Clinical Endoscopy

Original Article

Effect of antithrombotic therapies on small bowel bleeding: an European multicenter retrospective study: Lucia Scaramella, Stefania Chetcuti Zammit, Reena Sidhu, Maurizio Vecchi, Gian Eugenio Tontini, Nicoletta Nandi, Matilde Topa, Luca Elli; Clin Endosc 2025;58(1):102-111. Published online December 2, 2024; DOI: https://doi.org/10.5946/ce.2024.073

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Small bowel bleeding (SBB) is the main indication for videocapsule endoscopy (VCE); the diagnostic yield (DY) could be influenced by antithrombotic therapies. We explored the effects of these therapies on SBB.
Methods
Consecutive patients from two centers (Milan, Italy and Sheffield, UK) who underwent VCE between March 2001 and July 2020 were considered. Demographic data, clinical parameters, drug therapy, and technical characteristics of the procedure were collected. VCE findings and DY were evaluated.
Results
In total, 957 patients (1,052 VCEs) underwent VCE for SBB (DY 50.6%, no retention); 27 patients (27 VCEs) received direct oral anticoagulants, 87 (88 VCEs) received other anticoagulants, 115 (135 VCEs) received antiplatelet therapy, 198 (218 VCEs) received monotherapy, and 31 (32 VCEs) received combined therapy. There were no differences in the completion rate, findings, and DYs between each subgroup or between monotherapy and combined therapy. The overt bleeding rate was similar in all groups, even when comparing antithrombotic users versus those not on therapy (p=0.59) or monotherapy versus combined therapy (p=0.34).
Conclusions
VCE is safe and has a high clinical impact on SBB. Antithrombotic therapies did not affect DY or overt bleeding rate and, consequently, can be considered safe in terms of SBB risk.

Citations

Citations to this article as recorded by

Do all antithrombotic agents have a similar impact on small bowel bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clinical Endoscopy.2025; 58(1): 80. CrossRef

727 View
92 Download
1 Crossref

Review

International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy: Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee, The Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines; Clin Endosc 2024;57(2):141-157. Published online March 14, 2024; DOI: https://doi.org/10.5946/ce.2024.002

Abstract PDF PubReader ePub

Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Citations

Citations to this article as recorded by

EUS-guided gallbladder drainage for patients with antithrombotic therapy: Intervention or medication?
Liqi Sun, Jiang Liu
Gastrointestinal Endoscopy.2025; 101(1): 226. CrossRef
Do all antithrombotic agents have a similar impact on small bowel bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clinical Endoscopy.2025; 58(1): 80. CrossRef
Prediction of immediate bleeding after cold snare polypectomy: A prospective observational study
Shin Ju Oh, Yunho Jung, Young Hwangbo, Young Sin Cho, Il Kwun Chung, Chang Kyun Lee
Medicine.2024; 103(36): e39597. CrossRef

7,828 View
473 Download
2 Web of Science
3 Crossref

Original Articles

Evaluation of Non-invasive Fibrosis Markers in Predicting Esophageal Variceal Bleeding: Sami Cifci, Nergiz Ekmen; Clin Endosc 2021;54(6):857-863. Published online May 26, 2021; DOI: https://doi.org/10.5946/ce.2021.028

Abstract PDF PubReader ePub

Background
/Aims: Esophageal variceal bleeding (EVB) is an important cause of mortality and morbidity in liver cirrhosis. In this study, we aimed to predict the possibility of EVB in patients with cirrhosis using a non-invasive score.
Methods
A total of 359 patients with cirrhosis were divided into two groups based on the presence or absence of EVB. ChildTurcotte-Pugh (CTP) score, a model for end-stage liver disease, aspartate aminotransferase to alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4-index (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio/platelet ratio index (AARPRI), and S-index were measured for all participants. Receiver operating characteristic curves were obtained for all parameters, and the optimal cut-off value was determined in predicting EVB.
Results
In patients with EVB, the number of platelets (PLT) were low (p<0.001) and APRI, AARPRI, FIB-4, and S-index were significantly higher than those in patients without EBV. APRI, AARPRI, FIB-4, PLT, and S-index were statistically significant predictors of EVB (p<0.05).
Conclusions
FIB-4 and AARPRI, which are non-invasive markers of fibrosis, can be used to predict EVB. In addition, the 66.5 10⁹/L cut-off value for PLT is important for EVB.

