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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.

Citations

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
  • 3,000 View
  • 206 Download
  • 1 Web of Science
  • 1 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: Gastric Metastasis revealing a Disseminated Skin Melanoma: A Case Report and Literature Review
    Ramzi Tababi, Amal Khsiba, Moufida Mahmoudi, Asma Ben Mohamed, Manel Yakoubi, Ghada Gharbi, Abir Chaabane, Emna Chelbi, Mouna Medhioub, Mohamed Lamine Hamzaoui
    F1000Research.2024; 13: 1019.     CrossRef
  • Case report: Malignant melanoma of the lower limb with gastric metastasis
    Qiang Hu, Fengru Zhou, Yuanshui Sun
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • 2,700 View
  • 183 Download
  • 1 Web of Science
  • 3 Crossref
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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.

Citations

Citations to this article as recorded by  
  • Long-term outcomes of endoscopic resection followed by additional surgery after non-curative resection in undifferentiated-type early gastric cancer: a nationwide multi-center study
    Jie-Hyun Kim, Young-Il Kim, Ji Yong Ahn, Woon Geon Shin, Hyo-Joon Yang, Su Youn Nam, Byung-Hoon Min, Jae-Young Jang, Joo Hyun Lim, Wan Sik Lee, Bong Eun Lee, Moon Kyung Joo, Jae Myung Park, Hang Lak Lee, Tae-Geun Gweon, Moo In Park, Jeongmin Choi, Chung H
    Surgical Endoscopy.2022; 36(3): 1847.     CrossRef
  • Diffuse-type Gastric Cancer
    Jie-Hyun Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(1): 11.     CrossRef
  • The future of endoscopic resection for early gastric cancer
    Raquel Ortigão, Diogo Libânio, Mário Dinis‐Ribeiro
    Journal of Surgical Oncology.2022; 125(7): 1110.     CrossRef
  • Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
    Eun Jeong Gong, Chang Seok Bang
    Journal of the Korean Medical Association.2022; 65(5): 284.     CrossRef
  • Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study
    Chang Seok Bang, Ji Yong Ahn, Jie-Hyun Kim, Young-Il Kim, Il Ju Choi, Woon Geon Shin
    Journal of Medical Internet Research.2021; 23(4): e25053.     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
  • 6,556 View
  • 179 Download
  • 5 Web of Science
  • 6 Crossref
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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.

Citations

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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
  • 5,687 View
  • 98 Download
  • 4 Web of Science
  • 3 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.

