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Original Article
Prevalence and natural course of incidental gastric subepithelial tumors
Dae-Hyuk Heo, Min A Yang, Jae Sun Song, Won Dong Lee, Jin Woong Cho
Received May 4, 2023  Accepted July 16, 2023  Published online March 29, 2024  
DOI: https://doi.org/10.5946/ce.2023.124    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Gastric subepithelial tumors (SETs) are often encountered during the upper gastrointestinal endoscopic screening. We assessed the prevalence of gastric SETs and the risk factors for their progression.
Methods
We reviewed the electronic medical records of 30,754 patients who underwent upper gastrointestinal endoscopic screening at our medical center between January 2013 and December 2016.
Results
Among the 30,754 patients examined, 599 (1.94%) had gastric SETs. The prevalence increased with age and was 9.56% in patients aged ≥70 years. In total, 262 patients underwent serial endoscopy for more than 6 months. The median age was 68 years (interquartile range [IQR], 61–74), and the number of females was 167 (63.7%). During a median follow-up of 58 months (IQR, 38–75), 22 patients (8.4%) showed significant changes in tumor size. An irregular border (odds ratio, 4.623; 95% confidence interval, 1.093–19.558; p=0.037) was a significant risk factor for progression. Seven patients underwent surgical or endoscopic resections. The pathologies of gastric SETs included leiomyomas (n=3), gastrointestinal stromal tumors (n=2), and lipomas (n=2).
Conclusions
The prevalence of gastric SETs increases with age. Most gastric SETs do not progress during long-term endoscopic examinations, and the risk of an increase in size is low in asymptomatic small SETs without irregular borders.

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  • Artificial Intelligence-Based Diagnosis of Gastric Mesenchymal Tumors Using Digital Endosonography Image Analysis
    Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
    Journal of Clinical Medicine.2024; 13(13): 3725.     CrossRef
  • 1,723 View
  • 72 Download
  • 1 Crossref
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Review
Application of artificial intelligence for diagnosis of early gastric cancer based on magnifying endoscopy with narrow-band imaging
Yusuke Horiuchi, Toshiaki Hirasawa, Junko Fujisaki
Clin Endosc 2024;57(1):11-17.   Published online January 5, 2024
DOI: https://doi.org/10.5946/ce.2023.173
AbstractAbstract PDFPubReaderePub
Although magnifying endoscopy with narrow-band imaging is the standard diagnostic test for gastric cancer, diagnosing gastric cancer using this technology requires considerable skill. Artificial intelligence has superior image recognition, and its usefulness in endoscopic image diagnosis has been reported in many cases. The diagnostic performance (accuracy, sensitivity, and specificity) of artificial intelligence using magnifying endoscopy with narrow band still images and videos for gastric cancer was higher than that of expert endoscopists, suggesting the usefulness of artificial intelligence in diagnosing gastric cancer. Histological diagnosis of gastric cancer using artificial intelligence is also promising. However, previous studies on the use of artificial intelligence to diagnose gastric cancer were small-scale; thus, large-scale studies are necessary to examine whether a high diagnostic performance can be achieved. In addition, the diagnosis of gastric cancer using artificial intelligence has not yet become widespread in clinical practice, and further research is necessary. Therefore, in the future, artificial intelligence must be further developed as an instrument, and its diagnostic performance is expected to improve with the accumulation of numerous cases nationwide.

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Citations to this article as recorded by  
  • Pitfalls in Endoscopic Submucosal Dissection for Early Gastric Cancer with Papillary Adenocarcinoma
    Gwang Ha Kim
    Gut and Liver.2024; 18(3): 368.     CrossRef
  • 2,646 View
  • 198 Download
  • 1 Web of Science
  • 1 Crossref
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Original Article
Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake
Rino Hasegawa, Kenshi Yao, Takao Kanemitsu, Hisatomi Arima, Takayuki Hirase, Yuuya Hiratsuka, Kazuhiro Takeda, Kentaro Imamura, Kensei Ohtsu, Yoichiro Ono, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ohta, Satoshi Nimura
Clin Endosc 2024;57(1):65-72.   Published online May 9, 2023
DOI: https://doi.org/10.5946/ce.2022.257
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL.
Methods
The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake.
Results
In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2).
Conclusions
Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

Citations

Citations to this article as recorded by  
  • Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy
    Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Hiroaki Nomoto, Hirotsugu Sakamoto, Yoshikazu Hayashi, Tomonori Yano, Edward J. Despott, Hironori Yamamoto
    DEN Open.2025;[Epub]     CrossRef
  • Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
    Gwang Ha Kim
    Clinical Endoscopy.2024; 57(1): 51.     CrossRef
  • Drug-induced mucosal alterations observed during esophagogastroduodenoscopy
    Masaya Iwamuro, Seiji Kawano, Motoyuki Otsuka
    World Journal of Gastroenterology.2024; 30(16): 2220.     CrossRef
  • 2,573 View
  • 193 Download
  • 2 Web of Science
  • 3 Crossref
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Systematic Review and Meta-Analysis
Endoscopic diagnosis of gastric metastases from malignant melanoma: systematic review
Helena Campoli Reggiani, Ana Clara Aguiar Pongeluppi, Vitória Froes Miraglia Martins Ferreira, Isadora Pinheiro Felix, Paulo Moacir de Oliveira Campoli
Clin Endosc 2022;55(4):507-515.   Published online June 28, 2022
DOI: https://doi.org/10.5946/ce.2022.035
AbstractAbstract PDFPubReaderePub
Background
/Aims: Metastases of malignant melanoma (MM) are rare and associated with poor prognosis. The objective of this study was to analyze the clinical and endoscopic characteristics of gastric metastases of MM by systematically reviewing cases and case series involving patients diagnosed using upper gastrointestinal endoscopy.
Methods
The PubMed and LILACS databases were searched. Reports containing individual patient data were included. Outcomes such as clinical data, endoscopic findings, treatments, and survival were analyzed.
Results
A total of 88 studies with individual data from 113 patients with gastric metastases of MM were included. The primary sites of MM were the skin (62%), eyes (10%), and mucous membranes (6%). Most patients (56%) had multiple metastases in the stomach, located predominantly in the gastric body (approximately 80%). The overall survival rate at 2 years was 4%. There was a significant reduction in the survival of patients with multiple gastric metastases compared to that of patients with single metastasis (hazard ratio, 0.459; 95% confidence interval, 0.235−0.895; p=0.022).
Conclusions
Gastric metastases of MM have a poor prognosis, especially in patients with multiple implants in the stomach. Additional studies are needed to verify whether ocular and mucosal melanomas are associated with a higher risk of gastric metastases than that of cutaneous melanomas.

