Clinical Endoscopy

Original Articles

A stepwise cannulation strategy for conservative endoscopists: the clinical impact of transpancreatic precut after pancreatic stenting in a retrospective study from Taiwan: Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Tzu-Hsiang Kung, Chih-Hsiang Chen, Jiann-Hwa Chen; Clin Endosc 2026;59(1):132-141. Published online January 12, 2026; DOI: https://doi.org/10.5946/ce.2025.241

Abstract PDF PubReader ePub: Background
/Aims: Pancreatic stenting reduces post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and aids in cannulation in difficult cases. However, conservative endoscopists may stop at this step, resulting in suboptimal outcomes. This study assessed the efficacy of transpancreatic precut sphincterotomy (TPS) as a rescue procedure following pancreatic stenting.
Methods
Between March 2013 and November 2018, 82 patients underwent pancreatic stenting at our institution prior to successful biliary cannulation. TPS was introduced in April 2016, and patients were divided into Before TPS and After TPS groups. The outcomes included cannulation success, PEP incidence, and predictors of TPS conversion.
Results
There were 43 and 39 patients in the Before TPS and After TPS groups, respectively. Twenty-two patients (56.4%) underwent conversion to TPS in the After TPS group. The After TPS group had a higher bile duct cannulation rate (89.7% vs. 72.1%) than the Before TPS group, but this difference was not statistically significant (p=0.054). Multivariate analysis showed that age >50 years (odds ratio [OR], 0.181; p=0.021) and being in the After TPS group (OR, 0.712; p=0.039) were independently associated with reduced PEP risk. Haraldsson Type 2 and Type 4 papillae carried a relatively high TPS conversion rate.
Conclusions
A stepwise cannulation strategy that incorporates TPS after pancreatic stenting minimizes the need for advanced techniques and improves PEP outcomes.

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Endoscopic ultrasound-guided plugged liver biopsy using a fine-needle biopsy needle and coils in patients with deranged coagulation parameters: proof of concept study for feasibility and safety from India: Biswa Ranjan Patra, Shubham Gupta, Yash Kallurwar, Chetan Saner, Sidharth Harindranath, Ankita Singh, Arun Vaidya, Michael Kuruthukulangara, Jitendra Yadav, Gaurav Lodha, Souradeep Pal, Akash Shukla; Received June 11, 2025 Accepted September 7, 2025 Published online December 23, 2025; DOI: https://doi.org/10.5946/ce.2025.188 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic ultrasound (EUS)-guided liver biopsy in patients with coagulopathy remains unexplored mainly because of the lack of effective hemostatic techniques in the event of post-biopsy bleeding. This study evaluated the feasibility and safety of a novel technique, EUS-guided plugged liver biopsy (EUS-PLB), which incorporates coil embolization for tract hemostasis.
Methods
In a pilot study, 20 patients with coagulopathy (platelets 20,000–50,000/μL or international normalized ratio 1.5–2.5) underwent EUS-PLB using a modified heparinized wet suction technique. Hemostasis was achieved via real-time EUS-guided deployment of 1 to 2 coils (35-5-3) into the needle tract. Outcomes included technical and clinical success, sample adequacy, and adverse events.
Results
Coil placement was technically successful in all patients. Persistent needle-tract bleeding occurred in five cases and was effectively controlled. The clinical success rate for preventing significant bleeding (early or delayed) was 100%. Adequate biopsy samples were obtained in 18/20 patients (90%), with a mean total specimen length of 3.34±0.88 cm and median complete portal tracts of 18 (range, 6–25). Histological diagnosis was possible in 95% of cases. One patient experienced a mild adverse event (5%).
Conclusions
This novel EUS-PLB technique with coil embolization may offer a safe and effective biopsy solution for patients with coagulopathy and warrants further investigation.

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Review

Endoscopic full-thickness resection of upper gastrointestinal tract: a review on closure techniques: Siew Fung Hau, Shannon Melissa Chan; Received February 4, 2025 Accepted May 22, 2025 Published online September 29, 2025; DOI: https://doi.org/10.5946/ce.2025.037 [Epub ahead of print]

Abstract PDF PubReader ePub

Endoscopic full-thickness resection has become more and more popular. One of the most important parts of this procedure is the closure of these full-thickness defects. Apart from conventional through-the-scope (TTS) clips, several different methods and devices have emerged as safe and efficacious in recent years. New clips include the anchor pronged TTS clips, dual-action tissue clips, and over-the-scope-clips. There are also new line or loop-assisted closure methods such as clip loop method, reopenable clip over line method, loop 9 method, and the internal-traction-assisted suspended closure method. New devices include the helical tacking system and endoscopic suturing device. This review article will discuss in details the usage of these different methods and available literature on comparison between the different closure methods.

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Technische Fortschritte in der endoskopischen Resektion
Sandra Nagl, Johannes Wießner, Katharina Beyer, Helmut Messmann
Die Innere Medizin.2026; 67(1): 11. CrossRef

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Systematic Review and Meta-analysis

The impact of linked color imaging on adenoma detection rate in colonoscopy: a systematic review and meta-analysis: Bruna Haueisen Figueiredo Zwetkoff, Luiz Ronaldo Alberti, Fábio Gontijo Rodrigues, Nelson Carvas Junior, José Celso Ardengh, Otavio Micelli Neto, Fernando Rodrigues Guzman, Marcelo Morganti Ferreira Dias, Guilherme Camarotti de Oliveira Canejo, Carlos Eduardo Oliveira dos Santos; Clin Endosc 2025;58(2):225-239. Published online October 24, 2024; DOI: https://doi.org/10.5946/ce.2024.072

