Clinical Endoscopy

Original Article

Clinical efficacy of endoscopic resection for subepithelial tumors in the esophagogastric junction and gastric cardia: an observational study: Sang Jin Park, Min A Yang, Jae Sun Song, Won Dong Lee, Myoung Jin Ju, Jin Woong Cho; Received July 8, 2025 Accepted August 25, 2025 Published online January 7, 2026; DOI: https://doi.org/10.5946/ce.2025.219 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Gastric subepithelial tumors (SETs) located near the esophagogastric junction (EGJ) are difficult to treat surgically and endoscopically. This study aimed to evaluate the effectiveness and safety of endoscopic resection of SETs growing from the muscularis propria located in the EGJ and gastric cardia.
Methods
This study included 26 consecutive patients who underwent endoscopic resection of 27 gastric SETs between November 2012 and May 2023.
Results
Of the 27 gastric SETs, 3 and 24 were located in the EGJ and gastric cardia, respectively. The mean tumor size, operative time, and duration of hospitalization were 21 (6–52) mm, 35.4 (9–65) minutes, and 4.2 (3–7) days, respectively. Endoscopic resection of the SETs achieved an en bloc resection rate of 100% (27/27) and a complete resection rate of 88.9% (24/27). Pathological examination confirmed four gastrointestinal stromal tumors and 23 leiomyomas. No bleeding, peritonitis, or abdominal infection occurred after the endoscopic resections. Residual lesions were identified in three patients (11.1%). No recurrence was observed during follow-up (range, 3–24 months).
Conclusions
SETs in the EGJ and gastric cardia can be resected effectively, even if they originate from the muscularis propria layer.

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Reviews

Recent advancement in endoscopic diagnosis for risk stratification of gastric cancer: Takuma Hiramatsu, Naomi Kakushima, Hikaru Kuribara, Ryohei Miyata, Hideki Nakagawa, Hiroyuki Hisada, Dai Kubota, Yuko Miura, Hiroya Mizutani, Daisuke Ohki, Chihiro Takeuchi, Seiichi Yakabi, Yosuke Tsuji, Nobutake Yamamichi, Mitsuhiro Fujishiro; Clin Endosc 2025;58(6):787-796. Published online July 10, 2025; DOI: https://doi.org/10.5946/ce.2024.355

Abstract PDF PubReader ePub: Approximately 90% of cases of gastric cancer (GC) are caused by Helicobacter pylori infection, and screening esophagogastroduodenoscopy is effective for secondary prevention of GC. Endoscopic findings of the stomach due to H. pylori infection vary widely, and the risk of GC varies according to each finding. GC risk is evaluated by combining endoscopic and histopathological findings. In the operative link on gastritis assessment and operative link on gastric intestinal metaplasia assessment staging, GC risk is determined by histopathological evaluation. In the endoscopic grading of gastric intestinal metaplasia, Kyoto classification, and modified Kyoto classification, the risk is considered based on endoscopic findings. However, evaluating endoscopic findings is challenging because the evaluation varies depending on the skill of the endoscopist. Similarly, histopathological findings can be assessed differently by different pathologists. Histopathological evaluation by biopsy carries a risk of bleeding; thus, simpler and less-invasive risk stratification methods are desirable. Artificial intelligence for risk stratification, which has the potential for improved accuracy and consistency, has been developed for endoscopic and histopathological evaluations. Appropriate GC risk stratification would benefit the economy and patients, and further evaluation of surveillance intervals tailored to individual risks is warranted.

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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

Abstract PDF PubReader ePub

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

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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

Abstract PDF PubReader ePub

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.