Citations

Citations to this article as recorded by  
  • A Rare Case of Gastric Metastasis from a Rare Case of Mucosal Malignant Melanoma
    Zaim Gashi, Astrit Hamza, Blerina Ukimeri, Valon Hamza, Marigona Zubaku-Rakovic
    Open Access Macedonian Journal of Medical Sciences.2024; 12(2): 362.     CrossRef
  • Case report: Malignant melanoma of the lower limb with gastric metastasis
    Qiang Hu, Fengru Zhou, Yuanshui Sun
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • 2,491 View
  • 176 Download
  • 1 Web of Science
  • 2 Crossref
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Original Articles
Underestimation of endoscopic size in large gastric epithelial neoplasms
Jae Sun Song, Byung Sun Kim, Min A Yang, Young Jae Lee, Gum Mo Jung, Ji Woong Kim, Jin Woong Cho
Clin Endosc 2022;55(6):760-766.   Published online May 19, 2022
DOI: https://doi.org/10.5946/ce.2021.269
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcinomas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoing ESD. This study elucidates the factors affecting size discrepancy after formalin fixation.
Methods
The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location, gross shape, histology, and size after fixation in formalin were collected.
Results
The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm postfixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm, p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation (p<0.05).
Conclusions
The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, increased attention must be paid during ESD to avoid instances of incomplete resection.
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Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study
Sun Moon Kim, Eun Young Kim, Jin Woong Cho, Seong Woo Jeon, Ji Hyun Kim, Tae Hyeon Kim, Jeong Seop Moon, Jin-Oh Kim, the Research Group for Endoscopic Ultrasound of the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(6):872-880.   Published online November 18, 2021
DOI: https://doi.org/10.5946/ce.2021.251
AbstractAbstract PDFPubReaderePub
Background
/Aims: The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.
Methods
We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.
Results
Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.
Conclusions
The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.

Citations

Citations to this article as recorded by  
  • Results of the interim analysis of a prospective, multicenter, observational study of small subepithelial lesions in the stomach
    Masaya Iwamuro, Toshiharu Mitsuhashi, Tomoki Inaba, Kazuhiro Matsueda, Teruya Nagahara, Yoji Takeuchi, Hisashi Doyama, Masakatsu Mizuno, Tomoyuki Yada, Yoshinari Kawai, Jun Nakamura, Minoru Matsubara, Hiroko Nebiki, Keiko Niimi, Tatsuya Toyokawa, Ryuta Ta
    Digestive Endoscopy.2024; 36(3): 323.     CrossRef
  • Diagnostic Endoscopic Ultrasound (EUS) of the Luminal Gastrointestinal Tract
    Giovanna Impellizzeri, Giulio Donato, Claudio De Angelis, Nico Pagano
    Diagnostics.2024; 14(10): 996.     CrossRef
  • Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours
    Socrate Pallio, Stefano Francesco Crinò, Marcello Maida, Emanuele Sinagra, Vincenzo Francesco Tripodi, Antonio Facciorusso, Andrew Ofosu, Maria Cristina Conti Bellocchi, Endrit Shahini, Giuseppinella Melita
    Cancers.2023; 15(4): 1285.     CrossRef
  • Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis
    Rômulo Sérgio Araújo Gomes, Guilherme Henrique Peixoto de Oliveira, Diogo Turiani Hourneaux de Moura, Ana Paula Samy Tanaka Kotinda, Carolina Ogawa Matsubayashi, Bruno Salomão Hirsch, Matheus Oliveira Veras, João Guilherme Ribeiro Jordão Sasso, Roberto Pa
    World Journal of Gastrointestinal Endoscopy.2023; 15(8): 528.     CrossRef
  • Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
    Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
    Clinical Endoscopy.2023; 56(6): 744.     CrossRef
  • Significance of Ultrasound Endoscopy in the Differential Diagnosis of Cardiac Leiomyomas and Gastrointestinal Stromal Tumors
    燊 苏
    Advances in Clinical Medicine.2023; 13(11): 17185.     CrossRef
  • The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
    Masanari Sekine, Takeharu Asano, Hirosato Mashima
    Diagnostics.2022; 12(4): 810.     CrossRef
  • Diagnostic accuracy of endoscopic ultrasound with artificial intelligence for gastrointestinal stromal tumors: A meta‐analysis
    Xiao Hua Ye, Lin Lin Zhao, Lei Wang
    Journal of Digestive Diseases.2022; 23(5-6): 253.     CrossRef
  • 4,007 View
  • 164 Download
  • 5 Web of Science
  • 8 Crossref
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Focused Review Series: Image-Enhanced Endoscopy: Update on Clinical Practice
Application of Current Image-Enhanced Endoscopy in Gastric Diseases
Wansik Lee
Clin Endosc 2021;54(4):477-487.   Published online July 28, 2021
DOI: https://doi.org/10.5946/ce.2021.160
AbstractAbstract PDFPubReaderePub
Image-enhanced endoscopy (IEE) plays an integral role in endoscopic diagnosis and treatment. IEE enables an early and accurate detection of cancer and characterization of lesions prior to therapeutic decisions. Ideal IEE can serve as an optical or digital chromoscopic endoscopy, as well as an optical biopsy that predicts exact histopathology. Several IEE modalities have recently been developed and are used in the clinical field. The stomach is a challenging organ for imaging because of its complex secretion function and status of Helicobacter pylori infection. Therefore, understanding the current IEE modalities for their clinical applicability in an evidence-based approach is warranted. Along with technology refinements, the new paradigm will be available for the diagnosis of gastric cancer or other conditions in the stomach in the near future.

Citations

Citations to this article as recorded by  
  • The Diagnostic Performance of Linked Color Imaging Compared to White Light Imaging in Endoscopic Diagnosis of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis
    Jae Gon Lee, In Kyung Yoo, Abdullah Ozgur Yeniova, Sang Pyo Lee
    Gut and Liver.2024; 18(3): 444.     CrossRef
  • Magnifying Endoscopy with Narrow-Band Imaging for Duodenal Neuroendocrine Tumors
    Gwang Ha Kim, Kiyoun Yi, Dong Chan Joo, Moon Won Lee, Hye Kyung Jeon, Bong Eun Lee
    Journal of Clinical Medicine.2023; 12(9): 3106.     CrossRef
  • Endoscopic Resection for Gastric Adenocarcinoma of the Fundic Gland Type: A Case Series
    Hwa Jin Lee, Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
    The Korean Journal of Gastroenterology.2023; 81(6): 259.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • Role of linked color imaging for upper gastrointestinal disease: present and future
    Sang Pyo Lee
    Clinical Endoscopy.2023; 56(5): 546.     CrossRef
  • Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
    Gwang Ha Kim
    World Journal of Gastroenterology.2023; 29(43): 5800.     CrossRef
  • Quality indicators in esophagogastroduodenoscopy
    Sang Yoon Kim, Jae Myung Park
    Clinical Endoscopy.2022; 55(3): 319.     CrossRef
  • Endoscopic treatment for early gastric cancer
    Ji Yong Ahn
    Journal of the Korean Medical Association.2022; 65(5): 276.     CrossRef
  • Endoscopic diagnosis of early gastric cancer
    Dong Chan Joo, Gwang Ha Kim
    Journal of the Korean Medical Association.2022; 65(5): 267.     CrossRef
  • Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis
    Hee Seok Moon
    Journal of the Korean Medical Association.2022; 65(5): 259.     CrossRef
  • Current status of the gastric cancer screening program in Korea
    Young-Il Kim, Il Ju Choi
    Journal of the Korean Medical Association.2022; 65(5): 250.     CrossRef
  • Paneth Cell Carcinoma of the Stomach
    Jun Wan Kim, Gwang Ha Kim, Kyung Bin Kim
    The Korean Journal of Gastroenterology.2022; 80(1): 34.     CrossRef
  • Current Evidence for a Paradigm Shift in Gastric Cancer Prevention From Endoscopic Screening toHelicobacter pyloriEradication in Korea
    Young-Il Kim, Il Ju Choi
    Journal of Gastric Cancer.2022; 22(3): 169.     CrossRef
  • 4,546 View
  • 199 Download
  • 14 Web of Science
  • 13 Crossref
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Case Report
Successful Endoscopic Resection of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Unresponsive to Helicobacter pylori Eradication Therapy
Jeongmin Choi
Clin Endosc 2022;55(1):136-140.   Published online November 16, 2020
DOI: https://doi.org/10.5946/ce.2020.232
AbstractAbstract PDFPubReaderePub
Eradication of Helicobacter pylori is the first-line treatment for gastric mucosa-associated lymphoid tissue (MALT) lymphomas; however, lesions may persist in 20% of patients after initial treatment, thereby necessitating the use of an additional therapeutic approach. Other treatment options include radiation therapy, chemotherapy, endoscopic resection, rituximab therapy, or watchful waiting. We present a case of localized gastric MALT lymphoma that did not respond to H. pylori eradication therapy. The patient waited for 12 months but the tumor showed no signs of regression endoscopically. Histologic examination revealed residual MALT lymphoma. The tumor was then successfully treated using endoscopic submucosal dissection and the patient remained disease-free for 4 years. To our knowledge, this is the first case in which a gastric MALT lymphoma was treated with endoscopic submucosal dissection. In conclusion, endoscopic resection may be recommended as second-line therapy for properly selected patients with gastric MALT lymphoma as it is effective and minimally invasive.