Citations

Citations to this article as recorded by  
  • The correlation between the main and minor lesions of synchronous multiple gastric neoplasms assessed gastroscopically and microscopically
    Yudai Chen, Chaoying Fang, Jianmin Huang, Hui Pan, Liping He, Chenlin Zhuang, Xiaoling Zheng
    Surgical Endoscopy.2024; 38(3): 1211.     CrossRef
  • Analysis of Characteristics and Risk Factors of Patients with Single Gastric Cancer and Synchronous Multiple Gastric Cancer among 14,603 Patients
    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,
    Gut and Liver.2024; 18(2): 231.     CrossRef
  • Importance of Early Surveillance Endoscopy in Patients at a High Risk of Gastric Cancer
    Sang Hoon Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(2): 151.     CrossRef
  • Characteristics of multiple early gastric cancer and gastric high-grade intraepithelial neoplasia
    Yudai Chen, Liping He, Xiaoling Zheng
    Medicine.2023; 102(49): e36439.     CrossRef
  • Risk factors for gastric metachronous lesions after endoscopic or surgical resection: a systematic review and meta-analysis
    Raquel Ortigão, Gonçalo Figueirôa, Leonardo Frazzoni, Pedro Pimentel-Nunes, Cesare Hassan, Mário Dinis-Ribeiro, Lorenzo Fuccio, Diogo Libânio
    Endoscopy.2022; 54(09): 892.     CrossRef
  • Endoscopic diagnosis of early gastric cancer
    Dong Chan Joo, Gwang Ha Kim
    Journal of the Korean Medical Association.2022; 65(5): 267.     CrossRef
  • Clinical outcomes of metachronous recurrence of gastric epithelial neoplasia based on Helicobacter pylori infection status and microsatellite stability
    Yeon-Ji Kim, Jaeyoung Kim, Woo Chul Chung
    The Korean Journal of Internal Medicine.2022; 37(4): 768.     CrossRef
  • Diagnosis and clinical implication of collision gastric adenocarcinomas: a case report
    Hiromitsu Imataki, Hideo Miyake, Hidemasa Nagai, Yuichiro Yoshioka, Norihiro Yuasa, Junichi Takamizawa, Ayami Kiriyama, Masahiko Fujino
    Surgical Case Reports.2022;[Epub]     CrossRef
  • Long-term outcomes and clinical safety of expanded indication early gastric cancer treated with endoscopic submucosal dissection versus surgical resection: a meta-analysis
    Xing Xu, Guoliang Zheng, Na Gao, Zhichao Zheng
    BMJ Open.2022; 12(12): e055406.     CrossRef
  • Editors' Choice of Noteworthy Clinical Endoscopy Publications in the First Decade
    Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
    Clinical Endoscopy.2021; 54(5): 633.     CrossRef
  • A predictive risk‐scoring model for multiple synchronous early gastric cancers or gastric dysplasia before initial endoscopic resection
    Shan Shan Xu, Ning Li Chai, Xiao Wei Tang, En Qiang Linghu, Sha Sha Wang, Xiu Xue Feng, Bao Li
    Journal of Digestive Diseases.2021; 22(11): 637.     CrossRef
  • Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms
    Shan-Shan Xu, Ning-Li Chai, Xiao-Wei Tang, En-Qiang Linghu, Sha-Sha Wang, Bao Li
    Chinese Medical Journal.2021; 134(21): 2603.     CrossRef
  • Long-term outcomes of patients with gastric adenoma in Korea
    Tae Young Park, Su Jin Jeong, Tae Hyung Kim, Jin Lee, Jongha Park, Tae Oh Kim, Yong Eun Park
    Medicine.2020; 99(12): e19553.     CrossRef
  • Clinical Outcomes of Metachronous Gastric Cancer after Endoscopic Resection for Early Gastric Cancer
    Jue Lie Kim, Sang Gyun Kim, Jung Kim, Jae Yong Park, Hyo-Joon Yang, Hyun Ju Kim, Hyunsoo Chung
    Gut and Liver.2020; 14(2): 190.     CrossRef
  • Risk of multiple early gastric cancers in a patient with precursor lesions and endoscopic surveillance for 7 years
    Hui Pan, Chaoying Fang, Liping He, Houqiang Li, Lanzai Liu, Chao Wang, Jiansu Chen
    Medicine.2019; 98(22): e15686.     CrossRef
  • Assessment of Endoscopic Gastric Atrophy according to the Kimura-Takemoto Classification and Its Potential Application in Daily Practice
    Duc Trong Quach, Toru Hiyama
    Clinical Endoscopy.2019; 52(4): 321.     CrossRef
  • Common Locations of Gastric Cancer: Review of Research from the Endoscopic Submucosal Dissection Era
    Su Jin Kim, Cheol Woong Choi
    Journal of Korean Medical Science.2019;[Epub]     CrossRef
  • Risk Factors for Metachronous Recurrence after Endoscopic Submucosal Dissection of a Gastric Neoplasm
    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
  • Immunohistochemical Expression of Epithelial-Mesenchymal Transition Markers in Early Gastric Cancer: Cancer Tissue versus Noncancer Tissue
    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
  • Clinical Implications of Synchronous and Metachronous Multiple Gastric Tumors after Endoscopic Resection of Gastric Neoplasms
    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
  • 7,525 View
  • 209 Download
  • 21 Web of Science
  • 22 Crossref
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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.

Citations

Citations to this article as recorded by  
  • 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
    Advances in Clinical Medicine.2024; 14(03): 922.     CrossRef
  • Advances in Endoscopic Detection and Therapeutic Strategies for Early Gastric Signet Ring Cell Carcinoma
    Jiahui Xu, Fan Yin, Mengyu Cao, Linlin Ren, Shidong Wang, Congcong Min, Xiaoyu Li, Zibin Tian, Tao Mao
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    Yuichiro Hirai, Seiichiro Abe, Mai Ego Makiguchi, Masau Sekiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito
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    World Journal of Gastrointestinal Endoscopy.2023; 15(4): 240.     CrossRef
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    Surgical Endoscopy.2022; 36(3): 1847.     CrossRef
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    Jie-Hyun Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(1): 11.     CrossRef
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    Chun-Yan Weng, Shao-Peng Sun, Chang Cai, Jing-Li Xu, Bin Lv
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    Joo Hyun Lim, Jung Kim, Sang Gyun Kim, Hyunsoo Chung
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  • Pitfalls in the Interpretation of Publications about Endoscopic Submucosal Dissection of Early Gastric Cancer with Undifferentiated-Type Histology
    Chang Seok Bang, Gwang Ho Baik
    Clinical Endoscopy.2019; 52(1): 30.     CrossRef
  • Strategy for Curative Endoscopic Resection of Undifferentiated-Type Early Gastric Cancer
    Jie-Hyun Kim
    Clinical Endoscopy.2019; 52(1): 9.     CrossRef
  • Risk Factors for Lymph Node Metastasis in Undifferentiated-Type Gastric Carcinoma
    Myeong-Cherl Kook
    Clinical Endoscopy.2019; 52(1): 15.     CrossRef
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    Si Hyung Lee, Byung Sam Park
    Clinical Endoscopy.2019; 52(1): 21.     CrossRef
  • Characteristics of proximal early gastric cancer differentiating distal early gastric cancer
    Jin Sung Koh, Moon Kyung Joo, Jong-Jae Park, Beom Jae Lee, Hoon Jai Chun, Sang Woo Lee, You-Jin Jang, Young-Jae Mok, Masaru Katoh
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    Jie-Hyun Kim
    Clinical Endoscopy.2017; 50(6): 511.     CrossRef
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  • 28 Web of Science
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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.

