• Journal of Chest Surgery
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• v.53 no.4
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• pp.172-177
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• 2020

Superficial esophageal neoplasms (SENs) are being diagnosed increasingly frequently due to the screening endoscopy and advances in endoscopic techniques. Endoscopic resection (ER) is a relatively noninvasive treatment method with low morbidity and mortality that provides excellent oncologic outcomes. Endoscopic submucosal dissection is associated with higher rates of en bloc, complete and curative resections and lower rates of local recurrence than endoscopic mucosal resection. The most serious complication of ER is stricture, the treatment and prevention of which are crucial to maintain the patient's quality of life. ER for SEN is feasible, effective, and safe and can be considered a first-line treatment for SENs in which it is technically feasible.

• Clinical Endoscopy
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• v.56 no.1
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• pp.38-49
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• 2023

Background/Aims: Patients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC. Methods: We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM. Results: Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I²=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I²=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I²=0%). Conclusions: Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

• Clinical Endoscopy
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• v.55 no.1
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• pp.33-40
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• 2022

Background/Aims: Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethylene oxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review and meta-analysis was performed to assess the impact of ESRT on the contamination rates. Methods: A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model. Results: A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%-10.8%, inconsistency index [I²]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%-2.7%, I²=94.96). Conclusions: While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.

• Clinical Endoscopy
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• v.55 no.2
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• pp.191-196
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• 2022

Unlike simple forward-viewing endoscopes such as gastroscope or colonoscope, duodenoscope houses much more complex design to fulfil its function. This design differences leave duodenoscopes more prone to contamination from inadequate disinfection process and potential dissemination of pathogens. Recent reports on dissemination of infection through the duodenoscope mandated an overhaul of duodenoscope utilization including development of a disposable duodenoscope. This article reviews the current state of disposable duodenoscope development, including reported early efficacy as well as its future direction and utilization.

• Journal of The Korean Society of Clinical Toxicology
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• v.7 no.2
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• pp.113-120
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• 2009

Purpose: Though caustic injury of the upper digestive tract can lead to severe sequelae, there are few clinical studies on this subject. This study was undertaken to evaluate the clinical characteristics, the endoscopic findings and the risk factors of the upper digestive lesions in patient with caustic ingestion injury. Methods: We retrospectively reviewed the medical records of 137 patients who ingested caustic materials and who visited to our emergency room from January, 2000 to June, 2009. Results: The most common ingested agent was sodium hypochlorite (44.5%), followed by acetic acid (19.7%), hydrochloric acid (11.7%) and lye (8.0%). Ingestion for suicidal attempt (62.0%) was more frequent than accidental ingestion (30.7%). Grade IIa injury was the most frequent finding on endoscopy of the esophagus and Grade 1 injury was the most frequent finding on endoscopy of the stomach. For the late sequelae, there were 9 cases (6.6%) of esophageal stricture and 2 cases (1.5%) of gastric outlet obstruction. The initial signs and symptoms did not correlate with the development of stricture, but leukocytosis, and grade III injury were related to the risk of developing stricture. Conclusion: Caustic injury of the upper gastrointestinal tract is frequently observed on early endoscopy and it can cause significant late sequelae such as stricture. Therefore, it is necessary to evaluate these patients with regular follow up endoscopic examinations for the management of late sequelae.

• Clinical Endoscopy
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• v.57 no.2
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• pp.196-202
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• 2024

Background/Aims: Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies. Methods: We compared overweight patients (body mass index >25 kg/m²) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes. Results: We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO₂] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO₂ <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO₂ and the lowest SpO₂ recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008). Conclusions: Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.

• Journal of Digestive Cancer Research
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• v.11 no.2
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• pp.66-76
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• 2023

Endoscopy is an important noninvasive procedure for patients with gastrointestinal problems. However, surgical techniques are shifting to laparoscopic surgery, and changes in endoscopic findings after laparoscopic surgery differ from those after previous surgical methods. Postoperative endoscopic findings differ from normal anatomical structures, and findings reportedly vary depending on the type of surgical technique. Therefore, we aimed to summarize the surgical and endoscopic findings for each surgical method from the surgeon's point of view. The causes of gastric emptying delay, bleeding, afferent loop syndrome, or anastomosis leakage occurring after gastric cancer surgery can be identified via upper gastrointestinal endoscopy that is relatively less invasive than the surgical method. Regarding postoperative anastomosis leakage, endoscopy can directly evaluate the degree of leakage at the anastomosis site more accurately than computed tomography and enable immediate intervention. As endoscopy is less invasive than the surgical method, patients can be evaluated and treated more safely. However, coordination between the surgeon and the endoscopist is necessary to perform the procedures effectively. Therefore, reviewing the changes in surgical and endoscopic findings is important.

• Journal of Korean Clinical Nursing Research
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• v.20 no.2
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• pp.189-199
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• 2014

Purpose: The purpose of this study was to investigate job stress and job satisfaction among nurses in gastrointestinal endoscopy units, and factors related to their job stress and job satisfaction. Methods: The study participants were 153 nurses working in gastrointestinal endoscopy units at eleven general hospitals. Job stress and job satisfaction were measured using nurses's job stress scale and the index of work satisfaction respectively. Results: The average job stress was 3.67 (range 1~5) and job satisfaction was 2.90 (range 1~5). Gastrointestinal endoscopy unit nurses, who were full time worker, having more than 7 years of clinical experiences, having higher incomes, having high subjective work-intensity, and having an intention to change their working units, showed greater job stresses than those of the others. There were significant differences in job satisfaction according to subjective health status, the types of employment, subjective work-intensity, subjective aptitude, intention to change working units, major nursing tasks, and the numbers of major nursing tasks. Also, the subjects's job stress showed a negative correlation with job satisfaction. Conclusion: Findings suggest that management strategies should be developed to increase job satisfaction focusing on general and job characteristics associated with job stress.

• Clinical Endoscopy
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• v.57 no.2
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• pp.141-157
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• 2024

Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

• Journal of Digestive Cancer Research
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• v.10 no.2
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• pp.56-64
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• 2022

Narrow-band imaging (NBI) is the most widely used image-enhanced endoscopic technique. The superficial microanatomy of gastric mucosa can be visualized when used with a magnifying endoscopy with narrow-band imaging (ME-NBI). The diagnostic criteria for early gastric cancer (EGC), using the classification system for microvascular and microsurface pattern of ME-NBI, have been developed, and their usefulness has been proven in the differential diagnosis of small depressed cancer from focal gastritis and in lateral extent delineation of EGC. Some studies reported on the prediction of histologic differentiation and invasion depth of gastric cancer using ME-NBI; however, its application is limited in clinical practice, and further well-designed studies are necessary. Clinicians should understand the ME-NBI classification system and acquire appropriate diagnostic skills through various experiences and training to improve the quality of endoscopy for EGC diagnosis.