Citations

Citations to this article as recorded by  
  • A Common Symptom With an Uncommon Diagnosis: A Case of Primary Esophageal Diffuse Large B-cell Lymphoma
    Shruthi Narasimha, Rasiq Zackria, Jonathan Hughes, Vijay Jayaraman
    Cureus.2024;[Epub]     CrossRef
  • A Case of Esophageal MALT Lymphoma Mimicking a Subepithelial Tumor
    Ha Eun Lee, Gwang Ha Kim, Min Ji Kim, Kyung Bin Kim, Dong Chan Joo, Hye Kyung Jeon, Moon Won Lee, Bong Eun Lee
    The Korean Journal of Gastroenterology.2024; 83(4): 157.     CrossRef
  • Clinical Management of Patients with Gastric MALT Lymphoma: A Gastroenterologist’s Point of View
    Tamara Matysiak-Budnik, Kateryna Priadko, Céline Bossard, Nicolas Chapelle, Agnès Ruskoné-Fourmestraux
    Cancers.2023; 15(15): 3811.     CrossRef
  • Endoscopic Submucosal Dissection for Treatment of Localized Gastric Mucosa-associated Lymphoid Tissue Lymphoma: A Case Series
    Jun-young Seo, Kee Don Choi, In Hye Song, Young Soo Park, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(3): 188.     CrossRef
  • Bacteria-Mediated Oncogenesis and the Underlying Molecular Intricacies: What We Know So Far
    Shashanka K. Prasad, Smitha Bhat, Dharini Shashank, Akshatha C. R., Sindhu R., Pornchai Rachtanapun, Devananda Devegowda, Prasanna K. Santhekadur, Sarana Rose Sommano
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • Primary Esophageal Lymphoma: Clinical Experience in Diagnosis and Treatment
    Junchi Qu, Yanyan Zhuang, Dandan Zheng, Fengting Huang, Shineng Zhang
    Cureus.2021;[Epub]     CrossRef
  • 4,452 View
  • 210 Download
  • 5 Web of Science
  • 6 Crossref
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Original Articles
Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy
Kazuya Inoki, Seiichiro Abe, Yusaku Tanaka, Koji Yamamoto, Daisuke Hihara, Ryoji Ichijima, Yukihiro Nakatani, HsinYu Chen, Hiroyuki Takamaru, Masau Sekiguchi, Masayoshi Yamada, Taku Sakamoto, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Takahisa Matsuda, Yutaka Saito
Clin Endosc 2021;54(3):363-370.   Published online September 8, 2020
DOI: https://doi.org/10.5946/ce.2020.058
AbstractAbstract PDFPubReaderePub
Background
/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE.
Methods
Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in the study. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination of the optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by three endoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were not deemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated.
Results
A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to 0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLE with IV fluorescein at 0.5 mg/kg.
Conclusions
In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both the upper and lower GI tract.

Citations

Citations to this article as recorded by  
  • Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy
    Francesco Vito Mandarino, Silvio Danese, Toshio Uraoka, Adolfo Parra‐Blanco, Yasuharu Maeda, Yutaka Saito, Shin‐Ei Kudo, Michael J. Bourke, Marietta Iacucci
    Digestive Endoscopy.2024;[Epub]     CrossRef
  • 4,873 View
  • 105 Download
  • 1 Web of Science
  • 1 Crossref
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Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs
Hiroya Sakaguchi, Toshitatsu Takao, Yoshitaka Takegawa, Yuki Koga, Kazunori Yamanaka, Masataka Sagata, Shinwa Tanaka, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
Clin Endosc 2021;54(1):64-72.   Published online July 16, 2020
DOI: https://doi.org/10.5946/ce.2020.014
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods
PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results
With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions
The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.

Citations

Citations to this article as recorded by  
  • Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases
    Kai Korekawa, Atsushi Kunimitsu
    Clinical Journal of Gastroenterology.2024;[Epub]     CrossRef
  • Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy
    Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama
    Clinical Endoscopy.2022; 55(1): 86.     CrossRef
  • The importance of pH adjustment for preventing fibrin glue dissolution in the stomach: an in vitro study
    Yoshitaka Takegawa, Toshitatsu Takao, Hiroya Sakaguchi, Tatsuya Nakai, Kazuhiro Takeo, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
    Scientific Reports.2022;[Epub]     CrossRef
  • A Novel Self-Assembled Gel for Gastric Endoscopic Submucosal Dissection-Induced Ulcer: A Preclinical Study in a Porcine Model
    Meng Li, Haifeng Jin, Changpei Shi, Bin Lyu, Xiao Ying, Yuan Shi
    Frontiers in Pharmacology.2021;[Epub]     CrossRef
  • 4,997 View
  • 119 Download
  • 5 Web of Science
  • 4 Crossref
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Review
Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis
Moon Won Lee, Gwang Ha Kim
Clin Endosc 2021;54(3):324-328.   Published online June 18, 2020
DOI: https://doi.org/10.5946/ce.2020.061
AbstractAbstract PDFPubReaderePub
Gastric mesenchymal tumors (GMTs) are incidentally discovered in national gastric screening programs in Korea. Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. The differentiation of gastrointestinal stromal tumors from benign mesenchymal tumors, such as schwannomas or leiomyomas, is important to ensure appropriate clinical management. However, this is difficult and operator dependent because of the subjective interpretation of EUS images. Digital image analysis computes the distribution and spatial variation of pixels using texture analysis to extract useful data, enabling the objective analysis of EUS images and decreasing interobserver and intraobserver agreement in EUS image interpretation. This review aimed to summarize the usefulness and future of digital EUS image analysis for GMTs based on published reports and our experience.