Citations

Citations to this article as recorded by

Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study
Jun-Yi Zhan, Jie Chen, Jin-Zhong Yu, Fei-Peng Xu, Fei-Fei Xing, De-Xin Wang, Ming-Yan Yang, Feng Xing, Jian Wang, Yong-Ping Mu
World Journal of Gastroenterology.2025;[Epub] CrossRef
Non-invasive Fibrosis Markers for Predicting Esophageal Varices: A Potential Alternative to Endoscopic Screening
Kunza Ali, Saad Slah-Ud-Din, Mishal Afzal, Mah R Tariq, Tallha Waheed, Haroon Yousuf
Cureus.2024;[Epub] CrossRef
Diagnostic accuracy of shear wave elastography versus laboratory parameters as non-invasive screening tool for esophageal varices
Khaled Mohamed Ali Shehata, Abdul-Allah Ismael Kelany, Salma Mokhtar Osman Hassan, Ramy Mohamed Ahmed, Peter Atef Mounir, Amira Hassan AbdelAziz
The Egyptian Journal of Internal Medicine.2024;[Epub] CrossRef
Assessment of nomogram model for the prediction of esophageal variceal hemorrhage in hepatitis B-induced hepatic cirrhosis
Jing Xu, Lin Tan, Ning Jiang, Fengcheng Li, Jinling Wang, Beibei Wang, Shasha Li
European Journal of Gastroenterology & Hepatology.2024; 36(6): 758. CrossRef
Predicting High-Risk Esophageal Varices in Cirrhosis: A Multi-Parameter Splenic CT Study
Cheng Yan, Chunhua Xia, Qiuting Cao, Jingwen Zhang, Mingzi Gao, Jing Han, Xiaohong Liang, Mingxin Zhang, Lin Wang, Liqin Zhao
Academic Radiology.2024; 31(12): 4866. CrossRef
Progress in Noninvasive Assessment of Esophageal Varices
Yuki Arita
Academic Radiology.2024; 31(12): 4875. CrossRef
Non-invasive predictors of the first episode of bleeding from esophageal varices in patients with liver cirrhosis awaiting transplantation
V. L. Korobka, Yu. V. Khoronko, V. D. Pasechnikov, R. V. Korobka, M. V. Malevanny, E. S. Pak, D. V. Pasechnikov
Transplantologiya. The Russian Journal of Transplantation.2024; 16(4): 507. CrossRef
Diagnosis of esophageal varices by liver stiffness and serum biomarkers in virus-related compensated advanced chronic liver disease
Amine Zoughlami, Jordana Serero, Stephen Congly, Irene Zhao, Julie Zhu, Alnoor Ramji, Curtis Cooper, Philip Wong, Robert Bailey, Carla S Coffin, Giada Sebastiani
Canadian Liver Journal.2023; 6(3): 332. CrossRef
Albumin‑bilirubin grade and INR for the prediction of esophagogastric variceal rebleeding after endoscopic treatment in cirrhosis
Fenghui Li, Tao Wang, Jing Liang, Baoxin Qian, Fei Tang, Yanying Gao, Jiayu Lv
Experimental and Therapeutic Medicine.2023;[Epub] CrossRef
Biochemical markers to predict the development of gastrointestinal bleeding and esophageal varices after portoenterostomy in biliary atresia
Wataru Sumida, Takahisa Tainaka, Chiyoe Shirota, Kazuki Yokota, Satoshi Makita, Masamune Okamoto, Aitaro Takimoto, Akihiro Yasui, Shunya Takada, Yoichi Nakagawa, Daiki Kato, Shinya Yokoyama, Yoji Ishizu, Hizuru Amano, Yaohui Guo, Akinari Hinoki, Hiroo Uch
Pediatric Surgery International.2022; 38(12): 1799. CrossRef
Liver Fibrosis Indices Predict the Severity of SARS-CoV-2 Infection
Lucilla Crudele, Fabio Novielli, Stefano Petruzzelli, Stefano Battaglia, Antonio Francesco Maria Giuliano, Rosa Melodia, Chiara Maria Morano, Paola Dell’Aquila, Renata Moretti, Luigi Castorani, Roberto Salvia, Gianfranco Inglese, Nicola Susca, Lucrezia de
Journal of Clinical Medicine.2022; 11(18): 5369. CrossRef