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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

Abstract PDF PubReader ePub

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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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
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Diffuse-type Gastric Cancer
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Raquel Ortigão, Diogo Libânio, Mário Dinis‐Ribeiro
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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

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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

Abstract PDF PubReader ePub

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
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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
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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

Abstract PDF PubReader ePub

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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Bohyun Jang, Sangmin Lee, Gyuhyun Park, You Suk Suh, Jae Il Chung, Donghui Kim
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A systematic review and meta-analysis of incidence trends and risk factors for metachronous gastric lesions following endoscopic resection
Meixi Gong, Xuanbing Li, Ruijun Xin, Yuansen Ma, Xiaomei Wu, Yan Zhao, Yu Sun, Bo Zhu
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Ya-hui Sun, Yan Ma, Liang Chen, Hai-rong Li, Xian-Wen Liang, Xiong-hui He, Ke-jian Zou
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Yudai Chen, Chaoying Fang, Jianmin Huang, Hui Pan, Liping He, Chenlin Zhuang, Xiaoling Zheng
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Sang Hoon Kim
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Characteristics of multiple early gastric cancer and gastric high-grade intraepithelial neoplasia
Yudai Chen, Liping He, Xiaoling Zheng
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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
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Yeon-Ji Kim, Jaeyoung Kim, Woo Chul Chung
The Korean Journal of Internal Medicine.2022; 37(4): 768. CrossRef
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Su Jin Kim, Cheol Woong Choi
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Immunohistochemical Expression of Epithelial-Mesenchymal Transition Markers in Early Gastric Cancer: Cancer Tissue versus Noncancer Tissue
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Cheol Min Shin
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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

Abstract PDF PubReader ePub

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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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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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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San-Dong Gong, Huan Li, Yi-Bin Xie, Xiao-Hui Wang
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Hang Lak Lee
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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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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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Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline)
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36 Crossref

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

Abstract PDF PubReader ePub

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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Hasan Terzi, Unal Turkay, Navdar Dogus Uzun, Mehmet Salıcı
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Hwoon-Yong Jung
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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

Abstract PDF PubReader ePub

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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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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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.

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Gastric Diverticulum: A Comprehensive Review
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

Abstract PDF PubReader ePub

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.

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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

Abstract PDF PubReader ePub

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.

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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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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

Abstract PDF Supplementary Material PubReader ePub

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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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

Abstract PDF PubReader ePub

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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173 Download
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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

Abstract PDF PubReader ePub

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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Sijunzi Decoction Inhibits Stemness by Suppressing β-Catenin Transcriptional Activity in Gastric Cancer Cells
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Silencing lncRNA XIST exhibits antiproliferative and proapoptotic effects on gastric cancer cells by up-regulating microRNA-132 and down-regulating PXN
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Aging.2021; 13(10): 14469. CrossRef
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Reproductive Biology.2021; 21(3): 100534. CrossRef
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Aging.2021; 13(17): 21451. CrossRef
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Journal of Gastrointestinal Cancer.2020; 51(1): 267. CrossRef
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Journal of Cellular Biochemistry.2020; 121(10): 4052. CrossRef
Human adipose-derived mesenchymal stem cells inhibit proliferation and induce apoptosis of human gastric cancer HGC-27 cells
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OncoTargets and Therapy.2020; Volume 13: 1365. CrossRef
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OncoTargets and Therapy.2020; Volume 13: 4009. CrossRef
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International Journal of Molecular Sciences.2020; 21(11): 4012. CrossRef
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Scientific Reports.2020;[Epub] CrossRef
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Journal of Clinical Laboratory Analysis.2019;[Epub] CrossRef
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Journal of Translational Medicine.2019;[Epub] CrossRef
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Journal of Ethnopharmacology.2019; 235: 56. CrossRef
CD36 mediates palmitate acid-induced metastasis of gastric cancer via AKT/GSK-3β/β-catenin pathway
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Journal of Experimental & Clinical Cancer Research.2019;[Epub] CrossRef
Frequency of CDH1 germline variants and contribution of dietary habits in early age onset gastric cancer patients in Brazil
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Palmitate acid promotes gastric cancer metastasis via FABP5/SP1/UCA1 pathway
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Cancer Cell International.2019;[Epub] CrossRef
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Downregulation of IQGAP1 inhibits epithelial‐mesenchymal transition via the HIF1α/VEGF‐A signaling pathway in gastric cancer
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Journal of Cellular Biochemistry.2019; 120(9): 15790. CrossRef
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European Journal of Cancer Prevention.2019; 28(5): 397. CrossRef
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GLI1 activation by non-classical pathway integrin αvβ3/ERK1/2 maintains stem cell-like phenotype of multicellular aggregates in gastric cancer peritoneal metastasis
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Journal of Clinical Gastroenterology.2019; 53(10): 703. CrossRef
Clinical values of circular RNA 0000181 in the screening of gastric cancer
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Protein arginine methyltransferase 1 coordinates the epithelial-mesenchymal transition/proliferation dichotomy in gastric cancer cells
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Experimental Cell Research.2018; 362(1): 43. CrossRef
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Cancer Gene Therapy.2018; 25(3-4): 58. CrossRef
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Oncogene.2018; 37(29): 3953. CrossRef
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Journal of Hematology & Oncology.2018;[Epub] CrossRef
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World Journal of Gastroenterology.2018; 24(40): 4578. CrossRef
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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