Citations

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  • Schwannoma gástrico. Reporte de un caso
    Darío Montes N, Nixon Cevallos R, Rubén Montes N
    Oncología (Ecuador).2024; 34(1): 52.     CrossRef
  • Artificial Intelligence-Based Diagnosis of Gastric Mesenchymal Tumors Using Digital Endosonography Image Analysis
    Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
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Focused Review Series: Recent Update of Endoscopic Ultrasonography in Gastrointestinal Subepithelial Tumors
Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial Tumors
Gyu Young Pih, Do Hoon Kim
Clin Endosc 2019;52(4):314-320.   Published online July 30, 2019
DOI: https://doi.org/10.5946/ce.2019.100
AbstractAbstract PDFPubReaderePub
The incidence of asymptomatic and incidentally found upper gastrointestinal subepithelial tumors (SETs) is increasing with the implementation of national cancer screening and the development of high-resolution endoscopy in Korea. However, endoscopy alone cannot be used to determine whether SETs are benign or malignant. Endoscopic ultrasound (EUS) is used to further characterize these lesions through the examination of their layered structure, internal echogenicity, size, and relationship to the extramural structure. These provide additional information on whether the lesion is benign or malignant. Nevertheless, the sensitivity and specificity of EUS alone in predicting malignancy is unsatisfactory. Recent guidelines have recommended deciding the timing of EUS-fine needle aspiration and biopsy (EUS-FNA/B) for SETs based on tumor size, malignant features on endoscopy, and high-risk features on EUS. The diagnostic accuracy of EUS-FNA/B is reportedly influenced by factors including needle size, number of needle passes, use of suction, use of a stylet in the needle assembly, fanning technique, availability of an on-site cytopathologist, and experience of the endosonographer. Therefore, according to the characteristics of the SETs, various subsequent methods and techniques should be appropriately employed to improve the diagnostic yield of EUS-FNA/B.

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Focused Review Series: Endoscopic Submucosal Dissection for Undifferentiated-Type Early Gastric Cancer
Strategy for Curative Endoscopic Resection of Undifferentiated-Type Early Gastric Cancer
Jie-Hyun Kim
Clin Endosc 2019;52(1):9-14.   Published online January 24, 2019
DOI: https://doi.org/10.5946/ce.2018.199
AbstractAbstract PDFPubReaderePub
Endoscopic resection (ER) of undifferentiated-type early gastric cancer (UD-EGC) has a lower curative resection (CR) rate than differentiated-type EGC. However, if UD-EGC is curatively resected using ER, long-term outcomes can be favorable. Thus, the strategy for CR by ER is important in UD-EGC. To achieve CR in UD-EGC, biological behaviors including tumor growth patterns must be considered. This review aims to describe what is important for curative ER of UD-EGC.

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Original Article
Magnified Endoscopic Findings of Multiple White Flat Lesions: A New Subtype of Gastric Hyperplastic Polyps in the Stomach
Rino Hasegawa, Kenshi Yao, Shoutomi Ihara, Masaki Miyaoka, Takao Kanemitsu, Kenta Chuman, Go Ikezono, Akikazu Hirano, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ota, Seiji Haraoka, Akinori Iwashita
Clin Endosc 2018;51(6):558-562.   Published online November 21, 2018
DOI: https://doi.org/10.5946/ce.2018.104
AbstractAbstract PDFPubReaderePub
Background
/Aims: While the occurrence of multiple whitish flat elevated lesions (MWFL) was first reported in 2007, no studies on MWFL have been published to date. The present retrospective observational study aimed to clarify the endoscopic findings and clinicopathological features of MWFL.
Methods
Subjects were consecutive patients who underwent upper gastrointestinal endoscopy as part of routine screening between April 2014 and March 2015. The conventional white-light, non-magnifying and magnifying narrow-band images were reviewed. Clinical features were compared between patients with and without MWFL.
Results
The conventional endoscopic findings of MWFL include multiple whitish, flat, and slightly elevated lesions of various sizes, mainly located in the gastric body and fundus. Narrow-band imaging enhanced the contrast of MWFL and background mucosa, and magnifying narrow-band imaging depicted a uniformly long, narrow, and elliptical marginal crypt epithelium with an unclear microvascular pattern. Histopathological findings revealed hyperplastic changes of the foveolar epithelium, and parietal cell protrusions and oxyntic gland dilatations were observed in the fundic glands, without any intestinal metaplasia. The rate of acid-reducing drug use was significantly higher in patients with MWFL than in those without (100% [13/13] vs. 53.7% [88/164], p<0.001).
Conclusions
The present study indicated a relationship between the presence and endoscopic features of MWFL and history of acidreducing drug use.

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Focused Review Series: Current Status of Image-Enhanced Endoscopy (IEE)
Usefulness of Narrow-Band Imaging in Endoscopic Submucosal Dissection of the Stomach
Jung-Wook Kim
Clin Endosc 2018;51(6):527-533.   Published online November 19, 2018
DOI: https://doi.org/10.5946/ce.2018.186
AbstractAbstract PDFPubReaderePub
There have been many advances in endoscopic imaging technologies. Magnifying endoscopy with narrow-band imaging is an innovative optical technology that enables the precise discrimination of structural changes on the mucosal surface. Several studies have demonstrated its usefulness and superiority for tumor detection and differential diagnosis in the stomach as compared with conventional endoscopy. Furthermore, magnifying endoscopy with narrow-band imaging has the potential to predict the invasion depth and tumor margins during gastric endoscopic submucosal dissection. Classifications of the findings of magnifying endoscopy with narrow-band imaging based on microvascular and pit patterns have been proposed and have shown excellent correlations with invasion depth confirmed by microscopy. In terms of tumor margin prediction, magnifying endoscopy with narrow-band imaging offers superior delineation of gastric tumor margins compared with traditional chromoendoscopy with indigo carmine. The limitations of narrow-band imaging, such as the need for considerable training, long procedure time, and lack of studies about its usefulness in undifferentiated cancer, should be resolved to confirm its value as a complementary method to endoscopic submucosal dissection. However, the role of magnifying endoscopy with narrow-band imaging is expected to increase steadily with the increasing use of endoscopic submucosal dissection for the treatment of gastric tumors.

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Focused Review Series: Updates on endoscopic bariatric and metabolic therapies
Experimental Gastric Non-Balloon Devices
Youn I Choi, Kyoung Oh Kim
Clin Endosc 2018;51(5):420-424.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.150
AbstractAbstract PDFPubReaderePub
Endoscopic bariatric therapies (EBTs) are promising alternatives to the conventional surgeries used to treat obesity and related metabolic conditions, targeting gastrointestinal anatomical and physiological processes. Many EBTs are at various stages of development and are aimed at promoting an early sense of satiety via anatomical and physiological mechanisms. In the present study, we focused on relevant clinical issues and future perspectives with regard to gastric non-balloon methods treating obesity.