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Review
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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Review
How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program
Yu Kyung Cho
Clin Endosc 2016;49(4):312-317.   Published online July 29, 2016
DOI: https://doi.org/10.5946/ce.2016.084
AbstractAbstract PDFPubReaderePub
In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

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Original Article
Comparison of Endoscopic Submucosal Dissection and Surgery for Differentiated Type Early Gastric Cancer within the Expanded Criteria
Dong Woo Shin, Hee Young Hwang, Seong Woo Jeon
Clin Endosc 2017;50(2):170-178.   Published online May 9, 2016
DOI: https://doi.org/10.5946/ce.2016.017
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) is a novel alternative treatment for differentiated early gastric cancer (EGC) without lymph node metastasis. We conducted this study to verify the therapeutic usefulness of ESD for treating differentiated EGC compared to that of surgery.
Methods
This is a retrospective cohort study of 382 patients treated with differentiated EGC from March 2006 to May 2010. The propensity score yielded 275 matched patients. They were divided into an ESD group of 175 people and a gastrectomy group of 100 people. The patient demographics, pathologic characteristics, length of hospital stay, complication rate and survival rate were compared.
Results
The complication rate was higher for the gastrectomy group than for the ESD group (15.0% vs. 5.1%, p=0.007). The average length of patient hospitalization was longer after gastrectomy than after ESD (8.6 days vs. 2.4 days, p<0.001). There were two cases of mortality in the surgery group within 30 days of procedure. The 5-year survival rates of the two groups did not show a statistically significant difference (92.0% vs. 93.3%, p=0.496).
Conclusions
The long-term survival rates of ESD and gastrectomy were not significantly different. The complication rate was lower for ESD than for gastrectomy, and the length of hospital stay was shorter after ESD than after gastrectomy.

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Case Report
Hybrid Natural Orifice Transluminal Endoscopic Surgery with Sentinel Lymph Node Navigation for Deep Early Gastric Cancer in the Fundic Region
Yoon Suk Park, Seong Hwan Kim, Hee Yun Ryu, Young Kwan Cho, Yun Ju Jo, Tae il Son, Young Ok Hong
Clin Endosc 2016;49(3):298-302.   Published online March 29, 2016
DOI: https://doi.org/10.5946/ce.2015.114
AbstractAbstract PDFPubReaderePub
For patients refusing surgical treatment for deep early gastric cancer, hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation is a potential treatment option, particularly when the anatomic location of the cancer has low probability of lymph node metastasis. We report a case of deep early gastric cancer of the fundus beyond the endoscopic submucosal dissection indication that was treated by hybrid natural orifice transluminal endoscopic surgery with sentinel lymph node navigation. In a conventional approach, a total gastrectomy would have been needed; however, the patient refused surgical intervention. In this case, since the patient showed no positivity of the sentinel lymph node on intraoperative navigation, laparoscopic basin lymph node dissection was not performed. Hybrid natural orifice transluminal endoscopic surgery might be considered for specific regions such as the safety zone where lymph node metastases are less likely to occur.

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Original Articles
Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection
Duk Su Kim, Yunho Jung, Ho Sung Rhee, Su Jin Lee, Yeong Geol Jo, Jong Hwa Kim, Jae Man Park, Il-Kwun Chung, Young Sin Cho, Tae Hoon Lee, Sang-Heum Park, Sun-Joo Kim
Clin Endosc 2016;49(3):273-281.   Published online March 4, 2016
DOI: https://doi.org/10.5946/ce.2015.086
AbstractAbstract PDFPubReaderePub
Background
/Aims: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy.
Methods
Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients.
Results
DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size ≥40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and non-hemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438; IIb, p=0.397; IIc, p=0.773) during second-look endoscopy.
Conclusions
The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.

