastrointest Endosc 2011;42:137-142)
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The Role of Endoscopy in Obscure Gastrointestinal Bleeding
Chang Soo Eun, M.D.
Korean J Gastrointest Endosc 2010;41(6):329-337.   Published online December 30, 2010
AbstractAbstract PDF
Obscure gastrointestinal bleeding (OGIB) is defined as occult or overt bleeding of unknown origin that persists or recurs after an initial negative endoscopic evaluation by gastroscopy or colonoscopy. Most of these problems occur in the small bowel, and it is not an uncommon condition encountered by gastroenterologists, accounting for approximately 5% of all GIB. Traditional endoscopic techniques, including push enteroscopy, have a limited role in diagnosing patients with OGIB because of the inaccessibility of a large part of the small bowel using an endoscopic procedure. The recent introduction of new enteroscopic modalities including capsule endoscopy (CE) and double balloon enteroscopy have allowed mucosal visualization of the entire small bowel, revolutionizing the diagnosis and treatment of patients with OGIB. The respective roles of CE and deep enteroscopy in patients with OGIB are discussed in this review. (Korean J Gastrointest Endosc 2010;41:329-337)
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A Case of a Patient Presenting with Upper Gastrointestinal Bleeding Due to Direct Stomach Invasion by Hepatocellular Carcinoma
Joon Mo Park, M.D. and Dong Hee Kim, M.D.
Korean J Gastrointest Endosc 2010;41(4):232-235.   Published online October 30, 2010
AbstractAbstract PDF
Gastrointestinal bleeding is a common complication of hepatocellular carcinoma, and the most common causes are esophageal varix, gastric varix and a bleeding ulcer. Hepatocellular carcinoma rarely invades the gastrointestinal tract, and this has been shown to occur in 0.7∼2% of the clinical hepatocellular carcinoma cases. A 52-year old male who had a history of a huge hepatocellular carcinoma on the left lobe of the liver and this had been by chemoembolization was admitted due to hematemesis and melena. Esophagogastroduodenoscopy showed a huge fungating mass with easy contact bleeding in the lesser curvature of the gastric body. The histology was consistent with the diagnosis of metastatic hepatocellular carcinoma and results of the CT scan supported this finding. This case illustrates a rare event of direct invasion of hepatocellular carcinoma into the stomach and this was followed by gastrointestinal hemorrhage. (Korean J Gastrointest Endosc 2010;41:232-235)
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Characteristics of Lesions Misdiagnosed as Obscure Gastrointestinal Bleeding
Hyun Sook Choi, M.D., Jin Oh Kim, M.D., Dong Kyun Kim, M.D., Sung Ran Jeon, M.D., Yoon Ho Jung, M.D.,

Hyun Gun Kim, M.D., Tae Hee Lee, M.D., Won Young Cho, M.D., Wan Jung Kim, M.D., Bong Min Ko, M.D., Moon Sung Lee, M.D., Joo Young Cho,

Korean J Gastrointest Endosc 2010;41(2):79-84.   Published online August 30, 2010
AbstractAbstract PDF
Background
/Aims: Double balloon enteroscopy (DBE) and capsule endoscopy (CE) are useful for evaluation of obscure gastrointestinal bleeding (OGIB). However, many bleeding sources within reach of conventional upper and lower endoscopes can be missed in patients who have undergone DBE and CE for OGIB. The aim of this study was to determine the incidence and characteristics of OGIB lesions within reach of a conventional endoscope in patients undergoing DBE and CE for the indication of OGIB.
Methods
This retrospective study included 134 patients who were evaluated for OGIB between March 2003 and May 2009 at Soonchunhyang University Hospital.
Results
Of the 134 patients, 76 underwent CE, 28 patients underwent DBE, and 30 underwent both CE and DBE. The incidence of OGIB lesions within reach of a conventional upper and lower endoscopy was 9.7% (n=13) and the mean age of patients was 51 years (range: 20 to 69 years). The most commonly missed lesion was duodenal ulcer (n=8). The other missed lesions were gastric ulcer (n=2), terminal ileal ulcer (n=2) and ileocecal valve ulcer (n=1).