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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

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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

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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.

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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

9,428 View
58 Download
4 Crossref

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

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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.

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Cutaneous Paraneoplastic Syndromes in Colorectal Cancer Patients
Vlad Alexandru Ionescu, Gina Gheorghe, Teodor Florin Georgescu, Vlad Buica, Mihai-Stefan Catanescu, Iris-Andreea Cercel, Beatrice Budeanu, Mihail Budan, Ancuta Nastac, Ninel Iacobus Antonie, Daniel O. Costache, Raluca Simona Costache, Nicolae Bacalbasa, L
Gastrointestinal Disorders.2025; 7(1): 8. CrossRef
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
The first European family with gastric adenocarcinoma and proximal polyposis of the stomach: case report and review of the literature
Rudolf Repak, Darina Kohoutova, Miroslav Podhola, Stanislav Rejchrt, Marek Minarik, Lucie Benesova, Michal Lesko, Jan Bures
Gastrointestinal Endoscopy.2016; 84(4): 718. CrossRef
Gastric Hamartomatous Polyps—Review and Update
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; 2016: bcr2016215629. CrossRef
Prevention Strategies for Gastric Cancer: A Global Perspective
Jin Young Park, Lawrence von Karsa, Rolando Herrero
Clinical Endoscopy.2014; 47(6): 478. CrossRef

8,931 View
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7 Crossref

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

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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.

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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

8,220 View
37 Download
1 Crossref

Review

Is Image-Enhanced Endoscopy Useful for the Diagnosis and Treatment of Gastrointestinal Tumor?: Kyoung Oh Kim, Yang Suh Ku; Clin Endosc 2013;46(3):248-250. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.248

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Since the introduction of endoscopic submucosal dissection method for the treatment of early gastric cancer, endoscopic treatment of early gastric cancer has increased exponentially. Accordingly, early diagnosis of cancerous or precancerous lesion has become one of the most important missions for endoscopists. The desire to improve diagnostic capability of white light endoscopy led to the development of new imaging techniques called "image enhanced endoscopy." The usefulness of these image enhanced endoscopy has not been proven yet, although there are several studies reporting diagnostic superiority of these new imaging methods over white light endoscopy. Among these new imaging modalities, narrow band image (NBI) with magnification endoscopy has been most widely used and studied. This manuscript will be focused on the NBI with magnification endoscopy.

