Clinical Endoscopy

Reviews

Hemostatic powder for gastrointestinal malignant tumor bleeding: Thanrada Vimonsuntirungsri, Rapat Pittayanon; Received October 21, 2025 Accepted December 20, 2025 Published online March 25, 2026; DOI: https://doi.org/10.5946/ce.2025.387 [Epub ahead of print]

Abstract PDF PubReader ePub: Gastrointestinal (GI) tumor bleeding remains a major clinical challenge worldwide, particularly for endoscopists. GI malignant tumor bleeding is uniquely characterized by diffuse oozing and friable tissue, which is vulnerable to further injury. This poses inherent limitations to conventional endoscopic treatments, resulting in low immediate hemostasis rates and a high risk of rebleeding. Traditional salvage surgery or embolization is the rescue treatment; however, they carry a higher mortality risk in the absence of stabilization. Importantly, survival in these patients depends on definitive oncological therapy, and endoscopic hemostasis is an essential frontline approach as a critical bridge to subsequent tumor treatment. Over the past decade, hemostatic powder has evolved into a promising treatment for malignant GI bleeding, distinguished by its ability to provide broad mucosal coverage through non-contact application. To date, adequately powered randomized controlled trials and meta-analyses have demonstrated superior immediate hemostasis and lower rebleeding rates with only a hemostatic powder agent (TC-325) over conventional endoscopic therapy. Thus, the efficacy of other hemostatic powder agents needs to be explored. To date, no luminal or systemic adverse events have been reported in studies on malignant bleeding, reassuring the safety of hemostatic powder in this setting.

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Precise and optimal delivery techniques of hemostatic powders in gastrointestinal bleeding: Hsueh-Chien Chiang, Xi-Zhang Lin; Received June 28, 2025 Accepted October 1, 2025 Published online March 3, 2026; DOI: https://doi.org/10.5946/ce.2025.209 [Epub ahead of print]

Abstract PDF PubReader ePub: Gastrointestinal (GI) bleeding is associated with a high risk of mortality. While conventional endoscopic hemostasis methods, including epinephrine injection, heater probe coagulation, hemostatic clips, and band ligation, achieve an overall hemostasis rate of 85%–90%, 10%–20% of patients do not respond to these treatments. Several novel powders have shown promise as effective hemostatic agents. In this review, we discuss the evolution of endoscopic hemostasis and explore the potential of innovative hemostatic powder treatments in managing GI bleeding. Relevant articles were identified by searching PubMed from 2010 to 2025 using the keywords’ “hemostatic powder”, “GI bleeding”, and “endoscopic hemostasis”. A review of recent PubMed articles on topical hemostatic powders used in endoscopy, including Hemospray, EndoClot, Ankaferd Blood Stopper, Nexpowder, and various drug-based powders, demonstrated that these agents offered high immediate hemostasis rates exceeding 90%. Topical hemostatic powders are valuable for managing active GI bleeding, especially when conventional endoscopic techniques are unsuccessful or technically challenging, such as refractory and tumor bleeding.

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Systematic Review and Meta-analysis

Pre-endoscopy erythromycin versus metoclopramide for upper gastrointestinal bleeding: a systematic review and network meta-analysis: Ravi Teja Pasam, Kanwal Bains, Srilekha Chava, Babu P. Mohan; Clin Endosc 2025;58(6):831-842. Published online July 4, 2025; DOI: https://doi.org/10.5946/ce.2024.351

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Given the limited head-to-head trials comparing the outcomes of pre-endoscopy erythromycin and metoclopramide for upper gastrointestinal bleeding (UGIB), a network meta-analysis (NMA) and component NMA were conducted.
Methods
A comprehensive review of the Medline, Embase, and Cochrane databases was conducted for randomized controlled trials comparing pre-endoscopy erythromycin or metoclopramide for UGIB with or without gastric lavage (GL) to placebo and/or GL. The primary outcome was the adequate visualization of the mucosa. The secondary outcomes were endoscopy visualization score, endoscopy duration, diagnosis established at initial endoscopy, second-look endoscopy, blood transfusions, mortality, and duration of hospitalization.
Results
A total of 16 studies (1,447 patients) were included. No significant differences were observed between erythromycin and metoclopramide in all the outcomes, but erythromycin had significantly better outcomes than the control group in terms of endoscopic visualization score (standardized mean difference, 0.58; 95% confidence interval [CI], 0.26–0.91), adequate mucosal visualization (risk ratio, 1.55; 95% CI, 1.18–2.04), second-look endoscopy, transfusion requirements, and duration of hospitalization. Component network meta-analysis revealed that erythromycin, but not metoclopramide or GL, provided significantly better endoscopic visualization than the placebo.
Conclusions
Erythromycin should be considered before UGIB endoscopy. The current data do not support the use of metoclopramide or GL.

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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; Clin Endosc 2024;57(5):620-627. Published online March 8, 2024; DOI: https://doi.org/10.5946/ce.2023.179

Graphical Abstract Abstract PDF PubReader ePub

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.