5,114 View
216 Download
11 Web of Science
11 Crossref

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

Citations to this article as recorded by

The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial
Konstantina Dinaki, Nikolaos Grigoriadis, Ioannis S. Vizirianakis, Jannis Constantinidis, Stefanos Triaridis, Petros Karkos
European Archives of Oto-Rhino-Laryngology.2024; 281(7): 3587. CrossRef

4,474 View
104 Download
1 Web of Science
1 Crossref

Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy: Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Akira Miyano, Daiki Fumihara, Moaz Elshair; Clin Endosc 2021;54(4):596-602. Published online February 17, 2021; DOI: https://doi.org/10.5946/ce.2020.194

Abstract PDF PubReader ePub

Background
/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy.
Methods
This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents.
Results
A total of 18 patients (8.1%) received antithrombotic agents and 202 patients (91.8%) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group.
Conclusions
The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy.

Citations

Citations to this article as recorded by

The New Potential for Using Franseen Needles in Interventional EUS
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Yoshitaro Yamamoto, Takashi Kondo
Internal Medicine.2024; 63(20): 2723. CrossRef
International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef
International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. CrossRef
Novel drill dilator facilitates endoscopic ultrasound‐guided hepaticogastrostomy
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Masanori Yamada, Toshitaka Fukui
Digestive Endoscopy.2023; 35(3): 389. CrossRef
Response
Takeshi Ogura
Gastrointestinal Endoscopy.2023; 97(6): 1171. CrossRef
Rescue technique for bleeding after placement of plastic stent in EUS–guided hepaticogastrostomy (with videos)
Akihisa Ohno, Nao Fujimori, Noboru Harada
Endoscopic Ultrasound.2023;[Epub] CrossRef
Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis
Suprabhat Giri, Babu P. Mohan, Vaneet Jearth, Aditya Kale, Sumaswi Angadi, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram
Gastrointestinal Endoscopy.2023; 98(4): 515. CrossRef
Endoscopic Ultrasound-Guided Biliary Interventions in Liver Disease
Shyam Vedantam, Sunil Amin
Clinics in Liver Disease.2022; 26(1): 101. CrossRef
B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video)
Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Daiki Fumihara, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Tsukasa Yasuda, Moaz Elshair
Endoscopic Ultrasound.2022; 11(4): 319. CrossRef
The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome
Zhengwang Liu, Xiaotang Qiu, Hua Yang, Xiaocui Wu, Wenjing Ye, Xinbing Zheng, Li Yuan
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
Clopidogrel

Reactions Weekly.2022; 1936(1): 165. CrossRef

4,802 View
128 Download
11 Web of Science
12 Crossref

Review

Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy: Hyun Lim, Eun Jeong Gong, Byung-Hoon Min, Seung Joo Kang, Cheol Min Shin, Jeong-Sik Byeon, Miyoung Choi, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun; Clin Endosc 2020;53(6):663-677. Published online November 26, 2020; DOI: https://doi.org/10.5946/ce.2020.192

Abstract PDF PubReader ePub

Antithrombotic agents, including antiplatelet agents and anticoagulants, are increasingly used in South Korea. The management of patients using antithrombotic agents and requiring gastrointestinal endoscopy is an important clinical challenge. Although clinical practice guidelines (CPGs) for the management of patients receiving antithrombotic agents and undergoing gastrointestinal endoscopy have been developed in the Unites States, Europe, and Asia Pacific region, it is uncertain whether these guidelines can be adopted in South Korea. After reviewing current CPGs, we identified unmet needs and recognized significant discrepancies in the clinical practice among regions. This is the first CPG in Korea providing information that may assist endoscopists in the management of patients on antithrombotic agents who require diagnostic or elective therapeutic endoscopy. This guideline was developed through the adaptation process as an evidence-based method, with four guidelines retrieved by systematic review. Eligible guidelines were evaluated according to the Appraisal of Guidelines for Research and Evaluation II process, and 13 statements were established using a grading system. This guideline was reviewed by external experts before an official. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Citations