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  • Response
    Thomas K.L. Lui
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    Hsu-Heng Yen, Ping-Yu Wu, Tung-Lung Wu, Siou-Ping Huang, Yang-Yuan Chen, Mei-Fen Chen, Wen-Chen Lin, Cheng-Lun Tsai, Kang-Ping Lin
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    Hsu-Heng Yen, Ping-Yu Wu, Pei-Yuan Su, Chia-Wei Yang, Yang-Yuan Chen, Mei-Fen Chen, Wen-Chen Lin, Cheng-Lun Tsai, Kang-Ping Lin
    Journal of Medical and Biological Engineering.2021; 41(4): 504.     CrossRef
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    S.G. Shapovalyants, R.V. Plakhov, M.V. Bordikov, E.V. Gorbachev, I.V. Zhitareva, E.D. Fedorov
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    Koichi Izumikawa, Masaya Iwamuro, Tomoki Inaba, Shigenao Ishikawa, Kenji Kuwaki, Ichiro Sakakihara, Kumiko Yamamoto, Sakuma Takahashi, Shigetomi Tanaka, Masaki Wato, Hiroyuki Okada
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    Hye Kyung Jeon, Gwang Ha Kim
    Clinical Endoscopy.2016; 49(3): 212.     CrossRef
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Feedback Survey of the Effect, Burden, and Cost of the National Endoscopic Quality Assessment Program during the Past 5 Years in Korea
Yu Kyung Cho, Jeong Seop Moon, Dong Su Han, Yong Chan Lee, Yeol Kim, Bo Young Park, Il-Kwun Chung, Jin-Oh Kim, Jong Pil Im, Jae Myung Cha, Hyun Gun Kim, Sang Kil Lee, Hang Lak Lee, Jae Young Jang, Eun Sun Kim, Yunho Jung, Chang Mo Moon, Ethics and Quality Control Committee of Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2016;49(6):542-547.   Published online March 2, 2016
DOI: https://doi.org/10.5946/ce.2015.113
AbstractAbstract PDFPubReaderePub
Background
/Aims: In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions.
Methods
We surveyed the staff of institutional endoscopic units via e-mail.
Results
Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program.
Conclusions
Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.

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Focused Review Series: Advances in the management of upper GI SET
Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors
Jin Woong Cho, the Korean ESD Study Group
Clin Endosc 2016;49(3):235-240.   Published online February 22, 2016
DOI: https://doi.org/10.5946/ce.2015.096
AbstractAbstract PDFPubReaderePub
Subepithelial tumors are frequently found in asymptomatic patients in Japan and Korea where cancer screening tests routinely include endoscopy. Most lesions are asymptomatic and clinically insignificant. However, carcinoid tumors, lymphomas, glomus tumor and gastrointestinal stromal tumors (GISTs) are malignant or have the potential to become malignant. Inflammation due to parasitic infestation by Anisakis and poorly differentiated adenocarcinomas in the stomach rarely present as subepithelial lesions. In contrast to the frequency of gastric GIST in the gastrointestinal system, they are uncommon in the duodenum and very rare in the esophagus. The prognosis of patients with GISTs in the stomach is relatively good compared with GISTs in other organs. Along with the location of the tumor, its size and mitotic count are major factors that determine the malignant potential of GIST. Small (<2 cm) asymptomatic GISTs usually have benign clinical course. GIST is the most common subepithelial tumor to occur in the stomach. Although various methods are employed to diagnose GISTs, the risk of GIST metastasis cannot be accurately predicted before lesions are completely resected. Recently, new endoscopic diagnostic methods and treatment techniques have been developed that allow the diagnosis and resection of lesions located in the muscularis propria, without any complications. These endoscopic methods have different indications depending on regions where they are performed.

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Case Report
Endoscopic Submucosal Dissection of an Inverted Early Gastric Cancer-Forming False Gastric Diverticulum
Yong-il Lee, Sang-kil Lee
Clin Endosc 2016;49(1):86-90.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.86
AbstractAbstract PDFPubReaderePub
Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer (EGC) that does not have any risk of lymph node or distant metastases. Here, we report a case of EGC resembling a diverticulum. Diverticular formation makes it difficult for endoscopists to determine the depth of invasion and to subsequently perform ESD. Because the false diverticulum does not have a muscular layer, this lesion can be treated with ESD. Our case was successfully treated with ESD. After ESD, the EGC was confined to the submucosal layer without vertical and lateral margin involvement. This is the first case in which ESD was successfully performed for a case of EGC that coexisted with a false gastric diverticulum. An additional, larger study is needed to determine the efficacy of ESD in various types of EGC, such as a false gastric diverticulum.

Citations

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  • A rare case of perforated gastric duplication cyst associated with gastric diverticulum
    Joseph M Smith, Jessie A Elliott, Amy E Gillis, Paul F Ridgway
    BMJ Case Reports.2021; 14(3): e239971.     CrossRef
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    Samiullah Khan, Kui Jiang, Lan-ping Zhu, Iftikhar-ahmad Khan, Kifayat Ullah, Saima Khan, Xin Chen, Bang-mao Wang
    Gastroenterology Research and Practice.2019; 2019: 1.     CrossRef
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    Jamil Shah, Kalpesh Patel, Tagore Sunkara, Charilaos Papafragkakis, Abul Shahidullah
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Focused Review Series: Image Enhanced Endoscopy
Usefulness and Future Prospects of Confocal Laser Endomicroscopy for Gastric Premalignant and Malignant Lesions
Sang Kil Lee
Clin Endosc 2015;48(6):511-515.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.511
AbstractAbstract PDFPubReaderePub
Confocal laser endomicroscopy (CLE) is a new technology enabling endoscopists to visualize tissue at the cellular level. CLE has the fundamental potential to provide a histologic diagnosis, and may theoretically replace or reduce the need for performing biopsy for histology. The clinical benefits of CLE are more obvious in esophageal disease, including Barrett’s esophagus. Currently, this technology has been adapted to the diagnosis and surveillance of Barrett’s esophagus and related neoplasia. Standard white light endoscopy is the primary tool for gastric cancer screening. Currently, the only method available to precisely diagnose these lesions is upper endoscopy with an appropriate biopsy. A recent study showed that CLE could characterize dysplasia or cancer and identify the risk factors for gastric cancer, such as intestinal metaplasia and the presence of Helicobacter pylori in vivo, although fewer studies on CLE were performed on the stomach than on Barrett’s esophagus and other esophageal diseases. However, the application of CLE to routine clinical endoscopy continues to be refined. This review focused on the usefulness and future prospects of CLE for gastric premalignant and malignant lesions.