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Comparison Trial between I-SCAN-Optical Enhancement and Chromoendoscopy for Evaluating the Horizontal Margins of Gastric Epithelial Neoplasms
Myeongseok Koh, Jong Yoon Lee, Song-Hee Han, Seong Woo Jeon, Su Jin Kim, Joo Young Cho, Seong Hwan Kim, Jae Young Jang, Gwang Ho Baik, Jin Seok Jang
Gut and Liver.2023; 17(2): 234. CrossRef
Comparison of the Diagnostic Usefulness of Conventional Magnification and Near-focus Methods with Narrow-band Imaging for Gastric Epithelial Tumors
Hee Yoon Jang, Su Jin Hong, Jae Pil Han, Se Kyung Park, Han Kyeol Yun, Bong Jin Ko
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2015; 15(1): 39. CrossRef
A comparison of NBI and WLI cystoscopy in detecting non-muscle-invasive bladder cancer: A prospective, randomized and multi-center study
Zhangqun Ye, Jia Hu, Xiaodong Song, Fan Li, Xuetao Zhao, Shan Chen, Xiaofeng Wang, Dalin He, Jinhai Fan, Dingwei Ye, Jinchun Xing, Tiejun Pan, Dongwen Wang
Scientific Reports.2015;[Epub] CrossRef
Interobserver Agreement in Using Magnifying Narrow Band Imaging System
Il Ju Choi
Clinical Endoscopy.2014; 47(1): 1. CrossRef
Efficacy of i-Scan Imaging for the Detection and Diagnosis of Early Gastric Carcinomas
Junichi Nishimura, Jun Nishikawa, Munetaka Nakamura, Atsushi Goto, Kouichi Hamabe, Shinichi Hashimoto, Takeshi Okamoto, Masato Suenaga, Yusuke Fujita, Yoshihiko Hamamoto, Isao Sakaida
Gastroenterology Research and Practice.2014; 2014: 1. CrossRef
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Kwang An Kwon, Il Ju Choi, Eun Young Kim, Seok Ho Dong, Ki Baik Hahm
Clinical Endoscopy.2013; 46(3): 203. CrossRef
Image-Enhanced Endoscopy for Diagnosis and Treatment of Gastrointestinal Tumor
Viroj Wiwanitkit
Clinical Endoscopy.2013; 46(4): 423. CrossRef

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Case Report

Signet-Ring Cell Carcinoma Mimicking Gastric Gastrointestinal Stromal Tumor Confirmed by Endoscopic Ultrasound-Guided Trucut Biopsy: Seong Hun Kim, Soo Teik Lee, Byung Jun Jeon, In Hee Kim, Sang Wook Kim, Seung Ok Lee, Dae Ghon Kim, Ho Sung Park; Clin Endosc 2012;45(4):421-424. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.421

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A submucosal gastric adenocarcinoma, especially the signet ring cell type, is rare. The histologic evaluation techniques for this lesion has not been established; however, histologic confirmation is very important for decision of treatment method. Here, we report a 57-year-old man with a 12-cm gastric submucosal signet ring cell type adenocarcinoma, diagnosed by an endoscopic ultrasound-guided Trucut biopsy and immunochemical studies. This case suggests that the endoscopic ultrasound-guided Trucut biopsy might be a useful diagnostic method in cases of gastric adenocarcinoma with features of gastrointestinal stromal tumor.

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Synchronous neuroendocrine tumor and signet ring cell carcinoma in the stomach: a case report and review of literature
Jian Han, Ying Wang, Hanlin Mu, Jingmei Liu
Frontiers in Medicine.2025;[Epub] CrossRef
Subepithelial Tumor-like Gastric Cancer
Kyoungwon Jung, Moo In Park
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Presentation of signet ring cell type at carcinoma ventriculi of the patient aged 20 years old
Afrim Avdaj, Ugur Gozalan, Nexhmi Hyseni, Hatim Baxhaku, Sherif Krasniqi, Shpejtim Rramanaj
Case Reports in Clinical Medicine.2013; 02(06): 358. CrossRef

8,223 View
56 Download
3 Crossref

Focused Review Series: Globalization and Universalization of ESD

Counter Traction Makes Endoscopic Submucosal Dissection Easier: Tsuneo Oyama; Clin Endosc 2012;45(4):375-378. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.375

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Poor counter traction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Good counter traction allows dissections to be performed more quickly and safely. Position change, which utilizes gravity, is the simplest method to create a clear field of vision. It is useful especially for esophageal and colon ESD. The second easiest method is clip with line method. Counter traction made by clip with line accomplishes the creation of a clear field of vision and suitable counter traction thereby making ESD more efficient and safe. The author published this method in 2002. The name ESD was not established in those days; the name cutting endoscopic mucosal resection (EMR) or EMR with hook knife was used. The other traction methods such as external grasping forceps, internal traction, double channel scope, and double scopes method are introduced in this paper. A good strategy for creating counter traction makes ESD easier.

