권호 표지

Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy

  • Bimonthly
  • /
  • 2234-2400(pISSN)
  • /
  • 2234-2443(eISSN)

Domain

  • Health Sciences ＞ Clinical Medicine
  • Health Sciences ＞ Medical Device for Therapy/Diagnosis

Aim & Scope

Clinical Endoscopy is an open-access and peer-reviewed journal, helping researchers, technicians, and practicing physicians stay updated on global advances in experimental, diagnostic, and therapeutic endoscopic techniques used in the treatment of disorders of the gastrointestinal and pancreatico-biliary tract. CE publishes well-structure original articles, state-of-theart review articles, instructive case reports, brief reports, and letters to the editor on all subjects in the field of experimental, diagnostic, and therapeutic endoscopy as well as newer technologies. In addition, editorials explore challenging issues and encourage debate among physicians dealing with peptic ulcer disease, inflammatory bowel disease, pancreatico-biliary disease, and gastrointestinal cancer. CE also publishes special issues that feature articles focusing on current practices and latest advances in equipment and techniques used for the endoscopic management of obesity, disorders of the gastrointestinal and pancreatico-biliary tract for clinicians who are concerned about the clinical manifestations of these disorders. The journal will try to seek out and publish outstanding original articles and reviews as well as articles describing new emerging techniques and practice guidelines.