Citations

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  • Newly proposed quantitative criteria can assess chronic atrophic gastritis via probe-based confocal laser endomicroscopy (pCLE): a pilot study
    Carlos Robles-Medranda, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Juan Alcívar-Vásquez, Raquel Del Valle, Carlos Cifuentes-Gordillo, Haydee Alvarado-Escobar, Daniel Ponce-Velez, Jesenia Ospina-Arboleda, Hannah Pitanga-Lukashok
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    Yuna Kim, Hyunki Kim, Minkyu Jung, Sun Young Rha, Hyun Cheol Chung, Sang Kil Lee
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    Sang Kil Lee
    Clinical Endoscopy.2019; 52(2): 91.     CrossRef
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    Violet Kayamba, Aaron Shibemba, Kanekwa Zyambo, Douglas C. Heimburger, Douglas R. Morgan, Paul Kelly, Esaki M. Shankar
    PLOS ONE.2017; 12(9): e0184272.     CrossRef
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Case Report
Simultaneous Esophageal and Gastric Metastases from Lung Cancer
Jae Yong Park, Seung Wook Hong, Joo Young Lee, Ji Hye Kim, Jin Woo Kang, Hyun Woo Lee, Jong Pil Im
Clin Endosc 2015;48(4):332-335.   Published online July 24, 2015
DOI: https://doi.org/10.5946/ce.2015.48.4.332
AbstractAbstract PDFPubReaderePub

We report of a patient with metastatic adenocarcinoma of the esophagus and stomach from lung cancer. The patient was a 68-year-old man receiving radiotherapy and chemotherapy for stage IV lung cancer, without metastases to the gastrointestinal (GI) tract at the time of the initial diagnosis. During the treatment period, dysphagia and melena newly developed. Upper GI endoscopy revealed geographic erosion at the distal esophagus and multiple volcano-shaped ulcers on the stomach body. Endoscopic biopsy was performed for each lesion. To determine whether the lesions were primary esophageal and gastric cancer masses or metastases from the lung cancer, histopathological testing including immunohistochemical staining was performed, and metastasis from lung cancer was confirmed. The disease progressed despite chemotherapy, and the patient died 5 months after the diagnosis of lung cancer. This is a case report of metastatic adenocarcinoma in the esophagus and stomach, which are very rare sites of spread for lung cancer.

Citations

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  • Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis
    Dong Tang, Jianjian Lv, Zhijing Liu, Shuhui Zhan, Yuqiang Gao
    Frontiers in Oncology.2022;[Epub]     CrossRef
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    Kanthi Rekha Badipatla, Niharika Yadavalli, Trupti Vakde, Masooma Niazi, Harish K Patel
    World Journal of Gastrointestinal Oncology.2017; 9(3): 129.     CrossRef
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Review
The Role of Endosonography in the Staging of Gastrointestinal Cancers
Jin Woong Cho
Clin Endosc 2015;48(4):297-301.   Published online July 24, 2015
DOI: https://doi.org/10.5946/ce.2015.48.4.297
AbstractAbstract PDFPubReaderePub

Endosonography (EUS) enables the acquisition of clear images of the gastrointestinal tract wall and the surrounding structures. EUS enables much greater accuracy for staging decisions compared to computed tomography. Surgery for esophageal cancer has a high rate of morbidity and mortality, and it is important to decide on an appropriate treatment method through pre-surgical evaluation. Minimal invasive surgery is widely used for the treatment of gastrointestinal cancer, and endoscopic submucosal dissection is a safe treatment method for early cancer of the gastrointestinal tract that does not result in lymph node metastasis. EUS is essential for pre-surgical evaluation for all esophageal cancers. The use of EUS can effectively reduce unnecessary surgeries and thereby allow for appropriate treatment planning for patients. A number of different diagnostic modalities are available, but EUS is still the mainstay for pre-surgical evaluation of esophageal cancer. The role of EUS for early stomach cancer treatment as a tool for determining the need for endoscopic resection and for pre-surgical assessment is increasing.