Conclusions
The duodenum should be observed closely in initial upper and lower endoscopy by experienced endoscopists. Performing a second EGD and ileocolonoscopy before DBE and CE may increase the diagnostic yield and improve cost-effectiveness in patients with OGIB. (Korean J Gastrointest Endosc 2010;41: 79-84)
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A Case of Transparent Cap-fitted Endoscopic Hemoclipping on a Bleeding Dieulafoy's Lesion in the Ampulla of Vater
Hoon Sup Koo, M.D., Yong Seok Kim, M.D., Gwang Il Kim, M.D., Jung Kyung Yang, M.D., Seung Min Kim, M.D., Sang Yeol Cheon, M.D., Je Hyung Sun, M.D. and Sun Moon Kim, M.D.
Korean J Gastrointest Endosc 2010;40(1):45-48.   Published online January 30, 2010
AbstractAbstract PDF
Dieulafoy's lesion is a rare cause of repetitive and massive gastrointestinal bleeding, and this is characterized by an isolated arteriole protruding through a small mucosal defect. Dieulafoy's lesion is generally found in the stomach within 6 cm of the gastroesophageal junction, and usually on the lesser curvature, but many lesions have been reported in extragastric locations, including the esophagus, small bowel and rectum. A Dieulafoy's lesion in the ampulla of Vater is extremely rare, and only one such case has been reported in the Korean population. We experienced a rare case of Dieulafoy's lesion in the ampulla of Vater with massive pulsatile bleeding, and this was successfully treated by transparent cap-assisted endoscopic hemoclipping. We report here on this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;40:45-48)
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Usefulness of Capsule Endoscopy in Children with Suspected Small Bowel Disease
Hae Jin Park, M.D., So Yeon Lee, M.D., Jae Sung Ko, M.D. and Jeong Kee Seo, M.D.
Korean J Gastrointest Endosc 2009;39(6):346-351.   Published online December 30, 2009
AbstractAbstract PDF
Background
/Aims: The aim of our study is to investigate the diagnostic value and safety of capsule endoscopy (CE) in the pediatric patients with small bowel (SB) disease.
Methods
We retrospectively reviewed the records of 29 children (mean age: 11.8 year) who underwent CE at Seoul National University Children's Hospital between November 2004 and April 2009.
Results
Six (20%) of the total 29 patients could not swallow the capsule (mean age: 10.5 years), so the capsule was endoscopically placed into the stomach of these 6 patients. The CE examination for the entire SB was finished in 89.6% of the patients. The indications for CE studies were obscure gastrointestinal bleeding (OGIB) or anemia in 14 patients, intestinal polyposis in 8, abdominal pain in 4 and Crohn's disease in 3. The diagnostic yield of CE was 35.7% for OGIB or anemia, 37.5% for intestinal polyposis, 25% for abdominal pain and 33.3% for Crohn's disease. One patient had capsule retention during our CE investigations.
Conclusions
CE is a safe and valuable tool for the detection of SB Crohn's disease, the focus of OGIB and the presence of SB polyps in pediatric patients. (Korean J Gastrointest Endosc 2009;39:346-351)
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A Case of Dieulafoy-like Lesion with Massive Bleeding at Ileocecal Valve Following Acute Infectious Colitis in a Pediatric Patient
Jae Seung Soh, M.D., Seong Hun Kim, M.D., Yoon Jae Lee, M.D., In Hee Kim, M.D., Sang Wook Kim, M.D., Seung Ok Lee, M.D., Dae Ghon Kim, M.D. and Soo Teik Lee, M.D.
