Clinical Endoscopy

Training in Endoscopy: Enteroscopy: Jinsu Kim; Clin Endosc 2017;50(4):328-333. Published online July 31, 2017; DOI: https://doi.org/10.5946/ce.2017.089

The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.

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Introduction to Starting Upper Gastrointestinal Endoscopy: Proper Insertion, Complete Observation, and Appropriate Photographing: Kyung Sik Park; Clin Endosc 2015;48(4):279-284. Published online July 24, 2015; DOI: https://doi.org/10.5946/ce.2015.48.4.279

Abstract PDF

Diagnostic upper gastrointestinal endoscopy is the most basic of endoscopy procedures and is the technique that trainee doctors first learn. Mastering the basics of endoscopy is very important because when this process is imprecise or performed incorrectly, it can severely affect a patient's health or life. Although there are several guidelines and studies that consider these basics, there are still no standard recommendations for endoscopy in Korea. In this review, basic points, including proper endoscope insertion, precise observation without blind spots, and appropriate photographing, for upper gastrointestinal endoscopy will be discussed.

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Effect of Previous Abdominal or Pelvic Surgery on Colonoscopy: Chang Wook Jeong, M.D., Sang Goon Shim, M.D., Geon Tae Park, M.D., Ji Eun Oh, M.D., Ji Eun Yi, M.D., Jae Gon Woo, M.D., Dae Hyeon Cho, M.D. and Gil Jong Yoo, M.D.; Korean J Gastrointest Endosc 2011;42(5):283-288. Published online May 28, 2011

Abstract PDF

Background/Aims: A number of studies have reported wide variability in the colonoscope insertion time among patients who had prior abdominal surgery. The aim of this study was to investigate the effect of abdominal surgery on colonoscope insertion time.

Methods: The subjects were 192 patients with prior abdominal surgery, among 3,600 patients who underwent a colonoscopy at Samsung Changwon Hospital from May 2008 to May 2010. We collected the following data: insertion time, age, gender, height, weight, BMI, waist circumference, method of abdominal surgery, and the degree of bowel cleanliness. Previous abdominal operations were divided into colectomy, non-colectomy abdominal surgery, pelvic surgery, and laparoscopic surgery groups.

Results: The average colonoscope insertion time in patients with prior abdominal surgery (7.73±5.95 min) was longer than that of the non-surgery group (6.4±3.88 min). Patients in the colectomy groups were older and had a shorter insertion time (5.11±3.32 min) than patients in the other groups.

Conclusions: Insertion of a colonoscope in patients with previous abdominal surgery was more difficult than that in the control group, except the colectomy group. (Korean J Gastrointest Endosc 2011;42:283-288)

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A Case of Afferent Loop Syndrome after Inserting a Double-Layered Pyloric Stent for Gastric Outlet Obstruction in a Patient with Stump Gastric Cancer after Undergoing Billroth II Radical Subtotal Gastrectomy: Seok Lee, M.D., Yu Jeong Hwang, M.D., Seong Hun Kim, 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;38(3):147-150. Published online March 30, 2009

Abstract PDF: Stent insertion is an effective method for treating a patient with gastric outlet obstruction that's caused by recurred cancer at the anastomosis site. There are some complications associated with stent insertion, such as perforation, bleeding, ulceration and obstruction. There are only rare Korean case reports of afferent loop syndrome after stent insertion. We report here on a case of afferent loop syndrome that occurred after insertion of a double-layered pyloric stent for gastric outlet obstruction in a patient with stump gastric cancer after undergoing Billroth II radical subtotal gastrectomy.(Korean J Gastrointest Endosc 2009;38:147-150)

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The Effect of Self-Expanding Metallic Stent Insertion for the Treatment ofMalignant Colorectal Obstruction: Kee Myung Lee, M.D., Tae Il Kim, M.D.*, Bong Min Ko, M.D.^†, Sung Jae Shin, M.D., Won Ho Kim, M.D.*, Jin Hong Kim, M.D., Moon Sung Lee, M.D.^†, Hyun Soo Kim, M.D.^‡, Young Soo Park, M.D.^§, Ka; Korean J Gastrointest Endosc 2008;36(5):274-281. Published online May 30, 2008