http://submit.e-ce.org/ KSCI KCI SCOPUS

Volume 55 Issue 5

  1. Jae Min Lee;Yehyun Park;Jin Myung Park;Hong Jun Park;Jun Yong Bae;Seung Young Seo;Jee Hyun Lee;Hyung Ku Chon;Jun-Won Chung;Hyun Ho Choi;Jun Kyu Lee;Byung-Wook Kim;Endoscopic Sedation Committee of the Korean Society of Gastrointestinal Endoscopy 581
    https://doi.org/10.5946/ce.2021.283 PDF
    Procedural sedation has become increasingly common in endoscopy. Sedatives and analgesics induce anxiolysis and amnesia. In addition, an appropriate level of sedation is necessary for safe procedures including therapeutic endoscopy. Midazolam and propofol are the most commonly used drugs in sedative endoscopy. In recent years, the need to ascertain the safety and effectiveness of sedation has increased in practice. Therefore, new sedatives and analgesic drugs for optimal sedative endoscopy, have recently emerged. This article reviews the characteristics of sedatives and analgesics, and describes their clinical use in gastrointestinal endoscopy.
  2. Chawisa Nampoolsuksan;Vitoon Chinswangwatanakul;Asada Methasate;Jirawat Swangsri;Atthaphorn Trakarnsanga;Chainarong Phalanusitthepha;Thammawat Parakonthun;Voraboot Taweerutchana;Nicha Srisuworanan;Tharathorn Suwatthanarak;Thikhamporn Tawantanakorn;Thawatchai Akaraviputh 588
    https://doi.org/10.5946/ce.2022.062 PDF
    In the highly contagious coronavirus disease 2019 pandemic, aerosol-generating procedures (AGPs) are associated with high-risk of transmission. Upper gastrointestinal endoscopy is a procedure with the potential to cause dissemination of bodily fluids. At present, there is no consensus that endoscopy is defined as an AGP. This review discusses the current evidence on this topic with additional management. Prevailing publications on coronavirus related to upper gastrointestinal endoscopy and aerosolization from the PubMed and Scopus databases were searched and reviewed. Comparative quantitative analyses showed a significant elevation of particle numbers, implying that aerosols were generated by upper gastrointestinal endoscopy. The associated source events have also been reported. To reduce the dispersion, certain protective measures have been developed. Endoscopic unit protocols are recommended for the concerned personnel. Therefore, upper gastrointestinal endoscopy should be classified as an AGP. Proper practices should be adopted by healthcare workers and patients.
  3. Chang Bong Yang;Sang Hoon Kim;Yun Jeong Lim 594
    https://doi.org/10.5946/ce.2021.229 PDF
    Over the past decade, technological advances in deep learning have led to the introduction of artificial intelligence (AI) in medical imaging. The most commonly used structure in image recognition is the convolutional neural network, which mimics the action of the human visual cortex. The applications of AI in gastrointestinal endoscopy are diverse. Computer-aided diagnosis has achieved remarkable outcomes with recent improvements in machine-learning techniques and advances in computer performance. Despite some hurdles, the implementation of AI-assisted clinical practice is expected to aid endoscopists in real-time decision-making. In this summary, we reviewed state-of-the-art AI in the field of gastrointestinal endoscopy and offered a practical guide for building a learning image dataset for algorithm development.
  4. Mamoru Takenaka;Masatoshi Kudo 605
    https://doi.org/10.5946/ce.2022.032 PDF
    The double-guidewire method has been increasingly used in endoscopic procedures for biliary and pancreatic diseases in recent years, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-related procedures. In addition, double-lumen catheters with uneven distal and proximal lumen openings have been introduced, making it possible to easily create a double-guidewire situation, and the usefulness of the double-guidewire technique using uneven double-lumen cannulas has been widely reported. Although the advantages of using two guidewires depend on the particular situation and the appropriate use of the two guidewires, deepening the knowledge of the double-guidewire method will contribute greatly to troubleshooting in daily practice. In this review, the usefulness of the double-guidewire technique is discussed with respect to two main areas: selective insertion of guidewires and devices and biliary cannulation.
  5. Suprabhat Giri;Shivaraj Afzalpurkar;Sumaswi Angadi;Sridhar Sundaram 615
    https://doi.org/10.5946/ce.2022.133 PDF
    Background/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis. Methods: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs. Results: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events. Conclusions: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.
  6. Dong-Hoon Yang 626
    https://doi.org/10.5946/ce.2022.160 PDF
  7. Seok Jeong 628
    https://doi.org/10.5946/ce.2022.188 PDF
  8. Shivanand Bomman;Sofya Malashanka;Adil Ghafoor;David J. Sanders;Shayan Irani;Richard A. Kozarek;Andrew Ross;Michal Hubka;Rajesh Krishnamoorthi 630
    https://doi.org/10.5946/ce.2022.003 PDF
    Background/Aims: Transoral incisionless fundoplication (TIF) is an accepted anatomic treatment for gastroesophageal reflux disease in selected patients. In this report, we analyze our institution's programmatic allocation of resources during the safe implementation of TIF as a new procedure. Methods: A retrospective analysis of all patients who underwent TIF from January 2020 to February 2021 at our institution was performed. The process of initially allocating the operating room (OR) with overnight admission and postoperative esophagram for added safety, and subsequently transitioning TIF to the endoscopy suite (ES) as an outpatient procedure was described. Patient safety and outcomes were evaluated during transition. Results: Thirty patients who underwent TIF were identified. The mean age was 51.2±16.0 years. TIF was performed in an OR in nine patients (30%) and 21 (70%) in the ES. All the OR patients were admitted overnight and had routine esophagogram. In contrast, four (19%) from the ES group required clinically-indicated admission and three (14.2%) required esophagram. The mean procedure duration was significantly lower in the ES group (65.7 min vs. 84 min, p=0.02). Conclusions: A stepwise, resource-efficient process was described that allowed safe initiation of TIF as a new technique and its effective transition to a fully outpatient procedure.