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Colorectal cancer prevention relies on surveillance colonoscopy, with the adenoma detection rate as a key factor in examination quality. Linked color imaging (LCI) enhances lesion contrast and improves the examination performance. This systematic review and meta-analysis aimed to evaluate the effect of LCI on adenoma detection rate in adults who underwent colonoscopy.
Methods
We searched the Medline, PubMed, BIREME, LILACS, and Scientific Electronic Library Online databases for randomized controlled trials comparing the use of LCI versus white light imaging (WLI), published up to March 2023. The outcomes included lesion characteristics, number of adenomas per patient, and the additional polyp detection rate.
Results
Sixteen studies were included in the analysis, which showed that LCI was more accurate than WLI in detecting adenomas, with an increased number of adenomas detected per patient. Although LCI performed well in terms of lesion size, morphology, and location, the subgroup analyses did not reveal any statistically significant differences between LCI and WLI. The addition of LCI did not result in significant improvements in the detection of serrated lesions, and there were no differences in the withdrawal time between groups.
Conclusions
LCI has been shown to be effective in detecting colonic lesions, improving the number of adenomas detected per patient and improving polyp detection rate without negatively affecting other quality criteria in colonoscopy.

Citations

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Linked color imaging improves polyp miss rates in total colonoscopy in a multicenter randomized back to back trial
Ryo Shimoda, Daisuke Yamaguchi, Kazutoshi Hashiguchi, Kazuhiro Mizukami, Akira Aso, Takashi Akutagawa, Koichi Miyahara, Tetsuro Honda, Keiichi Hashiguchi, Tetsuya Ohira, Kensuke Fukuda, Masayuki Kabayama, Hideaki Miyamoto, Ryosuke Gushima, Yorinobu Sumida
Scientific Reports.2025;[Epub] CrossRef
Comparison of adenoma detection rate using the novel 5-LED vs xenon-light endoscopic system: Propensity score matching analysis
Tatsuhiro Ito, Satoshi Osawa, Takanori Yamada, Keisuke Inagaki, Tomohiro Takebe, Satoru Takahashi, Shunya Onoue, Kiichi Sugiura, Natsuki Ishida, Tomoharu Matsuura, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto
Endoscopy International Open.2025;[Epub] CrossRef

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Review

Advanced endoscopic imaging for detection of Barrett’s esophagus: Netanel Zilberstein, Michelle Godbee, Neal A. Mehta, Irving Waxman; Clin Endosc 2024;57(1):1-10. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.031

Abstract PDF PubReader ePub

Barrett’s esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC), and is caused by chronic gastroesophageal reflux. BE can progress over time from metaplasia to dysplasia, and eventually to EAC. EAC is associated with a poor prognosis, often due to advanced disease at the time of diagnosis. However, if BE is diagnosed early, pharmacologic and endoscopic treatments can prevent progression to EAC. The current standard of care for BE surveillance utilizes the Seattle protocol. Unfortunately, a sizable proportion of early EAC and BE-related high-grade dysplasia (HGD) are missed due to poor adherence to the Seattle protocol and sampling errors. New modalities using artificial intelligence (AI) have been proposed to improve the detection of early EAC and BE-related HGD. This review will focus on AI technology and its application to various endoscopic modalities such as high-definition white light endoscopy, narrow-band imaging, and volumetric laser endomicroscopy.

Citations

Citations to this article as recorded by

Gender disparities and woman-specific trends in Barrett’s esophagus in the United States: An 11-year nationwide population-based study
Karina Fatakhova, Faisal Inayat, Hassam Ali, Pratik Patel, Attiq Ur Rehman, Arslan Afzal, Muhammad Sarfraz, Shiza Sarfraz, Gul Nawaz, Ahtshamullah Chaudhry, Rubaid Dhillon, Arthur Dilibe, Benjamin Glazebnik, Lindsey Jones, Emily Glazer
World Journal of Methodology.2025;[Epub] CrossRef
Image-enhanced endoscopy in upper gastrointestinal disease: focusing on texture and color enhancement imaging and red dichromatic imaging
Jae Yong Park
Clinical Endoscopy.2025; 58(2): 163. CrossRef
Future of image enhanced endoscopy of esophageal adenocarcinoma
Kerem Parlar, Mert Cakir, Ozlem Ozer, Prateek Sharma
Clinical Endoscopy.2025; 58(4): 503. CrossRef
Advances in diagnostic techniques for eosinophilic esophagitis: a systematic review of emerging noninvasive methods
Abdulrhman Khaled Al Abdulqader
European Journal of Medical Research.2025;[Epub] CrossRef
Revising the Model for Accurate Cost-Effectiveness of Barrett’s Esophagus Surveillance
Shenglong Li
Gastroenterology.2025;[Epub] CrossRef
Advancements in Barrett's esophagus detection: The role of artificial intelligence and its implications
Sara Massironi
World Journal of Gastroenterology.2024; 30(11): 1494. CrossRef
Advanced Esophageal Endoscopy
Kyoungwon Jung, Rebecca M. Haug, Andrew Y. Wang
Gastroenterology Clinics of North America.2024; 53(4): 603. CrossRef

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Original Articles

Preclinical study of a novel ingestible bleeding sensor for upper gastrointestinal bleeding: Kimberly F. Schuster, Christopher C. Thompson, Marvin Ryou; Clin Endosc 2024;57(1):73-81. Published online May 31, 2023; DOI: https://doi.org/10.5946/ce.2022.293

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model.
Methods
A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated.
Results
All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract.
Conclusions
This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.