Korean J Gastrointest Endosc 2009;39(3):166-168.   Published online September 30, 2009
AbstractAbstract PDF
The common causes of lower gastrointestinal bleeding in children are intussusception, rectal juvenile polyp, chronic inflammatory colitis and Meckel's diverticulum. Bleeding from Dieulafoy's ulcer at the lower gastrointestinal tract is rare, but this often occurs in the rectum. So far, there has been no report that a Dieulafoy lesion in the ileocecal valve might be formed after acute colitis in a pediatric patient. In this case report, a Dieulafoy-like lesion at the ileocecal valve caused lower gastrointestinal bleeding in an asymptomatic 14-year-old woman. A careful history taking and medical examination are mandatory to identify the bleeding focus in the GI tract and this can be treated by endoscopy. (Korean J Gastrointest Endosc 2009;39:166-168)
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A Case of Polyarteritis Nodosa That Presented as Hemobilia
Joo Wook Sung, M.D., Yun Jeong Lim, M.D., Jae Hyun Kwon, M.D.*, Kyung Jo Kim, M.D. and Jin Ho Lee, M.D.
Korean J Gastrointest Endosc 2009;38(6):364-367.   Published online June 30, 2009
AbstractAbstract PDF
Hemobilia is defined as hemorrhage into the biliary tract, and the patients with hemobilia present with abdominal pain, jaundice and gastrointestinal bleeding. The causes of hemobilia are traumatic or operative injury to the liver or bile ducts, intraductal rupture of the hepatic abscess or aneurysm of the hepatic artery. Cholecystitis can also develop in patients with hemobilia. Polyarteritis nodosa (PAN) is a multisystem, necrotizing vasculitis of the small and medium-sized muscular arteries and patients with this illness may present with fever, sweats, weight loss, severe arthralgia and myalgia. Mesentery artery involvement that can result in gastrointestinal hemorrhage, bowel infarction and perforation is rare, yet very serious in patients with PAN. We report here on a rare case of PAN that presented as hemobilia due to rupture of a hepatic arterial aneurysm. (Korean J Gastrointest Endosc 2009;38:364-367)
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The Usefulness of a Suspected Blood Identification System (SBIS) in Capsule Endoscopy according to Various Small Bowel Bleeding Lesions
Ju Young Kim, M.D., Hoon Jai Chun, M.D., Chul Young Kim, M.D., Jin Su Jang, M.D., Yong Dae Kwon, M.D., Sanghoon Park, M.D., Bora Keum, M.D., Yeon Seok Seo, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Hong Sik Lee, M.D., Soon Ho Um, M.D., Sang Woo Lee,
Korean J Gastrointest Endosc 2008;37(4):253-258.   Published online October 30, 2008
AbstractAbstract PDF
Background/Aims: Substantial time and attention are required to read and interpret the recordings of capsule endoscopic images. A suspected blood identification system (SBIS) has been developed to assist in the reading of capsule images. This software automatically marks "red tags" that correlate with suspected blood or red areas. However, the sensitivity and accuracy of the system have not been well characterized. We investigated the usefulness of the SBIS in capsule endoscopy according to various small bowel bleeding lesions. Methods: Two expert endoscopists reviewed the capsule images. Angiodysplasias, ulcers and erosion were considered as significant lesions, and active bleeding lesions were considered when bleeding or blood clots were seen in the capsule images. The red tags that were automatically marked by the use of the rapid software were compared to the significant lesions reviewed by the endoscopists. Results: A total of 95 patients were enrolled in the study. The endoscopists identified 159 significant lesions and 71 lesions marked by red tags were identified by the SBIS. Among the 71 lesions, 31 lesions correctly coincided with the significant lesions. The overall sensitivity and positive predictive value of the use of the SBIS were 20% and 44%, respectively. The sensitivities of active ulcers and active bleeding lesions were 83% and 93%, respectively. Conclusions: The SBIS should be considered as a rapid screening tool to identify active bleeding lesions, and a complete review of capsule images by a physician is still needed. (Korean J Gastrointest Endosc 2008;37:253-258)
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Clinical Overview of Acute Lower Gastrointestinal Bleeding
Kyeong Ok Kim, M.D., Byung Ik Jang, M.D., Tae Nyeun Kim, M.D., Jong Ryul Eun, M.D., Kyu Hyung Lee, M.D., Si Hyung Lee, M.D., Jae Won Choi, M.D. and Youn Sun Park, M.D.