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Case Report
Delayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer
Soo Hoon Kang, Kyungho Lee, Hyun Woo Lee, Ga Eun Park, Yun Soo Hong, Byung-Hoon Min
Clin Endosc 2015;48(3):251-255.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.251
AbstractAbstract PDFPubReaderePub

Delayed perforation is a very rare complication of endoscopic submucosal dissection (ESD), with a reported incidence of 0.1% to 0.45%. Few reports exist on the clinical features and outcomes of delayed perforation after ESD, and it is unclear whether the optimal management strategy is emergency surgery or endoscopic closure with conservative treatment. Here, we report two cases of delayed perforation occurring after ESD for early gastric cancer. In both cases, lesions were located in the antrum, and tumor depths were confined to the mucosal layer. Total procedure times for ESD were 25 and 45 minutes, respectively. Because delayed perforation may be associated with excessive thermal damage and necrosis of the muscle layer, treatment with emergency surgery should be used instead of conservative management in cases of delayed perforation after ESD.

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Original Article
The Efficacy of an Endoscopic Grasp-and-Traction Device for Gastric Endoscopic Submucosal Dissection: An Ex Vivo Comparative Study (with Video)
Dirk W. Schölvinck, Osamu Goto, Jacques J. G. H. M. Bergman, Naohisa Yahagi, Bas L. A. M. Weusten
Clin Endosc 2015;48(3):221-227.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.221
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims

To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD).

Methods

Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL-) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed.

Results

En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm2 vs. 0.91 min/cm2), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm2 vs. 0.68 [EL-] min/cm2, p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm2 vs. 1.01 [EL-] min/cm2, p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL-) min/cm2 (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm2 vs. 0.68 [EL-] min/cm2, p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm2 vs. 0.38 [EL-] min/cm2, p=0.03).

Conclusions

In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be excluded.

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Focused Review Series: Endoscopic Management of Upper Gastrointestinal Bleeding
Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer
Young-Il Kim, Il Ju Choi
Clin Endosc 2015;48(2):121-127.   Published online March 27, 2015
DOI: https://doi.org/10.5946/ce.2015.48.2.121
AbstractAbstract PDFPubReaderePub

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated.

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Focused Review Series: Endoscopic Screening and Surveillance for Gastrointestinal Cancers
Endoscopic Gastric Cancer Screening and Surveillance in High-Risk Groups
Il Ju Choi
Clin Endosc 2014;47(6):497-503.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.497
AbstractAbstract PDFPubReaderePub

Gastric cancer remains a major cancer problem world-wide and future incidence will likely increase due to rapidly aging population demographics. Population-based screening is being undertaken in Korea and Japan, where gastric cancer incidence rates are high, and seems to be effective in reducing mortality from gastric cancer. However, such strategies are difficult to implement in countries with a low incidence or limited resources. Thus, screening strategies should be directed towards high-risk population subgroups. Gastric cancer has a relatively long mean sojourn time, and prognosis of early-stage disease is excellent. In general population, screening at 2-year interval in Korea seems to be effective for early-stage diagnosis. In subjects with atrophic gastritis or intestinal metaplasia, surveillance is recommended at 1 to 3 years intervals according to European and Japanese recommendation. Screening intervals for family members with sporadic gastric cancer has not yet been adequately evaluated, but 1-year interval is recommended for hereditary diffuse gastric cancer family-members. Gastric cancer patients treated by endoscopic resection are the highest-risk group, and 1-year interval surveillance can detect most metachronous gastric cancers at an early stage. Future gastric cancer surveillance strategies using endoscopy should be guided by risk-stratification assessment, and further refinement of optimal surveillance intervals is needed.

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Screening for Gastric Cancer: The Usefulness of Endoscopy
Kui Son Choi, Mina Suh
Clin Endosc 2014;47(6):490-496.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.490
AbstractAbstract PDFPubReaderePub

Gastric cancer screening is common in countries with high prevalence rates of gastric cancer. However, data supporting the effectiveness of gastric cancer screening are lacking. Thus, the aim of this review was to examine the current evidence on gastric cancer screening. Herein, we reviewed radiographic and endoscopic tests as methods of gastric cancer screening. Previous cohort studies and case-control studies have demonstrated reduced gastric cancer mortality in study populations that had undergone gastric cancer screening with radiographic tests. Recently, a case-control study in Japan reported a 30% reduction in gastric cancer mortality when screening was undertaken via endoscopy. Also, endoscopic screening for gastric cancer exhibited higher sensitivity and specificity than radiographic screening. Moreover, most cost-effectiveness analyses on the best strategy for detecting early gastric cancer have generally concluded that endoscopy is more cost-effective than radiographic testing. Although data on the impact of endoscopy screening programs on gastric cancer mortality are limited, recent study results suggest that gastric cancer screening by endoscopy in average-risk populations performs better than radiography screening. Further evaluation of the impact of these screening methods should take into account cost and any associated reduction in gastric cancer mortality.