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Focused Review Series: Updates on Capsule Endoscopy from Esophagus to Colon
Evaluation of Gastric Disease with Capsule Endoscopy
Seung-Joo Nam, Hyun Seok Lee, Yun Jeong Lim
Clin Endosc 2018;51(4):323-328.   Published online July 31, 2018
DOI: https://doi.org/10.5946/ce.2018.092
AbstractAbstract PDFPubReaderePub
The clinical indication for capsule endoscopy has expanded from small bowel evaluation to include esophagus or colon evaluation.Nevertheless, the role of capsule endoscopy in evaluation of the stomach is very limited because of the large volume and surface.However, efforts to develop an active locomotion system for capsule manipulation in detailed gastric evaluation are ongoing, becausethe technique is non-invasive, convenient, and safe, and requires no sedation. Studies have successfully reported gastric evaluation usinga magnetic-controlled capsule endoscopy system. Advances in technology suggest that capsule endoscopy will have a major role notonly in the evaluation of gastric disorders but also in the pathologic diagnosis, intervention, and treatment of any gastrointestinal tractdisorder.

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  • Magnetic Navigation System Composed of Dual Permanent Magnets for Accurate Position and Posture Control of a Capsule Endoscope
    Seunguk Kim, Suhong Bae, Wonseo Lee, Gunhee Jang
    IEEE Transactions on Industrial Electronics.2024; 71(1): 739.     CrossRef
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    Yan Xu, Peng Zhang, Lei Wang, You Li, Bin Luo, Yue Yu, Ruizhi Chen
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    Apostolis Papaefthymiou, Apostolos Koffas, Faidon-Marios Laskaratos, Owen Epstein
    Clinics and Research in Hepatology and Gastroenterology.2022; 46(3): 101798.     CrossRef
  • Computer-Aided Diagnosis of Gastrointestinal Protruded Lesions Using Wireless Capsule Endoscopy: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis
    Hye Jin Kim, Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee, Ki Tae Suk, Gwang Ho Baik
    Journal of Personalized Medicine.2022; 12(4): 644.     CrossRef
  • First prospective European study for the feasibility and safety of magnetically controlled capsule endoscopy in gastric mucosal abnormalities
    Milán Szalai, Krisztina Helle, Barbara Dorottya Lovász, Ádám Finta, András Rosztóczy, László Oczella, László Madácsy
    World Journal of Gastroenterology.2022; 28(20): 2227.     CrossRef
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    Trials.2022;[Epub]     CrossRef
  • 10.07uW Multi-Mode Baseband Transceiver for Encrypted Capsule Endoscopy
    Jung Hyun Bae, Myung Hoon Sunwoo
    Journal of Signal Processing Systems.2021; 93(1): 25.     CrossRef
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    Shahrad Hakimian, Mark Hanscom, David R. Cave
    Gastrointestinal Endoscopy Clinics of North America.2021; 31(2): 399.     CrossRef
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    Zhenyu Li, Manh Cuong Hoang, Chang-Sei Kim, Eunpyo Choi, Doyeon Bang, Jong-Oh Park, Byungjeon Kang
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    Ji Hyung Nam, Kwang Hoon Lee, Yun Jeong Lim
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    Seung Han Kim, Hoon Jai Chun
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    Ji-Hyun Kim, Seung-Joo Nam
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    PLOS ONE.2021; 16(10): e0256519.     CrossRef
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    Kim Tien Nguyen, Manh Cuong Hoang, Eunpyo Choi, Byungjeon Kang, Jong-Oh Park, Chang-Sei Kim
    International Journal of Control, Automation and Systems.2020; 18(1): 65.     CrossRef
  • A New Active Locomotion Capsule Endoscopy under Magnetic Control and Automated Reading Program
    Dong Jun Oh, Kwang Seop Kim, Yun Jeong Lim
    Clinical Endoscopy.2020; 53(4): 395.     CrossRef
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Case Reports
Primary Gastric Small Cell Carcinoma: A Case Identified as a Large Subepithelial Tumor from Invisible State in 6 Months
Yun Im Lee, Hong Kil Jeon, Jae Wook Im, Sang Yu Oh, Kyung Bin Kim, Byunggyu Kim
Clin Endosc 2019;52(1):76-79.   Published online July 6, 2018
DOI: https://doi.org/10.5946/ce.2018.062
AbstractAbstract PDFPubReaderePub
Primary gastric small cell carcinoma (GSCC) is one of the gastroenteropancreatic neuroendocrine tumors. It is a rare cancer with a very aggressive behavior and a poor prognosis because of the high rate of metastases. It is usually found in far advanced stage. We experienced a case of GSCC which had developed into a large subepithelial tumor (SET) from invisible state in a short period. A 65-year-old man consulted our hospital because of early gastric cancer. He underwent endoscopic submucosal dissection for the early gastric cancer at high body posterior wall. After 6 months, the follow-up endoscopy showed a large newly developed SET-like lesion with central ulceration at the gastric cardia. Endoscopic biopsy revealed GSCC. Total gastrectomy was performed. One out of the 26 perigastric lymph nodes had a metastasis. He received 6 cycles of adjuvant chemotherapy with etoposide and cisplatin. He is still in good health 12 months after operation.

Citations

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  • Lysyl oxidase and hypoxia-inducible factor 1α: biomarkers of gastric cancer
    Ya-Lin Han, Li Chen, Rui Qin, Guan-Qing Wang, Xiao-Hua Lin, Guang-Hai Dai
    World Journal of Gastroenterology.2019; 25(15): 1828.     CrossRef
  • 4,973 View
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  • 2 Web of Science
  • 1 Crossref
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Gastric Ulceration and Bleeding with Hemodynamic Instability Caused by an Intragastric Balloon for Weight Loss
Larrite Reed, Hawa Edriss, Kenneth Nugent
Clin Endosc 2018;51(6):584-586.   Published online June 1, 2018
DOI: https://doi.org/10.5946/ce.2018.038
AbstractAbstract PDFPubReaderePub
Obesity in the United States is a medical crisis with many people attempting to lose weight with caloric restriction. Some patients choose minimally invasive weight loss solutions, such as intragastric balloon systems. These balloon systems were approved by the Federal Drug Administration (FDA) in 2015–2016 and have been considered safe, with minimal side effects. We report a patient with a two-day history of melena, abdominal pain, hypotension, and syncope which developed five months after placement of an intragastric balloon. Esophagogastroduodenoscopy with balloon removal revealed a small 8-mm gastric ulcer in the incisura. This gastric ulcer probably developed secondary to mechanical compression of the stomach mucosa by the gastric balloon which contained 900 mL of saline. The FDA is now investigating five deaths since 2016 associated with these second-generation balloons. Clinicians should be aware of these complications when evaluating patients with gastrointestinal complications, such as bleeding.