  9. Joon Seop Lee;Chang Min Cho;Yong Hwan Kwon;An Na Seo;Han Ik Bae;Man-Hoon Han 637
    https://doi.org/10.5946/ce.2021.257 PDF
    Background/Aims: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs. Methods: In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques. Results: The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis. Conclusions: SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.
  10. Nisa Netinatsunton;Natcha Cheewasereechon;Tanawat Pattarapuntakul;Jaksin Sottisuporn;Kanet Kanjanapradit;Bancha Ovartlarnporn 645
    https://doi.org/10.5946/ce.2022.048 PDF
    Background/Aims: Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Workgroup Serrated Polyps and Polyposis (WASP) classifications were developed for optical diagnosis of neoplastic and sessile serrated polyps, respectively. Near-focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not yet been evaluated. We aimed to compare the accuracy of near-focus NBI (group A) with normal-focus NBI (group B) in real-time optical diagnosis of colorectal polyps using combined NICE and WASP criteria. Methods: Among 362 patients, 118 with 227 polyps were recruited. Groups A and B included 62 patients with 130 polyps (three lost polyps) and 56 patients with 106 polyps (six lost polyps), respectively. Optical diagnoses were compared with pathological reports. Results: The accuracy of optical diagnosis of neoplastic polyps in groups A and B was not significantly different (76% vs. 71%, p=0.52). WASP criteria provided all false positive diagnoses of sessile polyps as serrated polyps in 31 (16.2%) patients. Conclusions: Near-focus NBI was not superior to normal-focus NBI in optical diagnostics of neoplastic polyps using NICE criteria. In our study, WASP classification yielded all false positives in the diagnosis of sessile serrated adenomas/polyps. Routine real-life optical diagnosis of polyps is still unadvisable.
  11. Daisuke Ide;Tomohiko Richard Ohya;Mitsuaki Ishioka;Yuri Enomoto;Eisuke Nakao;Yuki Mitsuyoshi;Junki Tokura;Keigo Suzuki;Seiichi Yakabi;Chihiro Yasue;Akiko Chino;Masahiro Igarashi;Akio Nakashima;Masayuki Saruta;Shoichi Saito;Junko Fujisaki 655
    https://doi.org/10.5946/ce.2022.009 PDF
    Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions: PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.
  12. Harshavardhan B. Rao;Paul K. Vincent;Priya Nair;Anoop K. Koshy;Rama P. Venu 665
    https://doi.org/10.5946/ce.2021.265 PDF
    Background/Aims: In patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), calcineurin activates zymogen, which results in pancreatitis. In this study, we aimed to determine the efficacy of tacrolimus, a calcineurin inhibitor, in preventing post-ERCP pancreatitis (PEP). Methods: This was a prospective pilot study in which patients who underwent ERCP received tacrolimus (4 mg in two divided doses); this was the Tac group. A contemporaneous cohort of patients was included as a control group. All patients were followed-up for PEP. PEP was characterized by worsening abdominal pain with an acute onset, elevated pancreatic enzymes, and a duration of hospital stay of more than 48 hours. Serum tacrolimus levels were measured immediately before the procedure in the Tac group. Results: There were no differences in the baseline characteristics between the Tac group (n=48) and the control group (n=51). Only four out of 48 patients (8.3%) had PEP in the Tac group compared to eight out of 51 patients (15.7%) who had PEP in the control group. The mean trough tacrolimus level in patients who developed PEP was significantly lower (p<0.05). Conclusions: Oral tacrolimus at a cumulative dose of 4 mg safely prevents PEP. Further randomized controlled studies are warranted to establish the role of tacrolimus in this context.
  13. Kwang Hyun Chung;Jeong Don Chae;Wonho Choe;Hyo Young Lee;Il Hwan Oh;Byoung Kwan Son 674
    https://doi.org/10.5946/ce.2021.210 PDF
    Background/Aims: Endoscopic channels are difficult to clean and can cause infection transmission. We examined the effectiveness of a newly developed channel-cleaning ball brush (BB), which is sucked into the endoscopic channel and scrapes and cleans the lumen as it passes through. Methods: The upper and lower gastrointestinal endoscopes used for patient examinations were randomly selected as the conventional brush (CB) or BB group. After manual cleaning, the presence or absence of carbohydrates, proteins, adenosine triphosphate, and hemoglobin was assessed. Results: Fifty-six and 58 endoscopes were cleaned with the CB and BB, respectively. Carbohydrate and protein were detected in one (1.8%) and two endoscopes (3.4%) in the CB and BB groups, respectively (p=1.000). Hemoglobin was observed in one (1.8%) and three endoscopes (5.2%) in the CB and BB groups, respectively (p=0.636). The adenosine triphosphate levels were 10.6±15.9 and 12.5±14.3 relative light units in the CB and BB groups, respectively (p=0.496). Twenty-seven (48.2%) and 19 (32.8%) endoscopes were positive for microbial cultures in the CB and BB groups, respectively (p=0.136). Conclusions: The efficacy of BB was not significantly different from that of CB in the endoscopic channel-cleaning process.
  14. Janusz Wlodarczyk;Tomasz Smeder 683
    https://doi.org/10.5946/ce.2021.144 PDF
    We report five patients treated for esophageal fibrovascular polyps using a minimally invasive technique. Esophageal fibrovascular polyps are benign pedunculated submucosal tumors of considerable size. The treated polyps size ranged from 1.5 to 13 cm. The polyps were removed by relocation to the oral cavity under endoscopic control. No perioperative complications occurred after the treatment. The follow-up of patients after surgery was 9-89 months, with no evidence of polyp recurrence. Thus, the described treatment is safe but requires experience with endoscopy as well as esophageal surgery.
  15. Kwang Hyun Chung;Soo-Jeong Cho 688
    https://doi.org/10.5946/ce.2022.146 PDF
  16. Zoe N. Memel;Duncan J. Flynn;Yasmin Hernandez-Barco;Kavel Harish Visrodia;Brenna Casey;Kumar Krishnan 691
    https://doi.org/10.5946/ce.2021.050 PDF
  17. Suhyun Park;Jihun Kim;Dong-Hoon Yang 695
    https://doi.org/10.5946/ce.2022.215 PDF
  18. Ji Young Chang 699
    https://doi.org/10.5946/ce.2022.123 PDF
  19. Istvan Racz;Andras Horvath;Zoltan Horvath 701
    https://doi.org/10.5946/ce.2022.123.1 PDF