• Journal of Digestive Cancer Research
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• 제11권1호
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• pp.30-34
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• 2023

Since the 1990s, serrated polyps have been established to contribute to intermediate cancer development, and their importance has begun to be recognized. Serrated polyps are morphologically difficult to detect through endoscopy, and an effective resection method has not been established. Among serrated polyps, studies on sessile serrated lesions, with a relatively high risk of colorectal cancer transformation and detected with difficulty, are in progress. Studies to date describe the endoscopic features as mucus cap, surface debris or stool, attenuation of underlying vasculature, cloud-like surface, dark spots in crypts, and ill-defined irregular border. Additionally, it is expected that relatively large serrated polyps can be safely removed through cold snare resection. A plan for an effective management of serrated polyps through continuous research in the future is warranted.

• Journal of Digestive Cancer Research
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• 제2권1호
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• pp.21-23
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• 2014

식도암으로 인한 기관지 식도 누공 환자는 음식물을 섭취하면 누공을 통하여 기관지로 음식물이 흡입되어 폐렴과 같은 합병증을 유발할 수 있다. 특히 전신쇠약이 동반되고 면역력이 저하되어 있는 식도암 환자에게는 치명적인 결과를 초래할 수 있다. 기관지 식도 누공의 내시경적 치료는 환자에게 경구 섭취를 가능하게 하고, 합병증의 발생을 예방할 수 있을 것으로 생각된다. 하지만 아직까지 장기간의 효과 지속성이나 재발에 관하여는 만족스러운 결과가 없는 실정이다. 향후 새로운 내시경 치료법의 개발 및 치료 효과에 대한 연구가 필요하다고 생각한다.

• Journal of Digestive Cancer Research
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• 제10권1호
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• pp.39-42
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• 2022

Primary duodenal follicular lymphoma is rare and presents as multiple, small polyp-like lesions on endoscopy. If this lesion is suspected, an endoscopic biopsy is crucial for diagnosis. A watchful wait would be appropriate management as it has a fairly indolent clinical course. Herein, we present a rare case of primary duodenal follicular lymphoma.

• Journal of Gastric Cancer
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• 제19권2호
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• pp.225-233
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• 2019

Purpose: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) was first reported as a rare adenocarcinoma found in the normal fundic mucosa. Recent studies have proposed the possibility that GA-FG-CCPs were also generated in the atrophic mucosa after Helicobacter pylori (HP) eradication therapy. However, little is known on the endoscopic findings of GA-FG-CCP generated in the atrophic mucosa due to its extreme rarity. Materials and Methods: A total of 8 patients who underwent endoscopic submucosal resection and were diagnosed with GA-FG-CCP generated in the HP-uninfected mucosa (4 cases, HP-uninfected group) or HP-eradicated atrophic mucosa (4 cases, HP-eradicated group) were retrospectively analyzed, and their endoscopic findings, including magnifying endoscopy with narrow band imaging (M-NBI), and pathological features were compared. Results: While GA-FG-CCPs in the 2 groups displayed similar macroscopic appearance, M-NBI demonstrated that characteristic microvessels (tapered microvessels like withered branches) were specifically identified in the HP-eradicated group. Pathological investigation revealed that a decreasing number of fundic glands and thinned foveolar epithelium covering tumor ducts were thought to lower the thickness of the covering layer over tumor ducts in the HP-eradicated group. Moreover, dilation of vessels just under the surface of the lesions contributed to the visualization of microvessels by M-NBI. Conclusions: The change in background mucosa due to HP infection influenced the thickness of the covering layer over the tumor ducts and M-NBI finding of GA-FG-CCP.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권1호
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• pp.79-88
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• 2020