Citations

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Endoscopic hemostatic powder as a salvage treatment for acute gastrointestinal bleeding
Duc Trong Quach
Clinical Endoscopy.2024; 57(5): 606. CrossRef

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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

Abstract PDF PubReader ePub

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

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Advancements in Endoscopic Closure
Lizeth Cifuentes, Harkirat Singh, Sultan Mahmood
Gastrointestinal Endoscopy Clinics of North America.2026; 36(2): 253. CrossRef
Narrative Review of Management Strategies and Risk Mitigation for Gastrointestinal Bleeding in Atrial Fibrillation Patients Receiving Warfarin
Abbas Sarvari Soltani, Ali Ebrahimi Nasab, Mehdi Hassani Ahangar, Mahan Khani, Sina Hemmati Bi'aragh, Kimia Rasouli, Reza Afsahi, Ramtin Pourahmad
Clinical and Applied Thrombosis/Hemostasis.2026;[Epub] CrossRef
Efficacy and safety of clipping prior to cyanoacrylate embolization in gastric varices: a single-arm systematic review and meta-analysis
Olivia Murga, Tamila Redzanova, Jariel Abreu Perez, Sally Ahmad, Alejandro Chen Liang, Martin Alexander Parra Salazar, Jashanpreet Gill, Muhammad Asfandyar Khan, Chinelo Okonkwo, Victor Sebastian Arruarana, Rashmi Advani, Ernesto Calderón Martínez
Surgical Endoscopy.2026;[Epub] CrossRef
Evaluating the efficacy of a novel hemostatic powder compared with traditional treatments in nonvariceal upper GI bleeding: a multicenter, randomized, noninferiority study
Da Hyun Jung, Jun Chul Park, Joon Sung Kim, Moon Won Lee, Hyuk Lee, Gwang Ha Kim
Gastrointestinal Endoscopy.2025; 101(4): 792. CrossRef
Endoscopic management of upper non-variceal and lower gastrointestinal bleeding: Where do we stand?
Grigorios Christodoulidis, Kyriaki Tsagkidou, Dimitra Bartzi, Ioana Alexandra Prisacariu, Eirini Sara Agko
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Endoscopic Closure Techniques for Perforations, Leaks, and Fistulae: Review Article
José Damasceno e Costa, Rita Seara Costa, Joana Neves, Patrícia Conde, Andreia Guimarães, Aníbal Ferreira
GE - Portuguese Journal of Gastroenterology.2025; : 1. CrossRef
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
Usage of Padlock Over-the-Scope-Clip in Difficult-to-Control Recurrent Gastrointestinal Bleeding Due to a Gastric Dieulafoy Lesion
John Joyce, Vishnu Kumar, Dayana Nasr, Ganesh Aswath, Hafiz M. Khan, Savio John
Journal of Investigative Medicine High Impact Case Reports.2024;[Epub] CrossRef
Comparison of mechanical and thermal therapy in upper gastrointestinal bleeding: an analysis of efficacy outcomes
Rahul Karna, Bandhul Hans, Thayer Nasereddin, Dhruv Chaudhary, Manish Dhawan
Baylor University Medical Center Proceedings.2024; 37(5): 734. CrossRef
Turn over the new leaf of the treatment in peptic ulcer bleeding: a review of the literature
Meng-Hsuan Lu, Hsueh-Chien Chiang
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef
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
Clinical Endoscopy.2024; 57(5): 620. 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

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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

Abstract PDF Supplementary Material PubReader ePub

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

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Incidence and Outcomes of Upper GI Bleeding in Hospitalized SARS‐CoV‐2 Patients
Erin Sanzone, Katherine Gheysens, Krystal Hunter, Adib Chaaya, Sangita Phadtare, Tatsuya Toyokawa
Gastroenterology Research and Practice.2025;[Epub] CrossRef
Increased Overall Mortality in Patients Admitted for Gastrointestinal Bleeding and COVID-19 Infection Compared to No COVID-19 Infection: A Systematic Review and Meta-Analysis
Sergiu Marian Cazacu, Adina Turcu-Stiolica, Cristina Maria Marginean, Ion Rogoveanu
Gastroenterology Insights.2025; 16(3): 20. CrossRef
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
Rates, Risk Factors, and Outcomes of Nonvariceal Upper Gastrointestinal Bleeding in Patients Hospitalized for COVID-19 in the United States
Mohammad Aldiabat, Wesam Aleyadeh, Taimur Muzammil, Kemi Adewuyi, Majd Alahmad, Ahmad Jabri, Laith Alhuneafat, Yassine Kilani, Saqr Alsakarneh, Mohammad Bilal
Current Medical Science.2024; 44(6): 1202. 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

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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

Abstract PDF PubReader ePub

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

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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

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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

Abstract PDF Supplementary Material PubReader ePub

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

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Faecal occult blood testing in persons aged 50–74 years with established spinal cord injury: a prospective case series
Michael Yulong Wu, Carmen Tung, McCawley Clark-Dickson, Samuel Arthurs, Steffanie Nario, Ian D. Norton
Spinal Cord Series and Cases.2025;[Epub] CrossRef
Frequency of Positive Fecal Occult Blood Test in Patients with Cirrhosis
Faisal Khan, Aliena Badshah, Durkho Atif, Muhammad Irshad
Journal of Gandhara Medical and Dental Science.2024; 12(1): 32. CrossRef
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

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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

Abstract PDF PubReader ePub

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.