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Digestive Diseases and Sciences.2023; 68(9): 3614. CrossRef
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World Journal of Gastrointestinal Endoscopy.2023; 15(10): 584. CrossRef
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VideoGIE.2023; 8(12): 509. CrossRef
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Darshan Parekh, Yohei Minato, Ken Ohata, Ryoju Negishi, Nao Takeuchi, Shunya Takayanagi, Marina Kim, Suryaprakash Bhandari
VideoGIE.2023; 8(12): 515. CrossRef
Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer
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World Journal of Gastrointestinal Endoscopy.2023; 15(11): 658. CrossRef
The efficacy and safety of multi-loop traction device for gastric endoscopic submucosal dissection: a single center prospective pilot study
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Scientific Reports.2023;[Epub] CrossRef
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Surgical Endoscopy.2022; 36(1): 321. CrossRef
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DEN Open.2022;[Epub] CrossRef
Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?
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World Journal of Gastroenterology.2022; 28(1): 1. CrossRef
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Endoscopy.2022; 54(10): E542. CrossRef
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Endoscopic Submucosal Dissection for Gastric Tube Carcinoma after Esophagectomy Contributes to Long-Term Outcomes
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Canadian Journal of Gastroenterology and Hepatology.2022; 2022: 1. CrossRef
Factors of technical difficulty in conventional and traction-assisted esophageal endoscopic submucosal dissection
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Gastroenterology Research and Practice.2022; 2022: 1. CrossRef
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Gastrointestinal Endoscopy.2022; 95(5): 918. CrossRef
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Randomized study of two endo-knives for the traction-assisted endoscopic submucosal dissection of early esophageal squamous cell carcinoma
Yoshiyasu Kitagawa, Asuka Ishigaki, Rino Nishii, Osamu Sugita, Takuto Suzuki
Scientific Reports.2022;[Epub] CrossRef
Traction method versus conventional endoscopic submucosal dissection for gastric epithelial neoplasms
Jun Kinoshita, Mikitaka Iguchi, Takao Maekita, Ke Wan, Toshio Shimokawa, Kazuhiro Fukatsu, Daisaku Ito, Shinya Taki, Masayuki Nishimoto, Masaki Takao, Yasuto Tabata, Yousuke Mukai, Masayuki Kitano
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Per anal endoscopic myectomy for rectal neuroendocrine tumor invading submucosal deep layer and ending at the muscle layer
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Successful resection of gastric cancer arising from a heterotopic gastric gland in the submucosa by endoscopic submucosal dissection
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Clinical Case Reports.2022;[Epub] CrossRef
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Surgical Endoscopy.2022; 36(11): 8021. CrossRef
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Experimental and Clinical Gastroenterology.2022; (5): 64. CrossRef
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Experimental and Clinical Gastroenterology.2022; (5): 110. CrossRef
Optimal traction direction in traction-assisted gastric endoscopic submucosal dissection
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World Journal of Gastrointestinal Endoscopy.2022; 14(11): 667. CrossRef
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Journal of Nippon Medical School.2021; 88(1): 17. CrossRef
Usefulness of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in elderly patients: a single-center retrospective cohort study