Korean J Gastrointest Endosc 2008;36(5):262-267.   Published online May 30, 2008
AbstractAbstract PDF
Background
/Aims: Acute lower gastrointestinal bleeding (LGIB) is a common disorder that requires hospitalization. Colonoscopy is considered as the procedure of choice for diagnosing acute LGIB. The aim of this study was to analyze the clinical characteristics, endoscopic diagnosis and clinical course of acute LGIB. Methods: From January 2000 to August 2007, 117 patients with hematochezia, who visited Yeungnam University hospital emergency center and underwent colonoscopy or sigmoidoscopy, were reviewed retrospectively. The male to female ratio was 2.25 (81:36). The mean age was 59.1±16.9 years. Results: The mean time from presentation to endoscopy was 12.6 hours. The cause of bleeding was identified in 88.9% of the cases after endoscopy. The causes of the acute LGIB were colitis: 26 cases, post polypectomy bleeding: 17 cases, colon ulcer: 16 cases, diverticular bleeding: 13 cases, colon cancer: 9 cases, angiodysplasia: 7 cases and hemorrhoid: 6 cases. Thirty six patients were treated by the endoscopic method; the mean duration of admission was 10.6±10.0 days and the mean amount of transfusion was 3.0±1.9 U. Those numbers showed statistically significant differences according to the diagnosis. Conclusions: The most common cause of acute LGIB was colitis and the causes of bleeding were a significant factor that affects the severity of bleeding and the duration of admission. (Korean J Gastrointest Endosc 2008;36:262-267)
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A Case of Acute Lower Gastrointestinal Bleeding from a Benign Appendiceal Ulcer
Sang Cheol Cho, M.D., Young Ho Seo, M.D., Chung Su Park, M.D., Sang Hyun Park, M.D., An Doc Chung, M.D., Bong Kyu Lee, M.D., So Young Chu, M.D., Nam Hun Lee, M.D., Keun Yeong Song, M.D.*, Sung Hwan Song, M.D.*, In Kyoung Lee M.D. and Hya
Korean J Gastrointest Endosc 2008;36(3):173-176.   Published online March 30, 2008
AbstractAbstract PDF
A hemorrhoid is the most common cause of acute lower gastrointestinal (LGI) bleeding. Diverticulosis, angiodysplasia and ischemic colitis can also cause LGI bleeding. Acute LGI bleeding from the appendix is very rare. We experienced a case of a 33‐year‐old woman with acute LGI bleeding from the appendix. Colonoscopy demonstrated an active hemorrhage from the orifice of the appendix. The patient was treated with a appendectomy, and a histological examination showed the presence of a small ulcer with inflamed granulation tissue in the mucosa and submucosa. (Korean J Gastrointest Endosc 2008;36: 173-176)
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An Ampulla of Vater Carcinoid Tumor that Presented with Upper Gastrointestinal Bleeding
Jae Serk Park, M.D., Sung Jo Bang, M.D., Seok Won Jung, M.D., Sung Ho Kwon, M.D., Byung Chul Kim, M.D., Dong Ha Han, M.D., Hyun Soo Kim, M.D., Young Min Kim, M.D.*, Chang Woo Nam, M.D. and Do Ha Kim, M.D.
Korean J Gastrointest Endosc 2007;35(6):420-423.   Published online December 30, 2007
AbstractAbstract PDF
A Carcinoid tumor of the ampulla of Vater is extremely rare, accounting for less than 0.3% of all gastrointestinal carcinoids. Most reported cases have arisen from the gallbladder. An ampullary carcinoid most commonly presents with jaundice or upper abdominal discomfort, and bleeding from the tumor is exceedingly rare. A diagnosis is most frequently made postoperatively due to submucosal spread of the tumor. As the metastatic potential cannot be predicted by tumor size, a Whipple pancreaticoduodenectomy rather than local excision is considered the treatment of choice. We herein report a case of a primary carcinoid tumor located at the ampulla of Vater that presented as gastrointestinal bleeding; the tumor was diagnosed by an endoscopic biopsy after a papillary sphinterotomy. (Korean J Gastrointest Endosc 2007;35:420-423)
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