Citations

Citations to this article as recorded by

Clinical impact and cost-effectiveness of a novel bedside ingestible optical sensor for detection of upper GI bleeding
Monica Saumoy, Andrew Storm, Seth Buller, Nikhil Thiruvengadam
The American Journal of Emergency Medicine.2026; 99: 497. CrossRef
Ingestible electrochemical sensors: Emerging tools for gastrointestinal disease detection and monitoring
Zhaodong Wang
International Journal of Electrochemical Science.2025; 20(3): 100952. CrossRef
An ingestible capsule for luminance-based diagnosis of mesenteric ischemia
J. Chen, A. Alexiev, A. Sergnese, N. Fabian, A. Pettinari, Y. Cai, V. Perepelook, K. Schmidt, A. Hayward, A. Guevara, B. Laidlaw, I. Moon, B. Markowitz, I. Ballinger, Z. Yang, C. Rosen, N. Shalabi, S. Owyang, G. Traverso
Science Robotics.2025;[Epub] CrossRef
Miniaturized Capsule System Toward Real‐Time Electrochemical Detection of H2S in the Gastrointestinal Tract
Justin M. Stine, Katie L. Ruland, Luke A. Beardslee, Joshua A. Levy, Hossein Abianeh, Santiago Botasini, Pankaj J. Pasricha, Reza Ghodssi
Advanced Healthcare Materials.2024;[Epub] CrossRef

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Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection: Wang Fangjun, Leng Xia, Gao Yi, Shen Xiuyun, Wang Wenping, Liu Huamin, Liu Pengfei; Clin Endosc 2022;55(4):525-531. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2021.241

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods
From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results
The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p>0.05).
Conclusions
The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.

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Focused Review Series: Recent Updates on the Role of EUS in Pancreatobiliary Disease

Endoscopic Ultrasound–Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Pancreatic Malignancy: Seong-Hun Kim, Eun Ji Shin; Clin Endosc 2021;54(3):314-323. Published online May 28, 2021; DOI: https://doi.org/10.5946/ce.2021.102

Abstract PDF PubReader ePub

Stereotactic body radiation therapy (SBRT) is an important treatment option for pancreatic cancer, which is known to be one of the malignancies with the worst prognosis. However, the high radiation doses delivered during SBRT may cause damage to adjacent radiosensitive organs. To minimize such damage, fiducial markers are used for localization during SBRT for pancreatic cancer. The development of endoscopic ultrasound (EUS) has enabled fiducial markers to be inserted into the pancreas using an EUS fine-needle aspiration (FNA) needle, unlike in the past when percutaneous placement was generally performed. For successful EUS-guided fiducial marker placement, it is necessary for the fiducial markers to be loaded within the EUS-FNA needles to have a low probability of complications and a low migration risk, and to be stably observed in SBRT imaging. A systematic review has shown that the technical success rate of EUS-guided fiducial marker placement is 96.27%, whereas the fiducial marker migration and adverse event rates are 4.33% and 4.85%, respectively. Nonetheless, standardized techniques for fiducial marker placement and the characteristics of optimal fiducial markers have not yet been established. This review will introduce the characteristics (e.g., materials and shapes) of fiducial markers used in fiducial marker placement for pancreatic cancer and will discuss conventional techniques along with their success rates, difficulties, and adverse events.

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Application of intrahepatic fiducial markers in carbon ion radiotherapy for pancreatic cancer—Achieving higher precision treatment
Junya Nagata, Yohsuke Kusano, Masataka Komori, Yoshiki Takayama, Shogo Kurokawa, Atsushi Ito, Tadashi Kamada, Daisaku Yoshida, Shohei Kawashiro, Hiroyuki Katoh
Journal of Applied Clinical Medical Physics.2026;[Epub] CrossRef
Interventional Endoscopic Ultrasonography: Advances in Application
Haidar Khan, Sharon Slomovich, Neal C. Shah, Frank Gress
Journal of Clinical Medicine.2025; 14(10): 3286. CrossRef
Fiducial Marker Placement for Gated Radiotherapy Using Real-Time Tumor-Tracking in Pancreatic Cancer: A Comparative Analysis of Transarterial and Percutaneous Approaches
Daisuke Kato, Daisuke Abo, Ryo Morita, Norio Katoh, Naoki Miyamoto, Ryota Yamada, Naoya Kinota, Takaaki Fujii, Kouji Yamasaki, Motoma Kanaya, Hidefumi Aoyama, Kohsuke Kudo
Journal of Vascular and Interventional Radiology.2025; 36(12): 2021. CrossRef
A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery
Patrick W. Chang, Jonathan Sadik, Ara B. Sahakian, Ravi Kankotia, Christopher Ko, Jessica Serna, Alex Rodriguez, Helen Lee, Sujit Kulkarni, Yuri Genyk, Mohd Sheikh, James L. Buxbaum
Journal of Clinical Gastroenterology.2024; 58(9): 931. CrossRef
EUS-guided interventional therapies for pancreatic diseases
Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
Frontiers in Medicine.2024;[Epub] CrossRef
Cardiac migration of an implanted hepatic fiducial marker used for stereotactic body radiation therapy - A case report
Youstina Soliman, Febin Antony, Mark Vivian, Sankar Venkatraman, Maged Nashed
Journal of Cancer Research and Therapeutics.2024; 20(5): 1628. CrossRef
Endoscopic Ultrasound-Guided Treatments for Pancreatic Cancer: Understanding How Endoscopic Ultrasound Has Revolutionized Management of Pancreatic Cancer
Sahib Singh, Antonio Facciorusso, Rakesh Vinayek, Sudhir Dutta, Dushyant Singh Dahiya, Ganesh Aswath, Neil Sharma, Sumant Inamdar
Cancers.2024; 17(1): 89. CrossRef
Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases
Masahiro Itonaga, Masayuki Kitano, Reiko Ashida
Digestive Endoscopy.2023; 35(3): 302. CrossRef
Endoscopic Ultrasound-Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Patients with Pancreatic Cancer
Irina M. Cazacu, Ben S. Singh, Rachael M. Martin-Paulpeter, Sam Beddar, Stephen Chun, Emma B. Holliday, Albert C. Koong, Prajnan Das, Eugene J. Koay, Cullen Taniguchi, Joseph M. Herman, Manoop S. Bhutani
Cancers.2023; 15(22): 5355. CrossRef
Endoscopic Management of Pancreatobiliary Malignancies
Dong Wook Lee, Eun Young Kim
Digestive Diseases and Sciences.2022; 67(5): 1635. CrossRef
Hot topics in therapeutic EUS
Daniela Tabacelia, Alexandru Martiniuc, Daniela Elena Burtea, Adrian Saftoiu, Cezar Stroescu
Endoscopic Ultrasound.2022; 11(3): 153. CrossRef