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Mortality prediction among ED patients with upper gastrointestinal bleeding: Comparison of NEWS-2 and conventional risk scores
Harun Yildirim, Murtaza Kaya, Suleyman Cosgun
The American Journal of Emergency Medicine.2026; 101: 14. CrossRef
Inflammatory indices as independent predictors of in-hospital mortality in acute upper gastrointestinal bleeding
Mustafa Oguz Cumaoglu, Abdussamed Vural, Mustafa Alpaslan, Turgut Dolanbay, Abdul Ridvan Kulu, Ercan Sezgin, Seyyid Rasim Yanmaz
BMC Gastroenterology.2026;[Epub] CrossRef
Argon Plasma Coagulation as Rescue Endoscopic Hemostasis for Acute Variceal Bleeding in Cirrhosis: A Retrospective Cohort Comparison with Band Ligation
Ilie Marius Ciorba, Nicoleta Crăciun Ciorba, Simona Maria Bățagă
Medicina.2026; 62(3): 547. CrossRef
Predictive Value of the Combination of Lactate and qSOFA Score for Clinical Outcomes in Cirrhotic Patients with Esophagogastric Variceal Bleeding
Mengyun Li, Nan Geng, Zhao Liu, Wen Pan, Chunlian Lai, Yingying Cui, Yixin Miao, Yueke Zhu, Benyong Yan, Haoqi Li, JingJing Wang, Bo Liu
International Journal of General Medicine.2026; Volume 19: 1. CrossRef
Impact of duration to endoscopy in patients with non-variceal upper gastrointestinal bleeding: propensity score matching analysis of real-world data from Thailand
Arunchai Chang, Natthawat Sitthinamsuwan, Nuttanit Pungpipattrakul, Kittiphan Chienwichai, Keerati Akarapatima, Sorawat Sangkaew, Manus Rugivarodom, Attapon Rattanasupar, Bancha Ovartlarnporn, Varayu Prachayakul
BMC Gastroenterology.2025;[Epub] CrossRef
Giá trị thang điểm Glasgow Blatchford và AIMS65 trong tiên lượng bệnh nhân xuất huyết tiêu hóa trên không do vỡ giãn đang dùng thuốc chống huyết khối
Phan Trung Nam, Nguyễn Văn Thu Hà, Trương Đình Vũ, Trần Phạm Chí
Tạp chí Y học lâm sàng Bệnh viện Trung Ương Huế.2025; 17(3): 119. CrossRef
Risk stratification and scoring systems in upper and lower gastrointestinal bleeding: review of performance and limitations in the emergency department
Fatemeh Mohammadyari, Amirreza Aflak, Mahta ZareDini, Reza Irandoost, Saeed Ghaffari, Arsham Gharib, Minaalsadat Roshanaei, Mazyar Tahavori, Sepehr Olangian-Tehrani
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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

Abstract PDF PubReader ePub

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

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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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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.

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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

Abstract PDF PubReader ePub

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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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

Abstract PDF PubReader ePub

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 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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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.

Citations

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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

Abstract PDF PubReader ePub

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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Angelo Gualberto de Macedo, Erika Ruback Bertges, Luiz Carlos Bertges, Renata Alvim Mendes, Thais Abranches Bueno Sabino Bertges, Klaus Ruback Bertges, Fernando Monteiro Aarestrup
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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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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.

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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