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    Mahdieh Golzarand, Karamollah Toolabi, Reza Parsaei
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    B. Betzel, M. I. Cooiman, E. O. Aarts, I. M. C. Janssen, P. J. Wahab, M. J. M. Groenen, J. P. H. Drenth, F. J. Berends
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    Sindhura Kolli, Andrew Ofosu, Harini Gurram, Simcha Weissman, Paul Khoi Dang‐Ho, Tej I. Mehta, Hailie Gill, Krishna C. Gurram
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Original Articles
Factors Affecting Endoscopic Curative Resection of Gastric Cancer in the Population-Based Screening Era
Yoon Gwon Mun, Myung-Gyu Choi, Chul-Hyun Lim, Han Hee Lee, Dong Hoon Kang, Jae Myung Park, Kyo Young Song
Clin Endosc 2018;51(5):478-484.   Published online June 1, 2018
DOI: https://doi.org/10.5946/ce.2018.006
AbstractAbstract PDFPubReaderePub
Background
/Aims: Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer.
Methods
We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer.
Results
Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection.
Conclusions
Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer.

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  • A model established using marital status and other factors from the Surveillance, Epidemiology, and End Results database for early stage gastric cancer
    Lixiang Zhang, Baichuan Zhou, Panquan Luo, Aman Xu, Wenxiu Han, Zhijian Wei
    Journal of Investigative Medicine.2022; 70(6): 1373.     CrossRef
  • Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea
    Si Hyung Lee, Min Cheol Kim, Seong Woo Jeon, Kang Nyeong Lee, Jong Jae Park, Su Jin Hong
    Clinical Endoscopy.2020; 53(2): 196.     CrossRef
  • The More, the Better: Is This True in Endoscopy for Gastric Cancer Screening?
    Seong Woo Jeon
    Clinical Endoscopy.2018; 51(5): 402.     CrossRef
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Characteristics of Synchronous and Metachronous Multiple Gastric Tumors after Endoscopic Submucosal Dissection of Early Gastric Neoplasm
Hyun Jik Lee, Yoo Jin Lee, Ju Yup Lee, Eun Soo Kim, Woo Jin Chung, Byoung Kuk Jang, Kyung Sik Park, Jae Seok Hwang, Kwang Bum Cho
Clin Endosc 2018;51(3):266-273.   Published online April 6, 2018
DOI: https://doi.org/10.5946/ce.2017.109
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) has been widely accepted as a method of treatment of early gastric tumor. This study aimed to identify the incidence and characteristics of multiple gastric tumors after ESD.
Methods
Patients with early gastric tumors who were treated by ESD from January 2004 to June 2012 and followed up with endoscopic examination periodically for at least 1 year were enrolled. All multiple gastric lesions were subsequently treated with ESD and the medical records of the patients were retrospectively reviewed.
Results
In total, 643 patients were included. The mean duration of endoscopic follow-up was 45.27±27.59 (range, 12–148) months. Overall, 144 patients (22.4%) showed multiple gastric tumors during the follow-up period (44 synchronous [6.8%] and 100 metachronous [15.5%]). The cumulative incidence rate steadily increased during the follow-up period. More than 50% of the tumors that developed at the same longitudinal location of the stomach were of the same macroscopic and histological type as the primary lesions.
Conclusions
Because synchronous and/or metachronous gastric tumors are common, considerable attention should be paid to detect multiple gastric lesions after ESD of early gastric neoplasm.

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    Du Hyun Song, Nayoung Kim, Hyeong Ho Jo, Sangbin Kim, Yonghoon Choi, Hyeon Jeong Oh, Hye Seung Lee, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Dong Ho Lee, So Hyun Kang, Young Suk Park, Sang-Hoon Ahn, Yun-Suhk Suh, Do Joong Park, Hyung Ho Kim, Ji-Won Kim,
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    Sang Hoon Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(2): 151.     CrossRef
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    Yudai Chen, Chaoying Fang, Jianmin Huang, Hui Pan, Liping He, Chenlin Zhuang, Xiaoling Zheng
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    Yudai Chen, Liping He, Xiaoling Zheng
    Medicine.2023; 102(49): e36439.     CrossRef
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    Raquel Ortigão, Gonçalo Figueirôa, Leonardo Frazzoni, Pedro Pimentel-Nunes, Cesare Hassan, Mário Dinis-Ribeiro, Lorenzo Fuccio, Diogo Libânio
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    Dong Chan Joo, Gwang Ha Kim
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    Yeon-Ji Kim, Jaeyoung Kim, Woo Chul Chung
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    Xing Xu, Guoliang Zheng, Na Gao, Zhichao Zheng
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    Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
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    Shan Shan Xu, Ning Li Chai, Xiao Wei Tang, En Qiang Linghu, Sha Sha Wang, Xiu Xue Feng, Bao Li
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    Shan-Shan Xu, Ning-Li Chai, Xiao-Wei Tang, En-Qiang Linghu, Sha-Sha Wang, Bao Li
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    Tae Young Park, Su Jin Jeong, Tae Hyung Kim, Jin Lee, Jongha Park, Tae Oh Kim, Yong Eun Park
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    Jue Lie Kim, Sang Gyun Kim, Jung Kim, Jae Yong Park, Hyo-Joon Yang, Hyun Ju Kim, Hyunsoo Chung
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    Hui Pan, Chaoying Fang, Liping He, Houqiang Li, Lanzai Liu, Chao Wang, Jiansu Chen
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    Duc Trong Quach, Toru Hiyama
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    Su Jin Kim, Cheol Woong Choi
    Journal of Korean Medical Science.2019;[Epub]     CrossRef
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    A Reum Choe, Ki-Nam Shim, Tae Oh Kim, Sang Yoon Kim, Jiyoung Lim, Chung Hyun Tae, Chang Mo Moon, Seong-Eun Kim, Hye-Kyung Jung, Sung-Ae Jung
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2019; 19(3): 184.     CrossRef
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    Hee Jae Jung, Su Jin Hong, Shin Hee Kim
    Clinical Endoscopy.2019; 52(5): 464.     CrossRef
  • 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
    Clinical Endoscopy.2019; 52(5): 472.     CrossRef
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    Cheol Min Shin
    Clinical Endoscopy.2018; 51(3): 209.     CrossRef
  • Characteristics of overlooked synchronous gastric epithelial neoplasia after endoscopic submucosal dissection
    Hyeong Seok Nam, Hyung Wook Kim, Cheol Woong Choi, Dae Hwan Kang, Su Bum Park, Su Jin Kim, Jung Sik Choi
    Medicine.2018; 97(39): e12536.     CrossRef
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Case Report
Stomach Perforation Caused by Ingesting Liquid Nitrogen: A Case Report on the Effect of a Dangerous Snack
Dong-Wook Kim
Clin Endosc 2018;51(4):381-383.   Published online March 5, 2018
DOI: https://doi.org/10.5946/ce.2017.178
AbstractAbstract PDFPubReaderePub
We report our experience with a case of stomach perforation after accidental ingestion of liquid nitrogen. A 13-year-old boy ate a snack at an amusement park and began to complain of sudden onset of severe abdominal pain with shortness of breath. It was determined that the snack he had ingested had been cooled with liquid nitrogen. A computed tomography scan of the abdomen and a chest X-ray showed a large volume of pneumoperitoneum. During surgery, a 4-cm perforation of the angularis incisura of the stomach was identified. Primary repair and omentopexy was performed. The patient was discharged without postoperative complications.