Citations to this article as recorded by

Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
A systematic critical appraisal of clinical practice guidelines of antithrombotic agents in gastrointestinal endoscopy using the AGREE II tool
Denisse Camille Dayto, Wojciech Blonski, Tea Reljic, Farina Klocksieben, Jeffrey Gill, Rene D. Gomez‐Esquivel, Brijesh Patel, Pushpak Taunk, Andrew Sephien, Camille Thelin, Ambuj Kumar
Journal of Gastroenterology and Hepatology.2024; 39(5): 818. CrossRef
The Impact of Sedation on Cardio-Cerebrovascular Adverse Events after Surveillance Esophagogastroduodenoscopy in Patients with Gastric Cancer: A Nationwide Population-Based Cohort Study
Sang Yoon Kim, Jun Kyu Lee, Kwang Hyuck Lee, Jae-Young Jang, Byung-Wook Kim
Gut and Liver.2024; 18(2): 245. CrossRef
International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
Top tips on the management of antithrombotic agents in the periendoscopic period
Alberto Tringali
Gastrointestinal Endoscopy.2024; 99(6): 1021. CrossRef
IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef
Anticoagulants Are a Risk Factor for Delayed Bleeding after Colorectal Endoscopic Submucosal Dissection: A HASID Multicenter Study
Seong-Jung Kim, Jun Lee, Hyo-Yeop Song, Geom Seog Seo, Byung Chul Jin, Sang-Wook Kim, Dong Hyun Kim, Hyun-Soo Kim, Hyung-Hoon Oh, Dae-Seong Myung, Young-Eun Joo
Digestion.2024; 105(5): 389. CrossRef
Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association
Seungchul Han, Pil Soo Sung, Soo Young Park, Jin Woong Kim, Hyun Pyo Hong, Jung-Hee Yoon, Dong Jin Chung, Joon Ho Kwon, Sanghyeok Lim, Jae Hyun Kim, Seung Kak Shin, Tae Hyung Kim, Dong Ho Lee, Jong Young Choi
Korean Journal of Radiology.2024; 25(9): 773. CrossRef
Reproducibility of the AGREE II Tool for Assessing the Methodological Quality of Clinical Practice Guidelines for the Management of Antithrombotic Agents in Patients Undergoing GI Endoscopy
Denisse Camille Dayto, Wojciech Blonski, Tea Reljic, Farina Klocksieben, Jeffrey Gill, Rene D. Gomez-Esquivel, Brijesh Patel, Pushpak Taunk, Andrew Sephien, Camille Thelin, Ambuj Kumar
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association
Seungchul Han, Pil Soo Sung, Soo Young Park, Jin Woong Kim, Hyun Pyo Hong, Jung-Hee Yoon, Dong Jin Chung, Joon Ho Kwon, Sanghyeok Lim, Jae Hyun Kim, Seung Kak Shin, Tae Hyung Kim, Dong Ho Lee, Jong Young Choi
Gut and Liver.2024; 18(5): 789. CrossRef
International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. CrossRef
Local ablation for hepatocellular carcinoma: 2024 expert consensus-based practical recommendation of the Korean Liver Cancer Association
Seungchul Han, Pil Soo Sung, Soo Young Park, Jin Woong Kim, Hyun Pyo Hong, Jung-Hee Yoon, Dong Jin Chung, Joon Ho Kwon, Sanghyeok Lim, Jae Hyun Kim, Seung Kak Shin, Tae Hyung Kim, Dong Ho Lee, Jong Young Choi
Journal of Liver Cancer.2024; 24(2): 131. CrossRef
Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology – 2024
Danielle Menosi Gualandro, Luciana Savoy Fornari, Bruno Caramelli, Alexandre Antonio Cunha Abizaid, Brenno Rizerio Gomes, Caio de Assis Moura Tavares, Caio Julio Cesar dos Santos Fernandes, Carisi Anne Polanczyk, Carlos Jardim, Carolina Leticia Zilli Viei
Arquivos Brasileiros de Cardiologia.2024;[Epub] CrossRef
Diretriz de Avaliação Cardiovascular Perioperatória da Sociedade Brasileira de Cardiologia – 2024
Danielle Menosi Gualandro, Luciana Savoy Fornari, Bruno Caramelli, Alexandre Antonio Cunha Abizaid, Brenno Rizerio Gomes, Caio de Assis Moura Tavares, Caio Julio Cesar dos Santos Fernandes, Carisi Anne Polanczyk, Carlos Jardim, Carolina Leticia Zilli Viei
Arquivos Brasileiros de Cardiologia.2024;[Epub] CrossRef
Safety of cold snare resection techniques for removal of polyps in the small colon in patients taking clopidogrel and aspirin: a Korean Association for the Study of Intestinal Diseases prospective multicenter study
Tae-Geun Gweon, Hyun Gun Kim, Yunho Jung, Seong Ran Jeon, Soo-Young Na, Yoo Jin Lee, Tae Ho Kim
Gastrointestinal Endoscopy.2024;[Epub] CrossRef
Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants
Mitsushige Sugimoto, Masaki Murata, Takashi Kawai
World Journal of Gastroenterology.2023; 29(19): 2916. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Predicting the Bleeding Risk for Patients on Anticoagulant Therapy Prior to Gastric Endoscopic Submucosal Dissection
Jie-Hyun Kim
Journal of Gastric Cancer.2022; 22(1): 1. CrossRef
Utility of a deep learning model and a clinical model for predicting bleeding after endoscopic submucosal dissection in patients with early gastric cancer
Ji Eun Na, Yeong Chan Lee, Tae Jun Kim, Hyuk Lee, Hong-Hee Won, Yang Won Min, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J Kim
World Journal of Gastroenterology.2022; 28(24): 2721. CrossRef