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Review

Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE): Moon Jae Chung, Se Woo Park, Seong-Hun Kim, Chang Min Cho, Jun-Ho Choi, Eun Kwang Choi, Tae Hoon Lee, Eunae Cho, Jun Kyu Lee, Tae Jun Song, Jae Min Lee, Jun Hyuk Son, Jin Suk Park, Chi Hyuk Oh, Dong-Ah Park, Jeong-Sik Byeon, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun, Ho Soon Choi, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(2):161-181. Published online March 24, 2021; DOI: https://doi.org/10.5946/ce.2021.069

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

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An optimal curriculum for training in endoscopic ultrasound: a summarized evidence-based literature systematic review
Julieta Montanelli, Ariosto Honorio Hernandez Lara, Ana Karla Uribe Rivera, Juan Manuel Verde, Eike Burmester, Mohammad A. Al-Haddad, Stephan Hollerbach, Peter Vilmann, Monder Abu-Suboh Abadia, Abdenor Badaoui, Paolo Giorgio Arcidiacono, Christoph Schlag,
Surgical Endoscopy.2025; 39(7): 4076. CrossRef
Expanding the horizon of diagnostic endosonograpy: the promise of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration
Hao-Che Chang, Ping-Huei Tseng, Li-Chun Chang
Clinical Endoscopy.2025; 58(6): 859. CrossRef
Role of Endoscopic Ultrasound in the Management of Pancreatic Cancer
Balaji Musunuri, Shiran Shetty
Indian Journal of Surgical Oncology.2024; 15(S2): 269. CrossRef
Endoscopic Ultrasound (EUS) guided biopsy of healthy pig pancreas: Towards the histological diagnosis of chronic pancreatitis.
Julio Iglesias-García, Yessica Domínguez-Novoa, Héctor Lazare-Iglesias, Antonio González-Cantalapiedra, Ihab Abdulkader-Nallib, Óscar Varela-López, José Lariño-Noia, Enrique Domínguez-Muñoz
Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef
When ROSE is not possible: Evaluating the diagnostic yield of>4mm tissue specimen with macroscopi c onsite evaluation. 22G EUS-FNB Acquire needle experience
S. Karim, S. Kadir, A. Faryal
Endoscopy.2024; 56(S 02): S153. CrossRef
Optimising EUS-FNB guided tissue acquisition: The significance of TRAP score in solid pancreatic and gastrointestinal lesions for positive diagnostic output
S. Karim, S. Kadir, A. Faryal
Endoscopy.2024; 56(S 02): S380. CrossRef
Endoscopic ultrasound-guided tissue acquisition for personalized treatment in pancreatic adenocarcinoma
Sang Myung Woo
Clinical Endoscopy.2023; 56(2): 183. CrossRef
Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ
Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito
Clinical Endoscopy.2023; 56(3): 353. CrossRef
Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study
Sneha Shaha, Yinglin Gao, Jiahao Peng, Kendrick Che, John J. Kim, Wasseem Skef
Clinical Endoscopy.2023; 56(5): 658. CrossRef
Endoscopic ultrasound-guided tissue acquisition and gene panel testing for pancreatic cancer
Kentaro SUDO, Emiri KITA, Akiko TSUJIMOTO, Kazuyoshi NAKAMURA, Akiko ODAKA, Makiko ITAMI, Sana YOKOI, Hiroshi ISHII
Suizo.2022; 37(1): 8. CrossRef
Impact of rapid on-site evaluation on diagnostic accuracy of EUS-guided fine-needle aspiration of solid pancreatic lesions: experience from a single center
Irem Guvendir, Itir Ebru Zemheri, Kamil Ozdil
BMC Gastroenterology.2022;[Epub] CrossRef
Endoscopic Ultrasound Guided Fine Needle Aspiration and Biopsy for Pancreatic Disease
Kwang Hyuck Lee
The Korean Journal of Pancreas and Biliary Tract.2021; 26(4): 241. CrossRef

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Original Articles

Diagnostic Efficacy of Endoscopic Ultrasound Elastography in Differentiating Solid Pancreatic Lesions: A Single-Center Experience: Ahmed Youssef Altonbary, Hazem Hakim, Ahmed Mohamed El-Shamy; Clin Endosc 2019;52(4):360-364. Published online January 8, 2019; DOI: https://doi.org/10.5946/ce.2018.160