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Japanese Journal of Clinical Oncology.2021; 51(6): 895. CrossRef
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Gastroenterology Research and Practice.2021; 2021: 1. CrossRef
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JGH Open.2021; 5(7): 734. CrossRef
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Endoscopy International Open.2021; 09(06): E881. CrossRef
Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection
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Journal of Clinical Medicine.2021; 10(11): 2511. CrossRef
Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice
Tara Keihanian, Mohamed O Othman
Clinical and Experimental Gastroenterology.2021; Volume 14: 317. CrossRef
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Endoscopy International Open.2021; 09(11): E1720. CrossRef
Endoscopic Submucosal Dissection Using EndoTrac, a Novel Traction Device
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Journal of Gastrointestinal Surgery.2020; 24(2): 307. CrossRef
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Gastrointestinal Endoscopy.2020; 91(1): 185. CrossRef
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Digestive Endoscopy.2020;[Epub] CrossRef
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Gastrointestinal Endoscopy.2020; 91(1): 66. CrossRef
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Tak Lit Derek Fung, Chi Woo Samuel Chow, Pak Tat Chan, Kam Hung Kwok
Surgical Endoscopy.2020; 34(9): 3766. CrossRef
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Clinical Endoscopy.2020; 53(3): 286. CrossRef
EMR/ESD: Techniques, Complications, and Evidence
Yahya Ahmed, Mohamed Othman
Current Gastroenterology Reports.2020;[Epub] CrossRef
Clip with thread attachment prior to incision – new strategy for traction-assisted esophageal endoscopic submucosal dissection
Shuichi Miyamoto, Tomohiko R. Ohya, Masayuki Higashino, Kazuteru Hatanaka, Yoshiya Yamamoto, Hirohito Naruse, Naoya Sakamoto
Endoscopy.2020; 52(09): E328. CrossRef
Wider downward angle of the GIF-H290T endoscope improves operability in esophageal endoscopic submucosal dissection
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Techniques and Innovations in Gastrointestinal Endoscopy.2020; 22(3): 91. CrossRef
Side-loop method easily enables dual traction during gastric endoscopic submucosal dissection
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Endoscopy International Open.2020; 08(10): E1439. CrossRef
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Cancers.2020; 12(10): 2849. CrossRef
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Gut and Liver.2020; 14(6): 673. CrossRef
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Yosuke Tsuji, Itaru Saito, Kazuhiko Koike
Digestive Endoscopy.2019;[Epub] CrossRef
Efficacy and safety of an internal magnet traction device for endoscopic submucosal dissection: ex vivo study in a porcine model (with video)
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Surgical Endoscopy.2019; 33(2): 663. CrossRef
Novel approach to endoscopic submucosal dissection of a large gastroesophageal junction mass by use of the mucosal bridge technique
Salmaan Jawaid, Dennis Yang, Peter V. Draganov
VideoGIE.2019; 4(6): 249. CrossRef
An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video)
Akira Dobashi, Andrew C. Storm, Louis M. Wong Kee Song, Jodie L. Deters, Charles A. Miller, Crystal J. Tholen, Christopher J. Gostout, Elizabeth Rajan
Surgical Endoscopy.2019; 33(8): 2696. CrossRef
Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia
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Clinical Endoscopy.2019; 52(3): 252. CrossRef
Novel pre‐incision clip and traction method for colorectal endoscopic submucosal dissection
Koichiro Kawaguchi, Yuichiro Ikebuchi, Hajime Isomoto
Digestive Endoscopy.2019;[Epub] CrossRef
UEG Week 2019 Poster Presentations