14,933 View
1,021 Download
17 Web of Science
20 Crossref

Original Articles

Effectiveness of Autologous Platelet-Rich Plasma for the Healing of Ulcers after Endoscopic Submucosal Dissection: Eunju Jeong, In kyung Yoo, Ozlem Ozer Cakir, Hee Kyung Kim, Won Hee Kim, Sung Pyo Hong, Joo Young Cho; Clin Endosc 2019;52(5):472-478. Published online May 17, 2019; DOI: https://doi.org/10.5946/ce.2018.152

Abstract PDF PubReader ePub

Background
/Aims: Platelet-rich plasma (PRP) has been used for wound healing in various medical fields. The aim of this study was to evaluate the clinical efficacy and safety of local PRP injections after endoscopic submucosal dissection (ESD).
Methods
Patients were non-randomly divided into the following two groups: (1) control group in which patients were administered only an intravenous proton pump inhibitor (PPI), and (2) a study group in which patients were administered an intravenous PPI and a topical PRP injection. We assessed the reduction in the ulcer area and stage of the ulcer after the procedure (24 hours, 48 hours, and 28 days after endoscopic surgery).
Results
We enrolled 7 study and 7 control patients. In the study group, the rate of ulcer reduction was 59% compared to 52% in the control group (p=0.372), 28 days after ESD. There were 5 patients in the S stage and 2 patients in the H stage in the study group compared to no patient in the S stage and 7 patients in the H stage in the control group (p=0.05), 28 days after ESD. There were no serious complications in either group.
Conclusions
The local injection of PRP is a safe and effective procedure for ulcer healing after ESD.

Citations

Citations to this article as recorded by

Clinical efficacy of blood derivatives on wound healing: A systematic review and network meta‐analysis
Yanhong Wu, Guang Peng, Yuzhi Wang, Jianwu Chen, Bin Zhang, Jianbing Tang, Biao Cheng
International Wound Journal.2024;[Epub] CrossRef
Endoscopic Shielding With Platelet-rich Plasma After Resection Of Large Colorectal Lesions
Vicente Lorenzo-Zúñiga, Vicente Moreno de Vega, Ramón Bartolí
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2021; 31(3): 376. CrossRef
The Additive Effect of Platelet-Rich Plasma in the Treatment of Actively Bleeding Peptic Ulcer
Waseem M. Seleem, Amr Shaaban Hanafy
Clinical Endoscopy.2021; 54(6): 864. CrossRef
Endless Challenges in Overcoming Complications Associated with Endoscopic Submucosal Dissection
Satoshi Ono, Shun Ito, Kenji Ogata
Clinical Endoscopy.2019; 52(5): 395. CrossRef