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound (EUS) has a limited ability to determine the nature of solid pancreatic lesions (SPLs). Most recent ultrasound processors are provided with elastography software, which allows quantification of the tissue hardness. The aim of this study is to evaluate the effectiveness of the elasticity score (ES) and strain ratio (SR) in the differentiation of benign pancreatic lesions from malignant pancreatic lesions.
Methods
The study had a retrospective design; it included 97 patients with SPLs and 19 patients with inflammatory lesions. The ES and SR were determined during the examination; finally, EUS-guided fine needle aspiration was performed.
Results
In this 2-year study, 116 patients were enrolled (97 with malignant lesions and 19 with benign lesions). There were 69 men and 47 women. Their median age was 55.9 years. A cut-off point was detected at SR of 7.75 with a specificity of 99.9%, sensitivity of 90.7%, positive predictive value (PPV) of 99.9%, negative predictive value (NPV) of 67.9%, and accuracy of 92.2%. After adding the ES to the SR, the cut-off point at 7.75 resulted in a specificity of 94.6%, sensitivity of 99%, PPV of 98%, NPV of 98.5%, and accuracy of 97%.
Conclusions
The use of the ES combined with the SR increases the accuracy of differentiation between benign and malignant SPLs and is an effective method for the evaluation of pancreatic masses.

Citations

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Diagnostic Value of Sound Speed Correction Endoscopic Ultrasound Compared With Other Endoscopic Ultrasound-Assisted Imaging Techniques in Solid Pancreatic Lesions
Dun-Wei Yao, Yi-Han Lu, Hai-Xing Jiang, Min-Zhen Qin, Shan-Yu Qin
Clinical and Translational Gastroenterology.2026; 17(1): e00947. CrossRef
Early Detection of Pancreatic Cancer: Current Advances and Future Opportunities
Zijin Lin, Esther A. Adeniran, Yanna Cai, Touseef Ahmad Qureshi, Debiao Li, Jun Gong, Jianing Li, Stephen J. Pandol, Yi Jiang
Biomedicines.2025; 13(7): 1733. CrossRef
Cystic tumors of the pancreas: Current perspectives on diagnosis and management
Nadica Shumka, Petko I Karagyozov
World Journal of Gastroenterology.2025;[Epub] CrossRef
Endoscopic ultrasound elastography in solid pancreatic lesions: individual and combined performance of strain ratio, fat-lesion strain ratio, and mean strain histogram for diagnosing pancreatic ductal adenocarcinoma
Fangzhou Wang, Jian Ma, Haonan Liu, Cancan Zhou, Jie Hao, Shuai Wu, Jiaoxing Wu, Ruiqi Cao, Zhengyuan Feng, Hao Sun, Zheng Wang, Weikun Qian, Zheng Wu
Clinical and Experimental Medicine.2025;[Epub] CrossRef
Diagnostic performance of endoscopic ultrasound elastography for differential diagnosis of solid pancreatic lesions: A propensity score-matched analysis
In Rae Cho, Seok-Hoo Jeong, Huapyong Kang, Eui Joo Kim, Yeon Suk Kim, Soyoung Jeon, Jae Hee Cho
Pancreatology.2023; 23(1): 105. CrossRef
The expanding role of endoscopic ultrasound elastography
Jahnvi Dhar, Jayanta Samanta
Clinical Journal of Gastroenterology.2022; 15(5): 841. CrossRef
Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes: Critical evaluation of strain ratio cutoff value
Miguel Puga-Tejada, Raquel Del Valle, Roberto Oleas, Maria Egas-Izquierdo, Martha Arevalo-Mora, Jorge Baquerizo-Burgos, Jesenia Ospina, Miguel Soria-Alcivar, Hannah Pitanga-Lukashok, Carlos Robles-Medranda
World Journal of Gastrointestinal Endoscopy.2022; 14(9): 524. CrossRef
Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer
Yasutaka Ishii, Masahiro Serikawa, Tomofumi Tsuboi, Ryota Kawamura, Ken Tsushima, Shinya Nakamura, Tetsuro Hirano, Ayami Fukiage, Takeshi Mori, Juri Ikemoto, Yusuke Kiyoshita, Sho Saeki, Yosuke Tamura, Sayaka Miyamoto, Kazuaki Chayama
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Impact of endoscopic ultrasound elastography in pancreatic lesion evaluation
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A Prospective Blinded Study of Endoscopic Ultrasound Elastography in Liver Disease: Towards a Virtual Biopsy: Allison R. Schulman, Ming V. Lin, Anna Rutherford, Walter W. Chan, Marvin Ryou; Clin Endosc 2018;51(2):181-185. Published online March 23, 2018; DOI: https://doi.org/10.5946/ce.2017.095

Abstract PDF PubReader ePub

Background
/Aims: Liver biopsy has traditionally been used for determining the degree of fibrosis, however there are several limitations. Endoscopic ultrasound (EUS) real-time elastography (RTE) is a novel technology that uses image enhancement to display differences in tissue compressibility. We sought to assess whether liver fibrosis index (LFI) can distinguish normal, fatty, and cirrhotic liver tissue.
Methods
A total of 50 patients undergoing EUS were prospectively enrolled. RTE of the liver was performed to synthesize the LFI in each patient. Univariate and multivariable analyses were performed. Chi-square and t-tests were performed for categorical and continuous variables, respectively. A p-value of <0.05 was considered significant.
Results
Abdominal imaging prior to endoscopic evaluation suggested normal tissue, fatty liver, and cirrhosis in 26, 16, and 8 patients, respectively. Patients with cirrhosis had significantly increased mean LFI compared to the fatty liver (3.2 vs. 1.7, p<0.001) and normal (3.2 vs. 0.8, p<0.001) groups. The fatty liver group showed significantly increased LFI compared to the normal group (3.8 vs. 1.4, p<0.001). Multivariable regression analysis suggested that LFI was an independent predictor of group features (p<0.001).
Conclusions
LFI computed from RTE images significantly correlates with abdominal imaging and can distinguish normal, fatty, and cirrhotic-appearing livers; therefore, LFI may play an important role in patients with chronic liver disease.