United European Gastroenterology Journal.2019; 7(S8): 189. CrossRef
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Surgical Endoscopy.2018; 32(1): 450. CrossRef
Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video)
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Gastrointestinal Endoscopy.2018; 87(5): 1231. CrossRef
Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study
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Digestive Endoscopy.2018; 30(4): 467. CrossRef
Gastric endoscopic submucosal dissection via gastrostoma before the second operation for esophageal perforation: A case report
Takuma Sasaki, Masaya Uesato, Takumi Ohta, Kentarou Murakami, Akira Nakano, Hisahiro Matsubara
World Journal of Gastrointestinal Endoscopy.2018; 10(6): 121. CrossRef
Traction‐assisted endoscopic submucosal dissection for a giant rectal tumor: Multiple clip‐and‐threads technique
Yasushi Yamasaki, Keita Harada, Hiroyuki Okada
Digestive Endoscopy.2018; 30(5): 697. CrossRef
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Gastrointestinal Endoscopy.2018; 88(3): 456. CrossRef
Usefulness of the clip-flap method of endoscopic submucosal dissection: A randomized controlled trial
Hiromitsu Ban, Mitsushige Sugimoto, Taketo Otsuka, Masaki Murata, Toshiro Nakata, Hiroshi Hasegawa, Osamu Inatomi, Shigeki Bamba, Akira Andoh
World Journal of Gastroenterology.2018; 24(35): 4077. CrossRef
Pulley traction-assisted colonic endoscopic submucosal dissection affords good visibility of submucosal layer
Satoki Shichijo, Kenshi Matsuno, Yoji Takeuchi, Noriya Uedo, Ryu Ishihara
VideoGIE.2018; 3(11): 358. CrossRef
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Xia Xie, Jian-Ying Bai, Chao-Qiang Fan, Xin Yang, Xiao-Yan Zhao, Hui Dong, Shi-Ming Yang, Jing Yu
Surgical Endoscopy.2017; 31(1): 462. CrossRef
Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection
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Surgical Endoscopy.2017; 31(7): 3040. CrossRef
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Surgical Endoscopy.2017; 31(11): 4838. CrossRef
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Gastrointestinal Endoscopy.2017; 86(5): 831. CrossRef
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Expert Review of Medical Devices.2017; 14(8): 657. CrossRef
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Mohamed Mortagy, Neal Mehta, Mansour A Parsi, Seiichiro Abe, Tyler Stevens, John J Vargo, Yutaka Saito, Amit Bhatt
World Journal of Gastroenterology.2017; 23(16): 2883. CrossRef
Insulated tip knife tunneling technique with clip line traction for safe endoscopic submucosal dissection of large circumferential esophageal cancer
Seiichiro Abe, Ichiro Oda, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito
VideoGIE.2017; 2(12): 342. CrossRef
Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection
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Clinical Endoscopy.2017; 50(6): 562. CrossRef
Efficacy of endoscopic submucosal dissection with dental floss clip traction for gastric epithelial neoplasia: a pilot study (with video)
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Surgical Endoscopy.2016; 30(7): 3100. CrossRef
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Digestive Diseases and Sciences.2016; 61(7): 2127. CrossRef
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Satoshi Shinozaki, Yoshikazu Hayashi, Alan Kawarai Lefor, Hironori Yamamoto
Digestive Endoscopy.2016; 28(3): 289. CrossRef
Scheme of counter-traction for Endoscopic submucosal dissection
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Progress of Digestive Endoscopy.2016; 89(1): 62. CrossRef
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World Journal of Gastroenterology.2016; 22(26): 5917. CrossRef
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Gastrointestinal Endoscopy.2015; 81(6): 1311. CrossRef
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Digestive Endoscopy.2015; 27(3): 303. CrossRef
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Surgical Endoscopy.2015; 29(12): 3491. CrossRef
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Case Report