7,415 View
158 Download
4 Web of Science
4 Crossref

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

Citations to this article as recorded by

Can Segmental Branch Embolization of the Left Gastric Artery Be an Alternative in the Treatment of Recurrent Dieulafoy Lesion Bleeding? A Case report
Gamze Sönmez, Serez İleri, Ferdi Çay, Bora Peynircioğlu, Onur Keskin
Akademik Gastroenteroloji Dergisi.2024; 23(2): 67. 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
Fatal exulceratio simplex (dieulafoy lesion) – a case report and review
Luzern Tan, John D. Gilbert, Roger W. Byard
Forensic Science, Medicine and Pathology.2024;[Epub] 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
Multiple Gastric Dieulafoy Lesions
Vikas Pemmada, Ganesh Bhat, Athish Shetty, Bharath Kumar Bhat, Megha Murali, Geetha Vasudevan
ACG Case Reports Journal.2023; 10(6): e01053. CrossRef
Retrospective analysis of patients with Dieulafoy’s lesions
Bünyamin SARITAŞ, Şehmus ÖLMEZ, Adnan TAŞ, Nevin AKÇAER ÖZTÜRK, Banu KARA
Akademik Gastroenteroloji Dergisi.2023; 22(3): 136. CrossRef
Gastrointestinal Bleeding From a Transverse Colon Dieulafoy Lesion
Xinyu Xie, Jian Qin, Xiaojua Ma, Shanshan Liu
Cureus.2023;[Epub] CrossRef
Cliniccal Analysis of 5 Cases of Upper Gastrointestinal Bleeding Caused by Duodenal Dieulafoy’s Disease
金明张
Advances in Clinical Medicine.2023; 13(10): 15268. CrossRef
Case report: The first description of a Dieulafoy's lesion in the gastric mucosa of a dog
Daniel Felipe Barrantes Murillo, Michael Tillson, Jennifer W. Koehler, Maninder Sandey
Frontiers in Veterinary Science.2022;[Epub] CrossRef
Diagnosis and Treatment of a Recurrent Bleeding Dieulafoy’s Lesion: A Case Report
Amanda R Levy, Sierra Broad, James R Loomis III, Julie A Thomas
Cureus.2022;[Epub] CrossRef
Dieulafoy lesions as cause of upper gastrointestinal bleeding in a patient with portal hypertension
Fahad Malik, Omar Al Salman, Marwah Alchalabi, Shobhana Chaudhari, Ali Tariq Khan
Journal of Community Hospital Internal Medicine Perspectives.2021; 11(1): 94. CrossRef
Jejunal Dieulafoy’s Lesion: A Systematic Review of Evaluation, Diagnosis, and Management
Adnan Malik, Faisal Inayat, Muhammad Hassan Naeem Goraya, Talal Almas, Rizwan Ishtiaq, Sohira Malik, Zahid Ijaz Tarar
Journal of Investigative Medicine High Impact Case Reports.2021;[Epub] CrossRef
Dieulafoy Lesion as a Source of Bleeding: A Report of Two Clinical Cases
Goran Sarafiloski, Mimi R. Marinova, Pencho T. Tonchev
Journal of Biomedical and Clinical Research.2021; 14(2): 186. CrossRef
Incidental massive lower gastrointestinal hemorrhage caused by a rectal Dieulafoy’s lesion
Genesis Perez Del Nogal, Rangesh Modi, Ivania Salinas, Kalyan Chakrala
BMJ Case Reports.2021; 14(9): e244264. CrossRef
Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms
Flavius F. Guglielmo, Michael L. Wells, David H. Bruining, Lisa L. Strate, Álvaro Huete, Avneesh Gupta, Jorge A. Soto, Brian C. Allen, Mark A. Anderson, Olga R. Brook, Michael S. Gee, David J. Grand, Martin L. Gunn, Ashish Khandelwal, Seong Ho Park, Vijay
RadioGraphics.2021; 41(6): 1632. CrossRef
A case of the lower gastrointestinal bleeding due to Dieulafoy’s ulcer in the cecum
Keisuke Kinoshita, Osamu Matsunari, Akira Sonoda, Kensuke Fukuda, Kazuhisa Okamoto, Ryo Ogawa, Kazuhiro Mizukami, Tadayoshi Okimoto, Masaaki Kodama, Kazunari Murakami
Clinical Journal of Gastroenterology.2020; 13(4): 564. CrossRef
Dieulafoy's Lesion: Decade-Long Trends in Hospitalizations, Demographic Disparity, and Outcomes
Raja Chandra Chakinala, Shantanu Solanki, Khwaja F Haq, Jagmeet Singh, Harshil Shah, Dhanshree Solanki, Asim Kichloo, Khwaja S Haq, Azam H Burney, Shanza Waqar, Manasee Vyas, Savneek Chugh, Christopher Nabors
Cureus.2020;[Epub] CrossRef
Lesión de Dieulafoy rectal: una causa rara, pero potencialmente mortal de hemorragia del tubo digestivo bajo
Benjamín Gallo Arriaga, José Raúl Nieto Saucedo, Benjamín Gallo Chico, J Jesús Ibarra Rodríguez, Karla Edith Santibáñez Bedolla, Carlos Hidalgo Valadez
Acta Médica Grupo Ángeles.2020; 18(3): 302. CrossRef
Gastric vascular abnormalities: diagnosis and management
Mohanad Awadalla, Mohamed Mahmoud, Philip McNamara, Wahid Wassef
Current Opinion in Gastroenterology.2020; 36(6): 538. CrossRef
Dieulafoy Lesion: Predictive Factors of Early Relapse and Long-Term Follow-Up
Paulo Massinha, Inês Cunha, Luís Tomé
GE - Portuguese Journal of Gastroenterology.2020; 27(4): 237. CrossRef
Lesión de Dieulafoy en estómago como causa de sangrado gastrointestinal alto: presentación de un caso
Jairo Alonso Sierra-Avendaño, Fabián Andrés Mejía-Casadiegos, María Paula Pérez-Barón, Gabriel Eduardo Pérez-García
Revista Médicas UIS.2019; 32(1): 27. CrossRef
Massive Gastrointestinal Bleeding from a Jejunal Dieulafoy Lesion: An Extraordinary Presentation
Majdi Saada, Shay Perek, Mohammad Agbaria, Ayelet Raz-Pasteur
Case Reports in Gastroenterology.2019; 13(3): 508. CrossRef
Postural Syncope and Constipation: An Unusual Presentation of a Duodenal Dieulafoy’s Lesion
Ahmed Dirweesh, Alvarez Chikezie, Muhammad Yasir Khan, Sana Zia, Muhammad Tahir
Case Reports in Gastrointestinal Medicine.2017; 2017: 1. CrossRef