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Focused Review Series: Training in Endoscopy

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

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

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Review

Resection of Diminutive and Small Colorectal Polyps: What Is the Optimal Technique?: Jun Lee; Clin Endosc 2016;49(4):355-358. Published online July 22, 2016; DOI: https://doi.org/10.5946/ce.2016.063

Abstract PDF PubReader ePub

Colorectal polyps are classified as neoplastic or non-neoplastic on the basis of malignant potential. All neoplastic polyps should be completely removed because both the incidence of colorectal cancer and the mortality of colorectal cancer patients have been found to be strongly correlated with incomplete polypectomy. The majority of colorectal polyps discovered on diagnostic colonoscopy are diminutive and small polyps; therefore, complete resection of these polyps is very important. However, there is no consensus on a method to remove diminutive and small polyps, and various techniques have been adopted based on physician preference. The aim of this article was to review the diverse techniques used to remove diminutive and small polyps and to suggest which technique will be the most effective.

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Application of artificial intelligence in colonoscopy imaging for polyp analysis-A systematic review
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Computer Methods and Programs in Biomedicine.2026; 277: 109239. CrossRef
Real-Time Polyp Detection, Localization and Segmentation in Colonoscopy Using Deep Learning
Debesh Jha, Sharib Ali, Nikhil Kumar Tomar, Havard D. Johansen, Dag Johansen, Jens Rittscher, Michael A. Riegler, Pal Halvorsen
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Prediction of Polyp Pathology Using Convolutional Neural Networks Achieves “Resect and Discard” Thresholds
Robin Zachariah, Jason Samarasena, Daniel Luba, Erica Duh, Tyler Dao, James Requa, Andrew Ninh, William Karnes
American Journal of Gastroenterology.2020; 115(1): 138. CrossRef
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Julián Parga, William Otero Regino, Martín Alonso Gómez Zuleta
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EFFICACY OF COLD POLYPECTOMY TECHNIQUES FOR SMALL POLYP (< 1CM) IN THE COLORECTUM
Tan Le Minh, Thuong Nguyen Thi Huyen, Huy Tran Van
Journal of Medicine and Pharmacy.2018; 8(3): 54. CrossRef

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Focused Review Series: Advanced Endoscopic Treatment for Pancreaticobiliary Diseases

Burdick's Technique for Biliary Access Revisited: Mahesh Kumar Goenka, Vijay Kumar Rai; Clin Endosc 2015;48(1):20-23. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.20

Abstract PDF PubReader ePub

The precut sphincterotomy is used to facilitate selective biliary access in cases of difficult biliary cannulation. Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc. Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o'clock direction. Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy. In this review, we discuss this non-needle technique of precut sphincterotomy and also share our experience using this "Burdick's technique."

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Causes and Countermeasures of Difficult Selective Biliary Cannulation: A Large Sample Size Retrospective Study
Yang Liu, Wei Liu, Junbo Hong, Guohua Li, Youxiang Chen, Yong Xie, Xiaojiang Zhou
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Difficult Biliary Access
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133 Download
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Case Report

Primary Fallopian Tube Carcinoma Diagnosed with Endoscopic Ultrasound Elastography with Fine Needle Biopsy: Eui Bae Kim, Tae Hee Lee, Jeong Sig Kim, In Ho Choi; Clin Endosc 2014;47(5):464-468. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.464

Abstract PDF PubReader ePub

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.

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The clinical impact of ultrasound contrast agents in EUS: a systematic review according to the levels of evidence
Pietro Fusaroli, Bertrand Napoleon, Rodica Gincul, Christine Lefort, Laurent Palazzo, Maxime Palazzo, Masayuki Kitano, Kosuke Minaga, Giancarlo Caletti, Andrea Lisotti
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Original Article

Endoscopic Ultrasound Elastography for the Pancreas in Korea: A Preliminary Single Center Study: Tae Hee Lee, Young Deok Cho, Sang-Woo Cha, Joo Young Cho, Jae Young Jang, Soung Won Jeong, Hyun Jong Choi, Jong Ho Moon; Clin Endosc 2013;46(2):172-177. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.172

Abstract PDF PubReader ePub

Background/Aims

Endoscopic ultrasound elastography (EUS-EG) has been widely used for the evaluation of pancreatic cancer in the Western world. To date, there is very little experience with EUS-EG in Korea. We described the results of comparison between normal pancreas and pancreatic cancer in Korea.

Methods

The present study was performed at a tertiary hospital on 35 subjects comprising 20 with normal pancreas (control group) and 15 with pancreatic cancer (disease group). We compared the EUS-EG performance of the two groups.

Results

The pancreas in the control group showed a mean elasticity value of 0.53% (95% confidence interval [CI], 0.45 to 0.61). The elasticity value was higher than that previously reported from Western country (0.47%; 95% CI, 0.38 to 0.57). In the disease group, the mean elasticity value of pancreatic lesions was 0.02% (95% CI, 0.01 to 0.02). The mean elasticity value of the disease group was significantly lower than that of the control group (p<0.0001).

Conclusions

EUS-EG could be a highly sensitive diagnostic modality for pancreatic cancer in Korea with little EUS-EG experience. We also provided the reference range of elasticity value of normal pancreas, which might be valuable in the interpretation of pancreatic elasticity data for Korean adults.