Abstract PDF PubReader ePub

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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Use of Hemospray® in post-sclerotherapy bleeding
Beatriz González Ortiz, Dora María Tapia Monge, Alicia Reyes Cerecedo, Oscar Hernández Mondragón
Boletín Médico Del Hospital Infantil de México (English Edition).2016; 73(5): 335. CrossRef
Deployment of a Short, Single-Opening Endoscopic Clip Versus a Long, Reopening Endoscopic Clip in Clinical Practice
Eric Wee, Mathew Philip Sachin, Uthamanand Chinnappa, Su Chang, Cherng Hann Benjamin Yip
Digestive Diseases and Sciences.2015; 60(8): 2287. CrossRef
Poudres hémostatiques et hémorragies digestives
M. Vincent
Acta Endoscopica.2015; 45(1-2): 2. CrossRef
Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer
Young-Il Kim, Il Ju Choi
Clinical Endoscopy.2015; 48(2): 121. CrossRef
Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding: State of the Art
Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura, Hiroshi Miyamoto, Tetsuji Takayama
Clinical Endoscopy.2015; 48(2): 96. CrossRef
Hemostatic powder spray: a new method for managing gastrointestinal bleeding
Kinesh Changela, Haris Papafragkakis, Emmanuel Ofori, Mel A. Ona, Mahesh Krishnaiah, Sushil Duddempudi, Sury Anand
Therapeutic Advances in Gastroenterology.2015; 8(3): 125. CrossRef
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Ki Bae Kim, Soon Man Yoon, Sei Jin Youn
Clinical Endoscopy.2014; 47(4): 315. CrossRef
Spontaneous Healing of Gastric Perforation after Endoscopic Ligation for Gastric Varices
Jung Ho Kim, Hong Dae Ahn, Kwang An Kwon, Yoon Jae Kim, Jun-Won Chung, Dong Kyun Park, Ju Hyun Kim
Journal of Korean Medical Science.2013; 28(4): 624. CrossRef
Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer
Young‐Il Kim, Il Ju Choi, Soo‐Jeong Cho, Jong Yeul Lee, Chan Gyoo Kim, Mi‐Jung Kim, Keun Won Ryu, Young‐Woo Kim, Young Iee Park
Journal of Gastroenterology and Hepatology.2013; 28(9): 1489. CrossRef
Neue Optionen der endoskopischen Blutstillung bei gastrointestinalen Blutungen
A. Hoffman, J.W. Rey, R. Kiesslich
Der Gastroenterologe.2013; 8(2): 140. CrossRef
Gastrointestinal bleeding with the new oral anticoagulants – defining the issues and the management strategies
Jay Desai, Jennifer Kolb, Jeffrey Weitz, James Aisenberg
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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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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

Abstract 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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A Case of Duodenal GIST Accompanied with Neurofibromatosis-1, Presenting with Gastrointestinal Bleeding: Sung O Seo, M.D., Hyo Jung Oh, M.D., Ki Hoon Kim, M.D., Chang Soo Choi, M.D., Geom Seog Seo, M.D., Tae Hyeon Kim, M.D., Ki Jung Yun, M.D.* and Suck Chei Choi, M.D.; Korean J Gastrointest Endosc 2007;35(4):254-257. Published online October 30, 2007

Abstract PDF: Gastrointestinal stroma tumors (GISTs) are CD117- positive primary mesenchymal tumors of the gastrointestinal tract and are noted to have a possible non-random association with neurofibromatosis-1 (NF-1, Von Recklinghausen disease). We report a case of a duodenal GIST presenting with gastrointestinal bleeding in a 74-year-old female, and this condition was accompanied with NF-1. A upper gastrointestinal endoscopy and abdominal computed tomography scan revealed several submucosal tumors in the duodenum, jejunum and ileum. Histological and immunohistochemical studies on the surgical resection specimen revealed gastrointestinal stromal tumors of an uncommitted type. The patient was treated with local excision of the tumors and is now in a favorable state. (Korean J Gastrointest Endosc 2007;35:254-257)

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A Case of Gastritis Cystica Profunda with a Long Stalk Presenting with Upper Gastrointestinal Bleeding: Ji Eun Yoon, M.D., Min Su Kim, M.D., Kyu Chol Lee, M.D., Hyo Jin Park, M.D. and Chan Il Park, M.D.*; Korean J Gastrointest Endosc 2007;35(3):186-189. Published online September 30, 2007

Abstract PDF: Gastritis cystica profunda (GCP) is a rare disease in which hyperplastic and cystic dilatation of the gastric mucous glands extend into the tissues beneath the submucosa. GCP is mainly observed at the site of a gastroenterostomy; however, it may occur in the stomach without a previous history of surgery. GCP may present not only as a submucosal tumor or as solitary or diffuse polyps but also rarely as a giant gastric mucosal fold. In a patient without a previous history of surgery, GCP presents mainly as a sessile polypoid protrusion or as a submucosal tumor. In addition, GCP presents with non-specific symptoms and is most commonly found incidentally. We present a case of GCP that developed upper gastrointestinal bleeding and showed a long stalk and a focal ulcerative lesion on the surface of a polyp that developed in the stomach without a history of previous surgery. This lesion was removed by the use of an endoscopic polypectomy and was histologically diagnosed as GCP. (Korean J Gastrointest Endosc 2007;35:186-189)

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A Case of Epithelioid Type Gastric Gastrointestinal Stromal Tumor with Gastrointestinal Bleeding: Eui Hyung Kim, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Kon Ho Shim, M.D., Hyeug Lee, M.D., Jeong Jo Jeong, M.D. and Sang Wook Choi, M.D.; Korean J Gastrointest Endosc 2007;35(2):87-90. Published online August 30, 2007

Abstract PDF: The stomach is the most frequently noted site (50∼60%) of gastrointestinal stromal tumor. This tumor is categorized into three subtypes (the spindle cell type, the epithelioid type or mixed type) according to the shape of the cells that make up the tumor. We herein report on a case of gastrointestinal stromal tumor with an epithelioid subtype in a 60-year-old male. On admission, the patient presented with epigastric pain and melena. Endoscopy revealed a submucosal tumor with a central ulcer at the gastric body. Gastric wedge resection was performed. The tumor cells showed a rounded shape and positive staining for CD117. Because the epithelioid type gastrointestinal stromal tumor is unusual in Korea, we report here on this case along with a review of the relevant literature.