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  • Gastric Perforation by Smoking Biscuits: Report of a Case
    Abhishek Mishra, Ashirbad Panda, Laxminarayan Mohanty, Mohammad Ibrarullah
    Indian Journal of Surgery.2023; 85(3): 630.     CrossRef
  • Liquid Nitrogen Applied at Point of Sale
    Victoria A. Pinilla Escobar, Caroline J. Granger, Anthony R. Hogan, Chad M. Thorson, Eduardo A. Perez, Juan E. Sola, Ann-Christina Brady
    Pediatric Emergency Care.2022; 38(1): e85.     CrossRef
  • 8,486 View
  • 152 Download
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  • 2 Crossref
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Original Articles
Non-Exposure Endoscopic-Laparoscopic Cooperative Surgery for Stomach Tumors: First Experience from the Czech Republic
Jan Hajer, Lukáš Havlůj, Adam Whitley, Robert Gürlich
Clin Endosc 2018;51(2):167-173.   Published online January 4, 2018
DOI: https://doi.org/10.5946/ce.2017.076
AbstractAbstract PDFPubReaderePub
Background
/Aims: The aim of this study was to investigate the use of non-exposure endoscopic wall-inversion surgery (NEWS) and the combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) in gastric tumors.
Methods
We reviewed all cases of NEWS and CLEAN-NET performed in the department of surgery of the Royal Vinohrady Teaching Hospital.
Results
Our department performed 12 gastric tumor resections (NEWS, n=10 and CLEAN-NET, n=2) between March 2016 and February 2017. The cases chosen for these resections included predominantly submucosal tumors with no signs of dissemination or local invasion and early gastric carcinomas (T1SM1 and T1M), where tumor location made it impossible to use endoscopic submucosal dissection. R0 resection margins were confirmed in all the cases.
Conclusions
NEWS and CLEAN-NET allow en bloc non-exposed full-thickness gastric wall resection in a way that uses a “close first, cut later” approach to prevent seeding of the peritoneal cavity with tumor cells. These mini-invasive techniques combine laparoscopic and endoscopic techniques, and preserve the full function of the stomach.

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  • Pure endoscopic resection versus laparoscopic assisted procedure for upper gastrointestinal stromal tumors: Perspective from a surgical endoscopist
    Hon Chi Yip, Jun Liang Teh, Anthony Y. B. Teoh, Philip Chiu
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    Lei Yue, Yingchao Sun, Xinjie Wang, Weiling Hu
    Frontiers in Surgery.2023;[Epub]     CrossRef
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    Peng-yue Zhao, Zhao-fu Ma, Ya-nan Jiao, Yang Yan, Song-yan Li, Xiao-hui Du
    Frontiers in Oncology.2022;[Epub]     CrossRef
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    S.V. Dzhantukhanova, Yu.G. Starkov, R.D. Zamolodchikov, A.A. Zvereva, P.K. Kontorshchikov
    Endoskopicheskaya khirurgiya.2021; 27(4): 47.     CrossRef
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    Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
    Clinical Endoscopy.2021; 54(5): 633.     CrossRef
  • CLEAN-NET: a modified laparoendoscopic wedge resection of the stomach to minimize the sacrifice of innocent gastric wall
    Eiji Kanehira, Aya Kamei Kanehira, Takashi Tanida, Kodai Takahashi, Yuichi Obana, Kazunori Sasaki
    Surgical Endoscopy.2020; 34(1): 290.     CrossRef
  • Clinical outcomes of non-exposed endoscopic wall-inversion surgery for gastric submucosal tumors: long-term follow-up and functional results
    Junya Aoyama, Osamu Goto, Hirofumi Kawakubo, Shuhei Mayanagi, Kazumasa Fukuda, Tomoyuki Irino, Rieko Nakamura, Norihito Wada, Hiroya Takeuchi, Naohisa Yahagi, Yuko Kitagawa
    Gastric Cancer.2020; 23(1): 154.     CrossRef
  • Comparison of Nonexposed Endoscopic Wall-Inversion Surgery with Endoscopic-Navigated Laparoscopic Wedge Resection for Gastric Submucosal Tumours: Results of a Two-Centre Study
    Jan Hajer, Lukáš Havlůj, Petr Kocián, Günther Klimbacher, Andreas Shamiyeh, Robert Gürlich, Adam Whitley
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    Cicilia Marcella, Rui Hua Shi, Shakeel Sarwar
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Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis
Chang Seok Bang, Jae Myung Park, Gwang Ho Baik, Jong Jae Park, Moon Kyung Joo, Jae Young Jang, Seong Woo Jeon, Suck Chei Choi, Jae Kyu Sung, Kwang Bum Cho
Clin Endosc 2017;50(6):569-577.   Published online July 25, 2017
DOI: https://doi.org/10.5946/ce.2017.017
AbstractAbstract PDFPubReaderePub
Background
/Aims: To assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology.
Methods
Cases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed.
Results
From 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years).
Conclusions
ER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.

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  • A Rare Case of Primary Gastric Signet Ring Cell Carcinoma: a Review of Guidelines for the Management of Gastric Cancer
    Ronald Mauricio Blanco Montecino, Mikhail Sukhorosl, Mayi Ann Francis, Neeraj Kancherla, Ogbonnaya Akuma, Nkiruka Lauretta Nwangene, Shreyas Nandyal, Rohan Raj, Chinaza Mercy Akuma, Tamer Zahdeh, Sharanya Kaushik, Adil M. Khan
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    鹏齐 陈
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    Jiahui Xu, Fan Yin, Mengyu Cao, Linlin Ren, Shidong Wang, Congcong Min, Xiaoyu Li, Zibin Tian, Tao Mao
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    Виктория Эдуардовна Тишакова , Дмитрий Валерьевич Ручкин , Александр Анатольевич Грицкевич , Николай Алексеевич Ефименко
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Case Report
Gastric Adenocarcinoma with Systemic Metastasis Involving the Intraocular Choroid and Duodenum
Soon Young Kim, Kee-Taek Jang, Jun Haeng Lee
Clin Endosc 2018;51(1):95-98.   Published online May 22, 2017
DOI: https://doi.org/10.5946/ce.2017.049
AbstractAbstract PDFPubReaderePub
Gastric cancer with double metastasis to the orbit and duodenum is extremely rare. We report the case of a patient with gastric adenocarcinoma who presented with synchronous orbital and duodenal metastases at the time of initial diagnosis. A 60-year-old man presented with a 1-month history of visual disorder and pain in his right eye. He underwent ophthalmological examinations. The biopsy results suggested intraocular metastatic carcinoma. We conducted a systemic evaluation to identify primary malignancy. Finally, a diagnosis of advanced gastric adenocarcinoma with multi-organ metastasis was made. He planned to be treated with systemic chemotherapy.