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Prevention Strategies for Gastric Cancer: A Global Perspective
Jin Young Park, Lawrence von Karsa, Rolando Herrero
Clin Endosc 2014;47(6):478-489.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.478
AbstractAbstract PDFPubReaderePub

Despite the substantial burden of gastric cancer worldwide, population strategies for primary prevention have not been introduced in any country. Recognizing the causal role of Helicobacter pylori infection, there is increasing interest in population-based programs to eradicate the infection to prevent gastric cancer. Nonetheless, the paucity of available evidence on feasibility and effectiveness has prevented implementation of this approach. There are very few secondary prevention programs based on screening with endoscopy or radiography, notably in the Republic of Korea and Japan, two of the countries with the highest incidence rates of gastric cancer. In Korea, where the organized screening program is in place, survival rate of gastric cancer is as high as 67%. More research is needed to quantify the specific contribution of the screening program to observed declines in mortality rates. Gastric cancer screening is unlikely to be feasible in many Low-Middle Income Countries where the gastric cancer burden is high. Prevention strategies are still under development and the optimal approach may differ depending on local conditions and societal values. The present review gives an overview of the etiology and burden of the disease, and possible prevention strategies for countries and regions confronted with a significant burden of disease.

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Focused Review Series: Endoscopic and Molecular Imaging of Premalignant GI Lesions, Part II
Confocal Laser Endomicroscopy and Molecular Imaging in Barrett Esophagus and Stomach
Kwi-Sook Choi, Hwoon-Yong Jung
Clin Endosc 2014;47(1):23-30.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.23
AbstractAbstract PDFPubReaderePub

Detection of premalignant lesions in the upper gastrointestinal tract may facilitate endoscopic treatment and improve survival. Despite technological advances in white light endoscopy, its ability to detect premalignant lesions remains limited. Early detection could be improved by using advanced endoscopic imaging techniques, such as magnification endoscopy, narrow band imaging, i-scanning, flexible spectral imaging color enhancement, autofluorescence imaging, and confocal laser endomicroscopy (CLE), as these techniques may increase the rate of detection of mucosal abnormalities and allow optical diagnosis. The present review focuses on advanced endoscopic imaging techniques based on the use of CLE for diagnosing premalignant lesions in Barrett esophagus and stomach.

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  • The Use of Confocal Laser Endomicroscopy in Diagnosing Barrett’s Esophagus and Esophageal Adenocarcinoma
    Jitka Vaculová, Radek Kroupa, Zdeněk Kala, Jiří Dolina, Tomáš Grolich, Jakub Vlažný, David Said, Lydie Izakovičová Hollá, Petra Bořilová Linhartová, Vladimír Procházka, Marek Joukal, Petr Jabandžiev, Ondřej Slabý, Lumír Kunovský
    Diagnostics.2022; 12(7): 1616.     CrossRef
  • Probe‐based confocal laser endomicroscopy versus biopsies in the diagnostics of oesophageal and gastric lesions: A prospective, pathologist‐blinded study
    Marek Kollar, Jana Krajciova, Lucia Prefertusova, Eva Sticova, Jana Maluskova, Zuzana Vackova, Jan Martinek
    United European Gastroenterology Journal.2020; 8(4): 436.     CrossRef
  • 7,189 View
  • 59 Download
  • 5 Web of Science
  • 2 Crossref
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Case Reports
A Case of Early Gastric Cancer with Solitary Metastasis to the Pleura
Eun Jung Hwang, Jae Young Jang, Yun Wha Kim, Seok Ho Dong, Hyo Jong Kim, Byung-Ho Kim, Young Woon Chang
Clin Endosc 2013;46(6):666-670.   Published online November 19, 2013
DOI: https://doi.org/10.5946/ce.2013.46.6.666
AbstractAbstract PDFPubReaderePub

The incidence of early gastric cancer (EGC) has increased to >50% in Korea owing to a higher detection rate caused by rapid advances in diagnostic instrumentation. EGC with distant metastasis has been rarely reported. Here, we report the case of a 76-year-old woman in whom general EGC was initially diagnosed by endoscopy and endoscopic ultrasonography. She subsequently underwent endoscopic submucosal dissection (ESD). Histological examination of the ESD specimen revealed that neoplastic cells were located predominantly in the submucosal layer and submucosal lymphatic channels. Metastatic cancer cells were also found in the pleural effusion. After conducting all analyses, including immunohistochemical staining, we concluded that the patient had primary EGC with pleural metastasis.