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Special Issue Articles of IDEN 2012

Endoscopic Ultrasound, Where Are We Now in 2012?: Eun Young Kim; Clin Endosc 2012;45(3):321-323. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.321

Abstract PDF PubReader ePub

Topics related with endoscopic ultrasound (EUS) made up considerable portion among many invited lectures presented in International Digestive Endoscopy Network 2012 meeting. While the scientific programs were divided into the fields of upper gastrointestinal (UGI), lower gastrointestinal, and pancreato-biliary (PB) categories, UGI and PB parts mainly dealt with EUS related issues. EUS diagnosis in subepithelial lesions, estimation of the invasion depth of early gastrointestinal cancers with EUS, and usefulness of EUS in esophageal varices were discussed in UGI sessions. In the PB part, pancreatic cystic lesions, EUS-guided biliopancreatic drainage, EUS-guided tissue acquisition, and improvement of diagnostic yield in indeterminate biliary lesions by using intraductal ultrasound were discussed. Advanced techniques such as contrast-enhanced EUS, EUS elastography and forward-viewing echoendoscopy were also discussed. In this paper, I focused mainly on topics of UGI and briefly mentioned about advanced EUS techniques since more EUS related papers by other invited speakers were presented afterwards.

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Focused Review Series: What Should We Know about EUS-FNA?s

How Can We Get the Best Results with Endoscopic Ultrasound-Guided Fine Needle Aspiration?: Jayapal Ramesh, Shyam Varadarajulu; Clin Endosc 2012;45(2):132-137. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.132

Abstract PDF PubReader ePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has evolved to become an indispensable tool for tissue acquisition. While the overall diagnostic accuracy of EUS-FNA is greater than 90% for lung cancer staging, it is lower for pancreatic mass lesions. Several factors such as location of the tumor, disease characteristics and procedural techniques determine the outcomes of EUS-FNA. In this review we evaluate the various technical factors that are keys to attaining optimal procedural outcomes.

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Introduction; Value of Endoscopic Ultrasound-Guided Fine Needle Aspiration: Eun Young Kim; Clin Endosc 2012;45(2):115-116. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.115

Abstract PDF PubReader ePub

Introduction of endoscopic ultrasound (EUS) to medical practice has brought a huge change in diagnostic algorithm of many gastrointestinal diseases. Addition of EUS-guided fine needle aspiration (FNA) upgraded diagnostic power of EUS. In this focused review series, value of EUS-FNA in the diagnosis of various diseases and tips for getting the best results with EUS-FNA are described by four invited authors including myself. First, Dr. Jeong Seop Moon discussed about EUS-FNA in submucosal lesion. He also touched on basic techniques and needles of EUS-FNA in his article. Next, I focused on additional value of EUS-FNA in the staging of hollow viscus cancer to optimize the treatment strategy. World's well-known endosonographer, Dr. Robert H. Hawes kindly presented his profound thoughts on EUS-FNA in pancreatic cystic lesions. Dr. Jayapal Ramesh and Dr. Shyam Varadarajulu shared their valuable tips for getting the best results when using EUS-FNA. Nobody doubts now EUS-FNA is an indispensable procedure in gastrointestinal endoscopy. Therefore, this focused review series will provide the readers with the concentrated knowledge of "What should we know about EUS-FNA."

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A Case of Giant Colonic Lipoma Endoscopically Removed Using an Unroofing Technique in Phases: Young Kook Shin, M.D., Eun Young Kim, M.D., Seung Woon Jeon, M.D., Chang Jae Huh, M.D., Byung Seok Kim, M.D., Jae Uk Shin, M.D.^†, Jin Tae Jung, M.D., Joong Goo Kwon, M.D. and Chang Ho Cho, M.D.*; Korean J Gastrointest Endosc 2008;36(4):242-247. Published online April 30, 2008

Abstract PDF: Gastrointestinal lipomas are benign adipose tumors that are usually submucosal, and most commonly found in the colon. However, they have also been discovered in the small bowel, stomach and very rarely in the esophagus. Although most of gastrointestinal lipomas are asymptomatic and are found incidentally at time of endoscopy, surgery or autopsy, large lipomas can cause acute abdominal pain, bowel habit changes, gastrointestinal bleeding, intussusception or bowel obstruction. Lipomas can be diagnosed by colonoscopy, abdominal CT, barium series and endoscopic ultrasonography (EUS). Large lipomas need to be treated using various techniques. However, the best treatment modality for large lipomas has not yet been established. A surgical resection of lipomas should be considered for a giant lipoma ＞2 cm in diameter due to the risk of perforation or hemorrhage. Currently, endoscopic snare polypectomy or endo-loop ligation is used to treat symptomatic lipomas, which may reduce the risk of complications associated with endoscopic treatment. We report a case of giant colonic lipoma that was diagnosed successfully with EUS and treated safely using an endoscopic unroofing technique, endoloop ligation and snare polypectomy in phases. (Korean J Gastrointest Endosc 2008;36:242-247)

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Bile Duct Cannulation Guided by a Percutaneous Transhepatic Biliary Drainage (PTBD) Tube: Modified Rendezvous Procedure: Hong Joo Kim, M.D., Seon Hyeong Choi, M.D.*, Jung Ho Park, M.D., Dong Il Park, M.D., Yong Kyun Cho, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.; Korean J Gastrointest Endosc 2007;34(3):138-142. Published online March 30, 2007