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A Case of Endoscopic Hemoclip Management of Dieulafoy-like Lesion on the Hyperplastic Polyp in the Duodenum: Nam Seon Park, M.D., Jung Hoon Song, M.D., Eun Bin Lee, M.D., Byung Kook Kang, M.D., Dae Ho Jin, M.D., Tae Hong Ahn, M.D., Yoon Ju Han, M.D. and Hyung Suk Lee, M.D.; Korean J Gastrointest Endosc 2007;34(6):329-333. Published online June 30, 2007

Abstract PDF: Dieulafoy's lesion (DL) is an uncommon but important cause of massive upper gastrointestinal bleeding that has been reported to be involved in 0.3∼6.7% of cases of major gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been observed in the esophagus, duodenum, small intestine, colon, and rectum. Most DLs encountered in the duodenum occur in the bulb. Recently, with the advances in endoscopic techniques, the successful management of DL has been achieved through the application of a hemoclip or elastic band ligation. In particular, the application of a hemoclip is considered to be a safe and effective treatment for DL located on a relatively narrow and thin walled canal such as the duodenum. We report the successful application of endoscopic hemoclipping for the treatment of a rare Dieulafoy-like lesion on a hyperplastic polyp in the 2nd portion of the duodenum.

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Massive Upper Gastrointestinal Bleeding from a Traction Type of Diverticulum in the Midesophagus: Chang Soo Jang, M.D., Kwang An Kwon, M.D., Soo Jin Choi, M.D.*, Yeon Suk Kim, M.D., Yang Suh Ku, M.D., Kee Sup Song, M.D., Uk Sun Chang, M.D., Sang Kyun Yu, M.D., Dong Kyun Park, M.D., Yu Kyung Kim, M.D. and Ju Hyun Kim, M.D.; Korean J Gastrointest Endosc 2007;34(4):200-204. Published online April 30, 2007

Abstract PDF: The common sites of esophageal diverticula are the pharyngoesophageal junction, midesophagus and epiphrenic. The pathophysiological mechanisms of acquired esophageal diverticula are traction and pulsion forces. Traction diverticula of the midesophagus are usually asymptomatic, and found incidentally on an esophagogastroduodenoscopy or barium contrast esophagogram. Midesophageal traction diverticula are caused by inflammatory processes between the external wall of the esophagus and the adjacent structure. Pneumonia, bronchoesophageal fistula and gastrointestinal bleeding can occur due to an extension of inflammatory process into the lung or blood vessels. There are a few reports of midesophageal diverticular bleeding. We present a case of massive upper gastrointestinal bleeding from a traction diverticulum of the midesophagus that was successfully managed by endoscopic treatment. (Korean J Gastrointest Endosc 2007;34:200⁣204)

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A Case of Gastrointestinal Stromal Tumor of the Proximal Jejunum Diagnosed by Double Balloon Enteroscopy: Min Ho Choi, M.D., Cheul Young Choi, M.D., Hyeon Woo Byun, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Woo Young Jang, M.D.^†, Jae Jung Lee, M.D.*, Sea Hyub Kae, M.D. and Jin Lee, M.D.; Korean J Gastrointest Endosc 2006;33(3):163-167. Published online September 30, 2006

Abstract PDF: A gastrointestinal stromal tumor (GIST) is a rare disease but is the most common nonepithelial neoplasm in the gastrointestinal tract. GIST accounts for 0.1∼3.0% of gastrointestinal malignancies, and 20∼30% of GISTs are found in the small intestine. GIST with extraluminal growth is difficult to diagnose. We report a case of a jejunal GIST with obscure bleeding that was diagnosed using double balloon enteroscopy. (Korean J Gastrointest Endosc 2006;33:163⁣167)

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Endoscopic Treatment with Band Ligation and Electrocoagulation for Non-Variceal, Non-Ulcer Upper Gastrointestinal Bleeding: Hwa Min Kim, M.D., Yang Suh Ku, M.D., Moon Gi Chung, M.D., Young Nam Kim, M.D., Do Yoon Lim, M.D., Kwang An Kwon, M.D., Dong Kyun Park, M.D., Sun Suk Kim, M.D., Yeon Suk Kim, M.D., So Young Kwon, M.D., Yu Kyung Kim, M.D., Duck Joo Choi, M.D. and Ju Hyun K; Korean J Gastrointest Endosc 2006;33(2):69-76. Published online August 30, 2006