Citations

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  • Clinicopathological Characteristics and Prognosis of cT1N0M1 Gastric Cancer: A Population-Based Study
    Jianbo Han, Junhao Tu, Chaoyang Tang, Xiang Ma, Chi Huang
    Disease Markers.2019; 2019: 1.     CrossRef
  • The Value of Computed Tomography in Preoperative N Staging of Early Gastric Cancer Meeting the Endoscopic Resection Criteria
    Su Jin Kim, Tae Un Kim, Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Hyeong Seok Nam, Dae Gon Ryu
    The Korean Journal of Gastroenterology.2017; 70(1): 21.     CrossRef
  • An Early Gastric Cancer Patient With Pleural Metastatic Recurrence
    Asako Shimazaki, Takao Katsube, Kentaro Yamaguchi, Atsuko Usuda, Minoru Murayama, Soihi Konno, Shinichi Asaka, Hajime Yokomizo, Kazuhiko Yoshimatsu, Shunichi Shiozawa, Takeshi Shimakawa, Yoshihiko Naritaka
    International Surgery.2016; 101(1-2): 84.     CrossRef
  • Collagen Nanofibers Facilitated Presynaptic Maturation in Differentiated Neurons from Spinal-Cord-Derived Neural Stem Cells through MAPK/ERK1/2-Synapsin I Signaling Pathway
    Yanling Yin, Peng Huang, Zhu Han, Guojun Wei, Changwei Zhou, Jian Wen, Bo Su, Xiaoqin Wang, Yansong Wang
    Biomacromolecules.2014; 15(7): 2449.     CrossRef
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Gastrointestinal Cancers in a Peutz-Jeghers Syndrome Family: A Case Report
Sang Hee Song, Kun Woo Kim, Won Hee Kim, Chang Il Kwon, Kwang Hyun Ko, Ki Baik Hahm, Pil Won Park, Sung Pyo Hong
Clin Endosc 2013;46(5):572-575.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.572
AbstractAbstract PDFPubReaderePub

A 17-year-old man was diagnosed as Peutz-Jeghers syndrome (PJS) because of pigmented lip and multiple gastrointestinal polyps. He had anemia and underwent polypectomy on the duodenum and colon. His maternal family members were patients with PJS. His mother used to be screened with endoscopy to remove large polyps. One and half years later, he underwent jejunal segmental resection due to intussusceptions. He underwent endoscopic polypectomy every 2 to 3 years. When he was 23 years old, high-grade dysplasia was found in colonic polyp and his mother underwent partial pancreatectomy due to intraductal papillary mucinous carcinoma. When he was 27 years old, diffuse gastric polyps on the greater curvature of corpus expanded and grew. Therefore, wide endoscopic polypectomy was done. Histological examination revealed focal intramucosal carcinoma and low-grade dysplasia in hamartomatous polyps. We report cases of cancers occurred in first-degree relatives with PJS.

Citations

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  • Familial and hereditary gastric cancer, an overview
    Fátima Carneiro
    Best Practice & Research Clinical Gastroenterology.2022; 58-59: 101800.     CrossRef
  • Small bowel intussusception and concurrent sigmoid polyp with malignant transformation in Peutz–Jeghers syndrome
    Maidah Algarni, Enas Raml, Nora Trabulsi, Mohammed Nassif
    Journal of Surgical Case Reports.2019;[Epub]     CrossRef
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    Rudolf Repak, Darina Kohoutova, Miroslav Podhola, Stanislav Rejchrt, Marek Minarik, Lucie Benesova, Michal Lesko, Jan Bures
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    Monika Vyas, Xiu Yang, Xuchen Zhang
    Clinical Medicine Insights: Gastroenterology.2016; 9: CGast.S38452.     CrossRef
  • Giant rectal polyp prolapse in an adult patient with the Peutz-Jeghers syndrome
    Ana Delfina Cano-Contreras, Arturo Meixueiro-Daza, Peter Grube-Pagola, Jose Maria Remes-Troche
    BMJ Case Reports.2016; : bcr2016215629.     CrossRef
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    Jin Young Park, Lawrence von Karsa, Rolando Herrero
    Clinical Endoscopy.2014; 47(6): 478.     CrossRef
  • 6,754 View
  • 58 Download
  • 6 Crossref
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Two Cases of Diffuse Large B-Cell Lymphomas in the Cervical Lymph Nodes in Patients with Low-Grade Gastric Marginal Zone B-Cell Lymphoma (MALT Lymphoma)
Ji Hoon Jung, Hwoon-Yong Jung, Hwan Yoon, Jae Kwang Lee, Ji Hoon Kang, Sung Jin Jeon, Young-Su Park, Jin-Ho Kim
Clin Endosc 2013;46(3):288-292.   Published online May 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.3.288
AbstractAbstract PDFPubReaderePub

It is well known that gastric mucosa-associated lymphoid tissue (MALT) lymphomas are associated with Helicobacter pylori infection and have a good prognosis. However, although rare, these low-grade lymphomas transform to the high-grade diffuse large B-cell lymphomas (DLBCLs) which are thought to be the important cause of death in patients with MALT lymphoma. We report two cases of DLBCLs in the cervical lymph nodes that occurred 10 years and 1.5 years after diagnosing low-grade gastric MALT lymphomas.

Citations

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  • Primary Pulmonary Diffuse Large B Cell Non-Hodgkin’s Lymphoma: A Case Report and Literature Review
    Ziqiang Zhu, Wei Liu, Omar Mamlouk, James E. O'Donnell, Debabrata Sen, Boris Avezbakiyev
    American Journal of Case Reports.2017; 18: 286.     CrossRef
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  • 32 Download
  • 1 Crossref
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