Abstract PDF: Background
/Aims: To describe a simple and useful modification of the rendezvous technique using a PTBD tube as guidance. Methods: From January 2005 to August 2006, a total of 436 ERCPs were performed. A diagnosis of choledocholithiasis was made in 235 cases. Deep cannulation of the bile duct using standard techniques was unsuccessful in 27 patients (11.5%). A precut papillotomy led to successful cannulation in 16 out of these 27 patients (59.3%). The remaining 11 patients (40.7%) underwent PTBD with the tube tip placed in the second portion of the duodenum. Bile duct cannulation was attempted with the guidance of a PTBD tube in 9 cases. In the other 2 cases, the transduodenal approach was impossible due to a previous Billroth II operation. Results: Bile duct cannulation guided by a PTBD tube, which is also known as a modified rendezvous procedure, was successful in 9 out of 11 patients (81.8%). Deep cannulation of the bile duct was achieved in 100% of patients, who could be treated by endoscopy. There were 7 cases of transient hyperamylasemia (77.8%) but no procedure-related major complications or mortality. Conclusions: Bile duct cannulation guided by a PTBD tube in patients with choledocholithiasis can be recommended when ERCP is unsuccessful using the standard technique. (Korean J Gastrointest Endosc 2007;34:138⁣142)

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A Study of Mucosal Sampling for Helicobacter pylori Using‘Two-bite’Technique in Relation to Time-saving: Mun Hee Bae, M.D., Min Hyung Kim M.D., Jun Haeng Lee, M.D., Hee Jung Son, M.D., Yoon-Ho Choi, M.D.*, Poong-Lyul Rhee, M.D., Jae J. Kim, M.D., Seung Woon Paik, M.D., Byung Cheol Yoo M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2004;29(1):1-5. Published online July 30, 2004

Abstract PDF: Background
/Aims: Multiple passages of biopsy forceps increase wear and tear on both the channel of endoscope and forceps. The two-bite technique can save time in obtaining sufficient specimens and also reduce the wear of the instruments. The aim of this study was to assess prospectively the efficacy of two-bite forceps technique in relation to time-saving. Methods: A total 84 patients needed histopathologic diagnosis for Helicobacter pylori were randomized into two groups (one-bite technique: 41 patients, two-bite technique: 43 patients). An experienced endoscopist carried out upper endoscopy and used same biopsy forceps (FB-25K^Ⱂ, Olympus, Tokyo, Japan). Mucosal biopsy specimens were obtained as follow: two from the antrum followed by two from the body. Rebiopsy was done when biopsy specimen was lost. The mean time in obtaining specimens and missing rate were analyzed. An experienced pathologist blinded to the technique of obtaining the samples evaluated the specimens for diameter, depth, crush artifact, and adequacy for histopathologic diagnosis. Results: A total 336 specimens were obtained from 84 patients. Of these, 12 (7.0%) samples were missed with the two-bite technique but only 1 (0.6%) with the one-bite technique (p=0.003). Regarding histopathologic evaluation, there were no significant differences between samples taken with the two-bite technique and the one-bite technique. The mean time with two-bite technique (47.6 sec) was compared with one-bite technique (62.6 sec)(p＜0.001). But there was no significant time difference if samples were missing during the process (62.5 sec). Conclusions: Although two- bite technique saves the time for biopsy, the main limitation is that there is a significant risk of losing samples. (Korean J Gastrointest Endosc 2004;29:1⁣5)

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Endoscopic Minor Papilla Intervention in a Patient with Traumatic Ductal Leak without Pancreas Divisum: Jong Ha Park, M.D., Myung-Hwan Kim, M.D., Moon Hee Song, M.D., Do Hyun Park, M.D.,Jung Joon Choi, M.D., Sung Hee Pyo, M.D., Jin Ook Jeong, M.D., Sung Doo Kim, M.D., Hyun Young Son, M.D.,Sang Soo Lee, M.D., Dong Wan Seo, M.D. and Sung Koo Lee, M.D.; Korean J Gastrointest Endosc 2004;28(5):273-276. Published online May 30, 2004

Abstract PDF: Endoscopic treatment has been performed in a variety of pancreatic ductal diseases such as stones, strictures, sphincter stenosis, and ductal disruption and is known to be an effective therapy in some patients. Endoscopic treatment through the minor papilla is frequently done in patients with pancreas divisum. Few data are, however, available concerning endoscopic minor papilla interventions in patients without pancreas divisum but with difficult access to the main pancreatic duct at the major duodenal papilla. We present a 49-year-old man, who had pancreatic ductal leak caused by previous pancreatic surgery. He was treated by endoscopic naso-pancreatic drainage and pancreatic ductal stenting through the minor papilla, so called pancreatic rendezvous technique. Follow- up ductography after two-weeks of naso-pancreatic drainage showed no leak. This case shows that minor papillar orifice could be an alternative access for therapeutic endoscopic intervention in a patient with traumatic pancreatic ductal leak without pancreas divisum. (Korean J Gastrointest Endosc 2004;28:273⁣276)

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상부 위장관 내시경검사에서 겸자를 한 번 통과 후 두 번 생검을 하는 수기의 임상적 유용성: Korean J Gastrointest Endosc 2003;27(5):394-394. Published online November 20, 2003

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박리생검법 ( Strip biopsy technique ) 으로 치유한 십이지장 유암종 1예 ( A Case of Small Duodenal Carcinoid Tumor Treated by Strip Biopsy Technique ): Korean J Gastrointest Endosc 2000;20(4):281-284. Published online November 30, 1999

Abstract PDF: Carcinoid tumors of the duodenum are infrequent, represent 2.0-3.0% of all gastrointestinal carcinoid tumors in western countries and 14.8% of those in Japan. Small carcinoid tumors of the duodenum are often asymptomatic, discovered endoscopically, Duodenal carcinoid tumors have been treated by surgical resection or endoscopic resection with strip biopsy or polypectomy. We experience a case of carcinoid tumor of duodenum in 49 years woman. Endoscopic examination, 0.7 cm sized polypoid mass with central depression was noted on duodenal bulb area. We present a case of a small duodenal carcinoid treated with strip biopsy technique. (Korean J Gastrointest Endosc 2000;20:281-284)

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