Abstract PDF: Background
/Aims: This study compared the therapeutic efficacy of endoscopic band ligation (EBL) with that of electrocoagulation for treating non-variceal, non-ulcer (NVNU) upper gastrointestinal (UGI) bleeding. Methods: This study included 89 patients who underwent EBL and 56 patients in whom monopolar electrocoagulation was performed for NVNU UGI bleeding. The lesions treated were Mallory-Weiss tear in 91 patients, Dieulafoy's lesion in 42 patients and angiodysplasia in 12 patients. Results: The initial hemostatic rate was 97% in the EBL group and 91% in the electrocoagulation group, but this was not statistically different. Rebleeding occurred in 5 of 89 patients (5.6%) in the EBL group and in 8 of 56 patients (14.3%) in the electrocoagulation group (p=0.07). Thrombocytopenia or prothrombin time prolongation was confirmed to be a significant risk factor for rebleeding. The rebleeding rate in the high risk group was significantly lower than in the EBL group (9% vs. 30%, respectively, p=0.03). The median procedure time was significantly shorter in the EBL group compared with that in the electrocoagulation group (median 5.6 minutes vs. 8.3 minutes, respectively, p=0.04). Conclusions: EBL and electrocoagulation are both effective for treating NVNU UGI bleeding, and EBL is especially safe and effective for the cases with a high risk for rebleeding. (Korean J Gastrointest Endosc 2006;33:69⁣76)

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A Case of Dieulafoy's Lesion in the Jejunum Treated by Double Balloon Enteroscopy: Min Ho Choi, M.D., You Sang Ko, M.D., Mi Jeong Kim, M.D., Su Hee Park, M.D., Yeong Je Chae, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D. and Jin Lee, M.D.; Korean J Gastrointest Endosc 2006;32(6):392-396. Published online June 30, 2006

Abstract PDF: Dieulafoy's lesion is an unusual cause of gastrointestinal hemorrhage that results from the erosion of an abnormally large submucosal artery. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction. However, similar lesions have been reported in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion is extremely rare. We report a case of jejunal Dieulafoy's lesion with recurrent and massive bleeding, which was diagnosed and treated with the double-balloon enteroscopy. (Korean J Gastrointest Endosc 2006;32:392⁣396)

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Clinical Features of Gastrointestinal Bleeding in Patients with Chronic Renal Failure: Hyung Keun Kim, M.D., Young-Soo Kim, M.D., Young Seok Cho, M.D., Jeong-Seon Ji, M.D., Sung Soo Kim, M.D., Young Ok Kim, M.D., Sun-Ae Yun, M.D., Hiun Suk Chae, M.D., Kyu Yong Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;32(6):374-380. Published online June 30, 2006

Abstract PDF: Background
/Aims: Gastrointestinal bleeding (GIB) in patients with chronic renal failure (CRF) is a common complication with a high mortality. However, the cause or mechanism of this condition is unclear. Therefore, this study investigated the clinical features of GIB in patients with CRF. Methods: The clinical features of 35 patients with CRF who were admitted to the Uijeongbu St. Mary's Hospital for GIB from January 1998 to August 2003 were examined retrospectively. Results: Thirty-five out of 803 patients had CRF (4.4%). The mean age of those with CRF was 62⁑11 years and 16 patients were male. The treatment for CRF was hemodialysis in 22 (62.9%), pre-dialysis in 10 (28.6%) and peritoneal dialysis in 3 (8.6%). The cause of GIB in CRF patients was an ulcer (45.7%), vascular disease (37.1%), hemorrhagic gastritis (8.6%), and Mallory-Weiss laceration (2.9%), etc. Rebleeding after the first treatment occurred in 5 patients (14.3%). Three of these patients (60%) had vascular disease. Surgical treatment for rebleeding was performed in 3 patients (60%) and the mortality rate in rebleeding patients was 60%. Conclusions: The most common cause of GIB in CRF patients is an ulcer followed by vascular disease. Vascular disease in cases with rebleeding is high with a high mortality rate. (Korean J Gastrointest Endosc 2006;32:374⁣380)

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A Case of Endoscopic Management of Dieulafoy's Lesion in the Ampulla of Vater: Ki Won Hwang, M.D., Jae Hyung Lee, M.D., Joo Ho Lee, M.D., Sang Yong Lee, M.D., Tae Oh Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2006;32(5):357-359. Published online May 30, 2006

Abstract PDF: Dieulafoy's lesion is an uncommon but important cause of massive upper gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction but extragastric locations of Dieulafoy's lesion are rare. In this study, diagnosis of Dieulafoy's lesion was frequently made by endoscopy instead of surgery. Hemostasis was achieved by endoscopic treatment in more than 90% of patients. We report the successful application of endoscopic hemoclipping for treatment of active bleeding from Dieulafoy's lesion in the ampulla of Vater of the duodenum. (Korean J Gastrointest Endosc 2006;32:357⁣360)