9,158 View
99 Download
24 Web of Science
23 Crossref

Biliary-Pancreatic Endoscopic and Surgical Procedures in Patients under Dual Antiplatelet Therapy: A Single-Center Study: Ahmed Abdel Samie, Michael Stumpf, Rui Sun, Lorenz Theilmann; Clin Endosc 2013;46(4):395-398. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.395

Abstract PDF PubReader ePub

Background/Aims

Dual antiplatelet therapy has to be used for at least 1 month after placement of bare metal coronary stents and for a minimum of 1 year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines strongly recommend to delay elective surgery until dual antiplatelet therapy is ended. However, no data are available regarding the bleeding risk in patients on combined aspirin/clopidogrel therapy undergoing surgical or high-risk endoscopic procedures.

Methods

We retrospectively analyzed the medical reports of patients on dual antiplatelet therapy, the patients who had to undergo emergency biliary-pancreatic surgery or endoscopic retrograde cholangiography with endoscopic sphincterotomy while in our unit between January 2009 and July 2012.

Results

In our series, biliary-pancreatic surgical and endoscopic procedures were safely performed in 11 consecutive patients on dual antiplatelet therapy with no evidence of bleeding.

Conclusions

In emergency, surgical and high risk endoscopic procedures may be performed in patients on dual antiplatelet therapy.

Citations

Citations to this article as recorded by

Risk of post-sphincterotomy bleeding with antiplatelet and anticoagulant use: a propensity-matched analysis of the U.S. Collaborative Network
Saurabh Chandan, Aakash Desai, Dushyant S. Dahiya, Daryl Ramai, Babu P. Mohan, Antonio Facciorusso, Douglas G. Adler, Gursimran S. Kochhar
Gastrointestinal Endoscopy.2023; 97(6): 1129. CrossRef
No Significant Difference in Post-ERCP Bleeding Rates Between Dual Antiplatelet Agents and Aspirin Alone
Abhishek Bhurwal, Hemant Mutneja, Akshay Goel, Vikas Bansal, Anish Patel, Bhaumik Brahmbhatt, Avik Sarkar
Journal of Clinical Gastroenterology.2022; 56(6): 546. CrossRef
Effects of antithrombotic therapy on bleeding after endoscopic sphincterotomy: A systematic review and meta-analysis
Gang Huang, Feng-Yu Tian, Wen An, Li-Si Ai, Yan-Bo Yu
Endoscopy International Open.2022; 10(06): E865. CrossRef
Pharmacologic venous thromboembolism prophylaxis is not associated with post sphincterotomy bleeding after endoscopic retrograde cholangiopancreatography
Timothy Krill, Dongming Li, Akhil Sood, Michelle Baliss, Robinder Abrol, Jenine Zaibaq, Sreeram Parupudi
Digestive and Liver Disease.2021; 53(6): 766. CrossRef
American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal
Robert Goggs, Marie‐Claude Blais, Benjamin M. Brainard, Daniel L. Chan, Armelle M. deLaforcade, Elizabeth Rozanski, Claire R. Sharp
Journal of Veterinary Emergency and Critical Care.2019; 29(1): 12. CrossRef
Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 5—Discontinuation of anticoagulant therapy in small animals
Benjamin M. Brainard, Yekaterina Buriko, Jennifer Good, Alan G. Ralph, Elizabeth A. Rozanski
Journal of Veterinary Emergency and Critical Care.2019; 29(1): 88. CrossRef
Does Rectal Indomethacin Given for Prevention of Post-ERCP Pancreatitis Increase Bleeding After Biliary Endoscopic Sphincterotomy or Cardiovascular Mortality?
Árpád Patai, Norbert Solymosi, Árpád V. Patai
Medicine.2014; 93(26): e159. CrossRef
A Single Institution's Experience of Infundibulotomy in Patients Taking Antiplatelet Agents: Outcomes, Safety and Complications
Dong Hoon Baek, Geun Am Song, Dong Uk Kim, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon, Joon Hyung Jhi, Jung Ho Bae, Hyun Jeong Lee
The Korean Journal of Gastroenterology.2014; 63(4): 216. CrossRef
Continue or Discontinue Dual Antiplatelet Therapy in Major Surgical or Endoscopic Procedures
Young Koog Cheon
Clinical Endoscopy.2013; 46(4): 315. CrossRef
Perioperative management of antiplatelet therapy
A.D. Oprea, W.M. Popescu
British Journal of Anaesthesia.2013; 111: i3. CrossRef