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the clinical and cost effectiveness of the use of stent insertion for malignant colorectal obstruction as compared with performing emergency surgery. Methods: We retrospectively reviewed the medical records of 201 patients. Malignant colorectal obstructions caused by a resectable tumor were treated with preoperative stenting followed by surgery (group A, n=55) or emergency surgery (group B, n=59). Malignant obstructions caused by an unresectable cancer were treated with palliative stenting (group C, n=58) or palliative emergency surgery (group D, n=29). Results: The one-staged radical resection rate was significantly higher in group A patients than in group B patients (87.3% vs. 52.5%, p＜0.05). Post-operative complications were more frequent in group A patients than in group B patients (9.1% vs. 32.2%, p＜0.05). The admission period was significantly shorter for group A patients than for group B patients (25.0 days vs. 33.7 days, p＜0.05). The medical cost was not different for group A and group B patients. Life-long stoma formation was necessary for 15.5% of group C patients and 69% of group D patients, respectively. The admission period was significantly shorter for group C patients than group D patients (10.5 days vs. 22.7 days, p＜0.05). The medical cost was not different for group C and D patients. Conclusions: Stent insertion was an effective treatment modality for malignant colorectal obstruction. (Korean J Gastrointest Endosc 2008;36:274- 281)

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증례 : 유두부로 개구하는 담낭관 급성 췌장염 - 증례보고 - ( Cystic Duct Insertion at the Ampulla of Vater and Acute Pancreatitis - A Case Report - ): Korean J Gastrointest Endosc 2000;20(6):496-498. Published online November 30, 1999

Abstract PDF: The two most common causes of acute pancreatitis are alcohol and cholelithiasis. Acute recurrent pancreatitis can result from a variety of abnormalities involving the terminal end of the distal choledochus, pancreatic duct, ampulla of Vater and the major duodenal papilla, which in turn may include a papillary stenosis, periampullary neoplasm, choledochocele, sphincter of Oddi dysfunction, and pancreatic ductal adenocarcinoma. Recently a case of recurrent acute pancreatitis associated with aberrant cystic duet insertion at the ampulla of Vater was experienced. Biliary-pancreatic reflux was speculated to be the mechanism responsible for causing this anomalous, recurrent, acute pancreatitis. Another case of acute pancreatitis associated with aberrant cystic duct insertion at the ampulla of Vater was also experienced in a 29-year-old man, 1Jnlike the previous report, our case showed cholestatic features on the initial blood chemistry. An endoscopic retrograde cholangiopancre-atography performed after recovry revealed only aberrant cystic duct insertion at the ampulla of Vater. This anomaly also seems to have played a role in causing acute pancreatitis in this patient. This interesting case is herein reported with a review of the relevant literature. (Korean J Gastrointest Endosc 2000;20:496-498)

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대장내시경검사 시 내시경 삽입 시간에 영향을 미치는 인자 ( Factors Affecting Insertion Time during Colonoscopy ): Korean J Gastrointest Endosc 1999;19(4):567-573. Published online November 30, 1998

Abstract PDF: Background
/Aims: The goal of this study was to examine whether certain variables are associated with insertion time during colonoscopy. Methods: A total of 703 consecutive subjects underwent colonoscopy by a single endoscopist from April of 1998 to August of 1998. The insertion time during colonoscopy was checked and the factors that may affect insertion time were analyzed. Results: The indications for colonoscopy were bowel habit change (34.8%), the diagnosis of and follow up for colonic neoplastic disease (31.6%), abdominal pain (22.8%), thin stool caliber (19.2%), hematochezia (16.1%), routine examination (10.7%), inflammatory bowel disease (9.4%), tenesmus (8.8%) and a family history of colonic disease (3.1%). Of 703 subjects, complete colonoscopy was possible in 678 (96.4%). Reasons for incomplete insertion included inadequate bowel cleaning (n=11), pain (n=6), a history of operations (n=3), and others (n=5). Therefore, the adjusted completion rate was 97.9% (678/692). The mean insertion time in complete colonoscopy was 7.07 4.26 min (range; 2∼35 min). Multivariable analysis revealed that inadequacy of bowel preparation was significantly associated with prolonged (＞10 min) insertion time (p=0.005), whereas the history of colorectal resection was inversely associated with prolonged insertion time (p=0.010). Conclusions: Among the factors affecting insertion time during colonoscopy, cleanness of the bowels is the only correctable factor. (Korean J Gastrointest Endosc 19: 567∼573, 1999)

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