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Risk Factors for Upper Gastrointestinal Rebleeding in Critically Ill Patients: Seong Joon Koh, M.D., Jae Hee Cheon, M.D., Joo Sung Kim, M.D., Byong Duk Ye, M.D., Hae Yeon Kang, M.D., Bo Hyun Kim, M.D., Jeong Hoon Lee, M.D., Ki Young Yang, M.D., Sang Gyun Kim, M.D., Hyun Chae Jung, M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2006;32(5):320-325. Published online May 30, 2006

Abstract PDF: Background
/Aims: To determine the incidence and risk factors associated with rebleeding after upper gastrointestinal bleeding (UGIB) in critically ill patients. Methods: This study retrospectively reviewed the medical records of 60 patients undergoing bedside esophagogastroduodenoscopy between April 2000 and February 2004 for UGIB that developed whilst in the intensive care unit (ICU). Results: Eight out of 60 patients died within 7 days, and an additional 7 patients died within 30 days after the initial bleeding. Two of these 15 patients (13.3%), died from GI bleeding. The 7-day and 30-day rebleeding rates were 34.6% (18/52 patients), and 51.1% (23/45 patients), respectively. Multiple logistic regression using the significant variables revealed, anemia (Hb＜9.0 g/dL) and hypoalbuminemia (＜3.0 g/dL) to be significant factor for 7-day rebleeding, and hypoxia (＜80 mmHg), anemia (Hb＜9.0 g/dL), blood transfusion (≥3 units) to be significant independent risk factor for 30-day rebleeding. Conclusions: The rebleeding rates in the ICU setting were as high as 34.6% at 7 days and 51.1% at 30 days. This suggests that the underlying conditions of the critically ill patients affect the rebleeding rate more than the endoscopic features. Therefore, adequate general ICU care including the prevention and correction of hypoxia, anemia, and hypoalbuminemia, and minimizing blood loss can reduce the risk of rebleeding after UGIB in an ICU setting. (Korean J Gastrointest Endosc 2006;32:320⁣325)

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Upper Gastrointestinal Bleeding Due to Gastric Ectopic Pancreas in a Young Aged Person: Jung Won Yun, M.D., Young Bum Park, M.D., Um Seok Lee, M.D., Choong Hyeon Lee, M.D., Dal Yeon Won, M.D.*, Ji Hoon Kim, M.D.^† and Jae Min Song, M.D.^‡; Korean J Gastrointest Endosc 2006;32(2):132-135. Published online February 27, 2006

Abstract PDF: An ectopic pancreas is the presence of pancreatic tissue outside of its usual location. This condition rarely causes clinical symptoms, and the most commonly reported sites of these lesions are the stomach, the duodenum and jejunum. The presence of this ectopic tissue is not a rare condition, but its unusual locations, clinical symptoms, and complications are of clinical interest. We report a case of a gastric ectopic pancreas with recurrent upper gastrointestinal bleeding in a 20-year-old man. (Korean J Gastrointest Endosc 2006;32:132⁣135)

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A Case of Gastric Syphilis Manifested by Upper Gastrointestinal Bleeding: Seung Woo Lee, M.D., Sang Beom Kang, M.D., Soon Woo Nam, M.D., Joo Yong Song, M.D., Sung Jin Moon, M.D., Dong Soo Lee, M.D. and Hye Kyung Lee, M.D.*; Korean J Gastrointest Endosc 2006;32(2):124-127. Published online February 27, 2006

Abstract PDF: Syphilis is a chronic systemic infection caused by Treponema pallidum; it is sexually transmitted and characterized by episodes of active disease interrupted by periods of latency. Syphilitic involvement of the stomach can occur via the blood flow in the primary or secondary period of syphilis, but its incidence is very rare. Because gastric syphilis has no pathognomic clinical findings and it shows variable gastroscopic findings, it's not so easy to diagnose. After gastric syphilis is correctly diagnosed, it can be easily cured by appropriate antibiotic therapy. The clinicians need to be aware of this disease entity when the patient has mucosal inflammation and ulceration of stomach with the past history of syphilis, or if the patient has lived in edemic areas of syphilis. We report on a case of gastric syphilis that manifested with upper gastrointestinal bleeding. It was initially thought to be stomach cancer, but it was correctly diagnosed by serologic testing and the histopathologic findings. (Korean J Gastrointest Endosc 2006;32:124⁣127)

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Hemorrhagic Small Bowel Tumor Diagnosed with Using Capsule Endoscopy and It was Treated with Laparoscopic Surgery: Report of a Case: Jae Im Lee, M.D., Kyo Young Song, M.D., Cho Hyun Park, M.D., Seung Nam Kim, M.D. and In Seok Lee, M.D.*; Korean J Gastrointest Endosc 2006;32(1):53-56. Published online January 30, 2006