A Case of Gastric Adenocarcinoma Arising from Ectopic Pancreas showing Gastric Outlet Obstruction: Suk Hyun Jung, M.D., Hang Lak Lee, M.D., Seung Sam Paik, M.D.^*, Hulin Han, M.D.^*, Tae Kyung Ha, M.D.^†, Byeong Bae Park, M.D., Chang Ryeol Choi, M.D. and Soon Young Song, M.D.^‡; Korean J Gastrointest Endosc 2011;42(6):373-377. Published online June 17, 2011

Abstract PDF: An ectopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We report herein a rare case of malignant transformation of ectopic pancreas in the stomach, associated with gastric outlet obstruction. A 69-year-old woman was admitted to our hospital, complaining of vomiting. Esophagogastroduodenoscopy revealed an encircling submucosal tumor-like lesion on the prepyloric antrum showing outlet obstruction. Abdominal CT showed an enhancing mass on the antrum and PET CT showed hypermetabolic wall thickening. So we performed a subtotal gastrectomy. Surgical specimens showed a moderately differentiated ductal adenocarcinoma, and the tumor cells were strongly positive for cytokeratin 7. The tumor was located close to the ectopic pancreas tissue. The tumor showed subserosal and omental invasion. There was one lymph node metastasis and no distant metastasis. The patient is being followed up in the outpatient department.

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Two Cases of Unusual Infectious Peritonitis Mimicking Peritoneal Carcinomatosis of Early Gastric Cancer: Seung Bum Lee, M.D., Ho June Song, M.D., Suk Won Choi, M.D., Hoon Yu, M.D., Jeong Hoon Lee, M.D., Hwoon-Yong Jung, M.D. and Jin-Ho Kim, M.D.; Korean J Gastrointest Endosc 2010;41(2):102-107. Published online August 30, 2010

Abstract PDF: Endoscopic mucosal resection is an organ-saving and minimally invasive treatment modality for early gastric cancer that is mucosa-confined, differentiated, and less than 2 cm in size. On pre-treatment cancer staging work-ups, unusual, benign, infiltrative peritoneal lesions can mimic metastasis of early gastric cancer, and thus lead to loss of an opportunity for the lesion to be properly treated by endoscopy. In the present cases, we report two unusual cases of infectious peritonitis, i.e., tuberculosis and paragonimiasis, which have been occurring sporadically in Korea. The two infectious lesions were confirmed by peritoneal biopsy and the gastric cancers were subsequently removed by endoscopic mucosectomy. These two cases remind us of 1) following indications for endoscopic mucosectomy, 2) the need for peritoneal biopsy for undetermined peritoneal lesions while avoiding laparoscopic gastrectomy, and 3) the coincidental occurrence of unusual infectious peritonitis with gastric cancer in our geographic region. (Korean J Gastrointest Endosc 2010;41:102-107)

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Treatment of Gastric Outlet Obstruction by Stomach Cancer with using Double-layered Pyloric Stent: Soo Hyoung Lee, M.D., Dae Hwan Kang, M.D.*, Yong Mock Bae, M.D., Cheul Woong Choi, M.D.*, Tai In Ha, M.D.*, Chan Ho Park, M.D.*, Hyoung Yoel Park, M.D.*, Sun Mi Lee, M.D.*, Gwang Ha Kim, M.D.* and Geun Am Song, M.D.*; Korean J Gastrointest Endosc 2007;35(4):221-227. Published online October 30, 2007

Abstract PDF: Backgroud/Aims: Endoscopic stent placement is widely used to treat an unresectable malignant gastric outlet obstruction. The covered stent has the disadvantage of an increased risk of migration, and the uncovered stent has an increased risk of ingrowth. This study examined the technical and clinical efficiency of stent placement of a double-layered combination pyloric stent that was newly designed to reduce tumor ingrowth and stent migration. Methods: Fifteen patients with a gastric outlet obstruction caused by unresectable stomach cancer were treated with the endoscopic placement of a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner PTEF-covered stent to prevent tumor ingrowth). The technical success, clinical success, and complication especially tumor ingrowth and stent migration were analyzed. Results: Technical success was achieved in 15 out of 15 (100%) patients. Among the 15 patients in whom endoscopic stenting was placed successfully, the clinical success rate was 93.3%, the incidence of tumor ingrowth was 0%, the rate of migration was 6.7%, and tumor overgrowth was observed in 13.3%. The median stent patency period was 105 days. Conclusions: The placement of a double- layered pyloric combination stent appears to be effective in overcoming the disadvantage of the increased migration observed for a covered stent and the increased ingrowth observed for the uncovered stent. (Korean J Gastrointest Endosc 2007;35:221-227)

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