Purpose: Management of eosinophilic esophagitis (EoE) varies from center to center. In this study, we evaluated the effectiveness of a dairy-free diet (DFD) and the 6-Food Elimination Diet (SFED) as initial therapies for the treatment of EoE in our practice. Methods: This was a retrospective study of children who had been treated for EoE at Connecticut Children's Medical Center, Hartford, CT, USA. Pre- and post-treatment endoscopy findings and histology results of patients treated with DFD or SFED were examined. Results: One hundred fifty-two patients (age 9.2±5.2 years, 76.3% male, 69.7% caucasian) met the inclusion criteria for initial treatment with DFD (n=102) or SFED (n=50). Response for DFD was 56.9% and for SFED was 52.0%. Response based on treatment duration (<10, 10-12, and >12 weeks) were 81.8%, 50.0%, and 55.1% for DFD, and 68.8%, 50.0%, and 40.0% for SFED. Response based on age (<6, 6-12, and >12 years) were 59.3%, 42.9%, and 67.5% for DFD, and 36.4%, 58.8%, and 72.7% for SFED. In patients treated with DFD, concomitant proton pump inhibitor (PPI) administration resulted in improved outcomes (p=0.0177). Bivariate regression analysis showed that PPI with diet is the only predictor of response (p=0.0491), however, there were no significant predictors on multiple regression analysis. Conclusion: DFD and SFED are effective first line therapies for EoE. DFD should be tried first before extensive elimination diets. Concomitant therapy with PPI's may be helpful.

• Clinical Endoscopy
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• 제56권2호
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• pp.169-179
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• 2023

Background/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)-guided tissue acquisition from pancreatic lesions. Methods: A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-tissue acquisition (TA) in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis. Results: Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52-0.90) and strict criteria (OR, 0.58; 95% CI, 0.46-0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76-1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents. Conclusions: The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

• Clinical Endoscopy
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• 제55권6호
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• pp.742-750
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• 2022

Background/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP. Methods: A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP. Results: Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97-1.09), overall bleeding (RR, 0.98; 95% CI, 0.40-2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97-1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72-2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis. Conclusions: CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

• Clinical Endoscopy
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• 제55권5호
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• pp.615-625
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• 2022

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.

• 한국간담췌외과학회지
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• 제27권4호
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• pp.350-365
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• 2023

Backgrounds/Aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically. Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome. Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome. Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.

• 지능정보연구
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• 제15권2호
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• pp.33-48
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• 2009

캡슐내시경검사는 일반 내시경 검사에 비해 고통이 없고 합병증이 적다고 보고되어 있어 향후 지속적인 발전 가능성이 매우 큰 분야로 잘 알려져 있다. 그러나, 캡슐내시경을 이용한 진단은 캡슐이 동일한 위치에 상주할 경우 반복적으로 촬영된 유사한 영상을 오래도록 관찰 하여야 하므로, 진단자로 하여금 막대한 시간적 비용을 발생하게 한다. 따라서 보다 현실적이고 실용적인 캡슐내시경 검사를 위한 효율적인 탐색 및 진단 방법으로써 캡슐내시경영상에 대한 지능형 탐색방법이 요구된다. 본 논문에서 제안하는 지능형 판독보조 시스템은 영상차감을 통해 중복영상을 최소화한 후 프레임단위로 영상이 내포한 정보를 일차원도표(map)의 형태로 제공하고, 이러한 결과도표의 분석도구 및 방법을 제안함으로써 진단시간을 큰 폭으로 단축할 수 있는 방법을 제안하였다. 즉, 비교연산 한 정규화된 교차상관(Normalized Cross-Correlation) 방법을 통해 전처리 된 인접영상에 대한 유사도를 추출하고, 설정된 임계값이상의 영상들만을 탐색 범위로 지정하여 중복 촬영된 영상의 탐색을 최소화 한다. 이외에도 영상간 유사도, 엔트로피와 명암도를 통해 얻어진 이동도표, 특성도표와 명암도표를 분석하여 효율적으로 사용자가 탐색을 원하는 부위에 대한 탐색밀도를 높이는 등의 다양한 진단 매뉴얼을 제시한다.