5,925 View
54 Download
10 Crossref

Case Report

Spontaneous Intramural Hematoma of the Sigmoid Colon Caused by Anti-platelet Agents: Gwang Il Kim, M.D., Yong Seok Kim, M.D., Jung Kyung Yang, M.D., Hoon Sup Koo, M.D., Sun Moon Kim, M.D., Tae Hee Lee, M.D., Euyi Hyeog Im, M.D. and Kyu Chan Huh, M.D.; Korean J Gastrointest Endosc 2011;42(6):397-400. Published online June 4, 2011

Abstract PDF: A 71-year-old man presented at the emergency department with an acute onset of hematochezia and abdominal pain that had developed 1 day previously. He had no history of surgery and was taking aspirin (100 mg) and clopidogrel (75 mg). CT revealed a short segmental concentric lower density bowel wall thickening at the proximal sigmoid colon. Sigmoidoscopy showed blue-colored elevated lesions and ruptured intramural hematomas with submucosal bleeding in the sigmoid colon. These findings correspond to intramural hematomas of the sigmoid colon. His symptoms were reduced with conservative treatment stopping aspirin and clopidogrel for 20 days. Here we report a case of non-traumatic intramural hematoma of the colon in a patient receiving dual antiplatelet agents. This had never been reported.

1,973 View
11 Download

Prophylactic Antibiotics, Anticoagulants and Antiplatelets for GI Endoscopy: Seon Mee Park, M.D.; Korean J Gastrointest Endosc 2010;40(4):221-228. Published online April 30, 2010

Abstract PDF: This review provides general recommendations, based on the literature, on antibiotic prophylaxis, anticoagulants and antiplatelets for GI endoscopy. Antibiotic prophylaxis is recommended for patients at high risk of infection - ERCP with incomplete drainage, ERCP with sterile pancreatic fluid collection (which communicates with the pancreatic duct), pancreatic pseudocyst drainage, EUS-FNA of cystic lesions, percutaneous endoscopic feeding tube placement and cirrhosis with acute GI bleeding. Prophylactic antibiotics are no longer recommended for GI endoscopy to prevent infectious endocarditis. To decide how to manage anticoagulants and antiplatelets during endoscopic procedures, the risk of an adverse ischemic event or a thromboembolic complication and the risk of bleeding must be weighed. For a low-risk procedure, no adjustments in anticoagulation and antiplatelets need to be made. For a high risk procedure, it is recommended to discontinue warfarin 3 to 5 days before the procedure and clopidogrel 7 to 10 days before. Low molecular weight heparin may be used as a bridge before endoscopy in patients with a high risk of a thromboembolism. In the absence of a pre-existing bleeding disorder, endoscopic procedures may be done in patients taking aspirin or other NSAIDs. Further controlled clinical studies are needed to clarify aspects of these recommendations. (Korean J Gastrointest Endosc 2010;40:221-228)

2,135 View
44 Download

First
Prev
Page of 1
Next
Last

Search