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Original Article
Can Endoscopic Ulcerations in Early Gastric Cancer Be Clearly Defined before Endoscopic Resection? A Survey among Endoscopists
Sung Min Park, Byung-Wook Kim, Joon Sung Kim, Young Wook Kim, Gi Jun Kim, Seung Ji Ryu
Clin Endosc 2017;50(5):473-478.   Published online April 24, 2017
DOI: https://doi.org/10.5946/ce.2016.143
AbstractAbstract PDFPubReaderePub
Background
/Aims: Early gastric cancer (EGC) with ulcerations can be treated via endoscopic resection (ER) when it is differentiated pathologically, limited to the mucosa, and <3 cm in diameter. The presence of ulceration is a key factor in deciding treatment strategies and is usually diagnosed during endoscopic examination. The aim of this study was to evaluate whether ulcerations in EGC can be clearly defined among endoscopists and which factors are related to the differences.
Methods
A survey questionnaire, composed of demographic features and endoscopic images of seven patients with EGC, was presented to the endoscopists via e-mail. The endoscopists were asked whether such patients have ulcerations in the lesions.
Results
The questionnaires were e-mailed to 197 endoscopists, and 103 doctors replied. The presence of an endoscopic ulceration was defined differently among the endoscopists, depending on the duration of endoscopic practice and the experience of endoscopic submucosal dissection (ESD). The differences were especially high in the lesions without mucosal breaks and converging folds, which were expected to be viewed as non-ulcerative.
Conclusions
Before ER, endoscopic ulcerations in EGC must be reviewed by experienced endoscopists to reduce overestimations, and adequate educational programs for trainees should be established.

Citations

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  • A standardized pathology report for gastric cancer: 2nd edition
    Young Soo Park, Myeong-Cherl Kook, Baek-hui Kim, Hye Seung Lee, Dong-Wook Kang, Mi-Jin Gu, Ok Ran Shin, Younghee Choi, Wonae Lee, Hyunki Kim, In Hye Song, Kyoung-Mee Kim, Hee Sung Kim, Guhyun Kang, Do Youn Park, So-Young Jin, Joon Mee Kim, Yoon Jung Choi,
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  • A Standardized Pathology Report for Gastric Cancer: 2nd Edition
    Young Soo Park, Myeong-Cherl Kook, Baek-hui Kim, Hye Seung Lee, Dong-Wook Kang, Mi-Jin Gu, Ok Ran Shin, Younghee Choi, Wonae Lee, Hyunki Kim, In Hye Song, Kyoung-Mee Kim, Hee Sung Kim, Guhyun Kang, Do Youn Park, So-Young Jin, Joon Mee Kim, Yoon Jung Choi,
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    Hang Lak Lee
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  • 10 Crossref
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Case Report
Acute Gastric Injury Caused by Undissolved Sodium Picosulfate/Magnesium Citrate Powder
Eun Young Ze, Chang Hwan Choi, Jeong Wook Kim
Clin Endosc 2017;50(1):87-90.   Published online October 12, 2016
DOI: https://doi.org/10.5946/ce.2016.081
AbstractAbstract PDFPubReaderePub
Sodium picosulfate/magnesium citrate (SPMC) is a widely used oral bowel cleansing agent considered to be relatively safe. However, partially dissolved or undissolved SPMC powder may cause severe injuries of the esophagus and stomach. We report a very rare case of acute gastric injury without esophageal damage caused by the ingestion of undissolved SPMC powder. A 69-year-old man experienced epigastric pain after swallowing SPMC powder without dissolving it in water in preparation for a screening colonoscopy. He realized his mistake immediately and subsequently drank 2 L of water. The esophagogastroduodenoscopy conducted after 12 hours indicated an acute gastric ulceration without injury of the esophagus or duodenum. The endoscopy conducted after 6 weeks of oral proton pump inhibitor treatment showed healing of the gastric injury. This suggested that drinking large amounts of water after ingesting partially dissolved or undissolved SPMC powder can prevent serious esophageal injury, but offers no preventive benefit for acute gastric injury.

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Reviews
Endoscopic Submucosal Dissection for Early Gastric Cancers with Uncommon Histology
Gwang Ha Kim
Clin Endosc 2016;49(5):434-437.   Published online September 30, 2016
DOI: https://doi.org/10.5946/ce.2016.127
AbstractAbstract PDFPubReaderePub
Endoscopic submucosal dissection (ESD) enables en bloc curative resection of early gastric cancers (EGCs) with a negligible risk of lymph node metastasis (LNM). Although ESD for EGCs with absolute and expanded indications is safe, the results differ between EGCs with specialized and common histologies. EGC with papillary adenocarcinoma is a differentiated-type adenocarcinoma. At present, it is treated with ESD according to the same criteria as other differentiated-type adenocarcinomas. The LNM rate under the current indication criteria is high, and over half of the patients who undergo ESD as a primary treatment for EGC with papillary adenocarcinoma achieve an out-of-ESD result. Gastric carcinoma with lymphoid stroma in EGC has a low LNM rate and a favorable outcome, despite deep submucosal invasion. Patients with this gastric cancer subtype may be good candidates for ESD, even with deep submucosal invasion. Large-scale prospective multi-center studies with longer follow-up periods are needed to set proper ESD criteria for these tumors. Clinicians should be aware of these disease entities and ESD should be more carefully considered for EGCs with papillary adenocarcinoma and gastric carcinoma with lymphoid stroma.

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Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions
Eun Jeong Gong, Do Hoon Kim
Clin Endosc 2016;49(5):425-433.   Published online September 5, 2016
DOI: https://doi.org/10.5946/ce.2016.065
AbstractAbstract PDFPubReaderePub
Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions.

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Original Article
Characteristics of Missed Simultaneous Gastric Lesions Based on Double-Check Analysis of the Endoscopic Image
Eun Jeong Gong, Jeong Hoon Lee, Kyoungwon Jung, Charles J. Cho, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim
Clin Endosc 2017;50(3):261-269.   Published online August 22, 2016
DOI: https://doi.org/10.5946/ce.2016.056
AbstractAbstract PDFPubReaderePub
Background
/Aims: The detection of multifocal lesions is important for the successful management of gastric neoplasms. We investigated the characteristics of missed simultaneous lesions and the reason for the missed diagnoses.
Methods
A total of 140 patients who underwent repeat endoscopy before endoscopic resection between June 2013 and June 2014 were retrospectively reviewed. We classified simultaneous lesions into three groups based on a review of earlier images: group 1, no images of the location of simultaneous lesions were taken; group 2, no corresponding lesion was evident in the previous images; and group 3, simultaneous lesions were visible in the earlier images but a biopsy was not performed.
Results
Simultaneous lesions were found in 12 patients (8.6%) with 13 lesions, comprising 10 dysplasia (76.9%) and three adenocarcinoma (23.1%). Regarding the reasons for missed diagnoses, seven lesions (53.8%) were classified as group 3, five (38.5%) as group 1, and the remaining lesion (7.7%) as group 2. There were no significant differences in the characteristics of the patients with and without simultaneous lesions.
Conclusions
Lesions disregarded or unnoticed during endoscopic examination were the main reason for missed diagnosis of simultaneous lesions. Endoscopists should consider the possibility of simultaneous lesions and attempt to meticulously evaluate the entire gastric mucosa.

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