Abstract PDF: For the patients presenting with obscure gastrointestinal bleeding, various diagnostic approaches have been tried such as push enteroscopy, technetium labeled RBC scan and enteroclysis. Capsule endoscopy is an emerging and powerful diagnostic method that enables physicians to investigate the entire small bowel. Therefore, it is useful to make a correct diagnosis of obscure gastrointestinal bleeding in cases with negative findings by endoscopy or colonoscopic examination. We experienced a case of a 30 year-old male patient who presented with obscure intestinal bleeding, and this was diagnosed with capsule endoscopy and he was treated with laparoscopic assisted small bowel resection. (Korean J Gastrointest Endosc 2006;32:53⁣56)

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A Case of Duodenal Ulcer Bleeding caused by Pancreatic Arteriovenous Malformation: Se Il Oh, M.D., Sang Soo Lee, M.D., Il No Do, M.D., Nae Yun Heo, M.D., Song Yi Han, M.D., Jung Min Ahn, M.D., Young Jun Choi, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Myung-Hwan Kim, M.D.; Korean J Gastrointest Endosc 2005;31(5):353-357. Published online November 30, 2005

Abstract PDF: Arteriovenous malformation (AVM) of the pancreas is an extremely rare disease. It may be asymptomatic, but more than half of the patients present with gastrointestinal bleeding. The most common cause of the gastrointestinal bleeding is variceal bleeding due to the portal hypertension resulting from AVM. Bleeding from a duodenal ulcer and AVM to the pancreatic duct are rare findings. Surgical excision is the treatment of choice, but when portal hypertension has developed, this cannot be corrected even after surgical resection. We experienced a case of recurrent duodenal ulcer bleeding that was due to arteriovenous malformation in the head of the pancreas in a 45 year old man. He was successfully treated with pylorus preserving pancreaticoduodenectomy. (Korean J Gastrointest Endosc 2005;31:353⁣357)

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The Usefulness of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding: Hyun Jeong Kim, M.D., Chan Sup Shim, M.D., Sang Ho Lee, M.D., In Seop Jung, M.D., Su Jin Hong, M.D., Chang Bum Ryu, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., June Seong Lee, M.D., Moon Sung Lee, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2005;31(3):140-146. Published online September 30, 2005

Abstract PDF: Background
/Aims: Obscure gastrointestinal bleeding (OGIB) is defined as recurrent bleeding for which no source has been identified by routine endoscopic and contrast studies. This study was performed to determine the utility of capsule endoscopy in patients with OGIB. Methods: This retrospective study included 21 patients with GIB which were not identified by esophagogastroduodenoscopy and colonoscopy. Those were sixteen patients with overt OGIB (including 6 ongoing overt bleeding) and five with occult OGIB. All underwent capsule endoscopy with Given M2A video capsule system. Results: Definite bleeding of small intestine were identified in 9 of 21 patients (42.9%) and 8 of 9 patients presenting as overt OGIB (50.0%, 8/16). Additionally, 5 of 6 patients with ongoing bleeding on the day of capsule endoscopy were found to have the lesion in small intestine (83.3%, 5/6). Ulcers were found in 6 patients, diverticulitis in 2 patients, and a tumor in 1 patients. Conclusions: Capsule endoscopy, providing a good visualization of small intestine, is safe and well tolerated. Capsule endoscopy is an useful diagnostic tool for OGIB, especially for ongoing overt bleeding, and can guide the subsequent therapy and expand diagnostic yield in OGIB. (Korean J Gastrointest Endosc 2005;31:140⁣146)

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The Usefulness of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding: Hyun Jeong Kim, M.D., Chan Sup Shim, M.D., Sang Ho Lee, M.D., In Seop Jung, M.D., Su Jin Hong, M.D., Chang Bum Ryu, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., June Seong Lee, M.D., Moon Sung Lee, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2005;31(3):140-146. Published online September 30, 2005

Abstract PDF: Background
/Aims: Obscure gastrointestinal bleeding (OGIB) is defined as recurrent bleeding for which no source has been identified by routine endoscopic and contrast studies. This study was performed to determine the utility of capsule endoscopy in patients with OGIB. Methods: This retrospective study included 21 patients with GIB which were not identified by esophagogastroduodenoscopy and colonoscopy. Those were sixteen patients with overt OGIB (including 6 ongoing overt bleeding) and five with occult OGIB. All underwent capsule endoscopy with Given M2A video capsule system. Results: Definite bleeding of small intestine were identified in 9 of 21 patients (42.9%) and 8 of 9 patients presenting as overt OGIB (50.0%, 8/16). Additionally, 5 of 6 patients with ongoing bleeding on the day of capsule endoscopy were found to have the lesion in small intestine (83.3%, 5/6). Ulcers were found in 6 patients, diverticulitis in 2 patients, and a tumor in 1 patients. Conclusions: Capsule endoscopy, providing a good visualization of small intestine, is safe and well tolerated. Capsule endoscopy is an useful diagnostic tool for OGIB, especially for ongoing overt bleeding, and can guide the subsequent therapy and expand diagnostic yield in OGIB. (Korean J Gastrointest Endosc 2005;31:140⁣146)

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