• Journal of Medicine and Life Science
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• v.21 no.2
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• pp.49-52
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• 2024

Massive gastric mucosal ruptures during upper gastrointestinal endoscopy in patients with esophageal hiatal hernias are rare. However, tearing of the gastric mucosa alone, without tearing of the gastroesophageal junction, is even rarer. This study reports a case of a large mucosal rupture that occurred on the posterior wall of the upper body of the stomach during upper gastrointestinal endoscopy in an 83-year-old woman with an esophageal hiatal hernia while sedated. The patient was treated with endoclips for the rupture.

• Journal of Digestive Cancer Research
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• v.2 no.1
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• pp.1-4
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• 2014

Palliative care for cancer aims to relieve the discomfort and pain from the cancer itself and associated conditions. Gastrointestinal cancers originate from the tube like structure of gastrointestinal tract and cause complications such as obstruction, bleeding, adhesion, invasion, and perforation to adjacent organ. Recent advances in interventional endoscopy enables endoscopy physicians to do safe and effective care for gastrointestinal cancer patients. Endoscopic palliation includes stent, hemostasis, nutritional support and targeted drug delivery. Self expandable metallic stent is one of the most important modalities in gastrointestinal palliation. Through the endoscopy or over the wire pre-placed by endoscopy, stents restore the gastrointestinal luminal patency and relieve the obstructive condition. Endoscopic hemostasis is another important palliation in gastrointestinal cancer patients. Epinephrine injection, argon plasma coagulation and thermal cauterization are usual modalities for hemostasis. Histoacryl glue and fibrin glue are also available. Hemostatic nanopowder spray is newly reported effective in benign disease and is supposed to be effective also in cancer bleeding. Enteral feeding tubes including gastro- or jejunostomy and nosoduodenal tubes are placed by using endoscopic guidance. Enteral feeding tubes role as the route of easily absorbable or semi-digested nutrients and effectively maintain both patients calorie requirements and gut microenvironment. Photodynamic therapy is the one of the outstanding medical employments of photo-physics. Especially for superficial cancers in esophagus, photodynamic therapy is very useful in cancer removal and maintaining organ structure. In biliary neoplasm, photodynamic therapy is well known to be effective in cancer ablation and biliary ductal patency restoration. Targeted drug delivery is the lastest issue in palliative endoscopy. Debates and questions are still on the table. In this article, the role of endoscopic interventions in palliative care for the gastrointestinal tumors will be thoroughly reviewed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.6
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• pp.291-300
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• 2023

Purpose: The impact of coronavirus 2019 (COVID-19) on gastrointestinal (GI) endoscopy procedures in adults has been reported, with a drastic reduction in the number of procedures. However, there are no sufficient data regarding the impact on pediatric GI endoscopy. Here, we aimed to report that impact in the Asia-Pacific region. Methods: A questionnaire-based internet survey was conducted from June to November 2021 among pediatric endoscopy institutions in the Asia-Pacific region, with each institution providing a single response. Overall, 25 questions focused on the impact of the number of procedures conducted, the usage of personal protective equipment (PPE), and endoscopy training programs during the pandemic. Results: A total of 162 institutions across 13 countries in the Asia-Pacific region participated in the study, and 133 (82.1%) institutions underwent procedure changes since the emergence of COVID-19. The number of esophagogastroduodenoscopy and ileocolonoscopy procedures decreased in 118/133 (88.7%) and 112/133 (84.2%) institutions, respectively. Endoscopy for patient with positive COVID-19 in an emergency or urgent cases still carried out in 102/162 (62.9%) institutions. Screening of COVID-19 for all patients before endoscopy was done across 110/162 (67.9%) institutions. PPE recommendations varied among institutions. Pediatric gastrointestinal endoscopy training programs were discontinued in 127/162 (78.4%) institutions. Conclusion: This study reports the impact of the COVID-19 pandemic on pediatric gastrointestinal endoscopy in the Asia-Pacific region. There has been a significant reduction in the number of endoscopic procedures and relevant training programs.

• Clinical Endoscopy
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• v.56 no.3
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• pp.268-282
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• 2023

The sex/gender of gastroenterologists impact patients' satisfaction, compliance, and clinical outcomes. For instance, female gastrointestinal (GI) endoscopist-patient gender concordance improves health-related outcomes. This finding suggests that it is important to increase the number of female GI endoscopists. While the number of women in the field of gastroenterology is increasing in the United States and Korea by over 28.3%, it is not enough to account for the gender preferences of female patients. GI endoscopists are at a high risk of endoscopy-related injuries. However, there is a different distribution of muscle and fat; male endoscopists are more affected in their back, while females are more affected in the upper extremities. Women are more susceptible to endoscopy-related injuries than men. There is a correlation between the number of colonoscopies performed and musculoskeletal pain. Job satisfaction is lower in young female gastroenterologists (30' and 40') than in the opposite gender and other ages. Thus, it is important to address these issues in the development of GI endoscopy.

• Clinical Endoscopy
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• v.57 no.1
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• pp.73-81
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• 2024

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.

• Clinical Endoscopy
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• v.57 no.3
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• pp.335-341
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• 2024

Background/Aims: The coronavirus disease 2019 pandemic has affected the worldwide practice of upper gastrointestinal endoscopy. Here we designed a modified N95 respirator with a channel for endoscope insertion and evaluated its efficacy in upper gastrointestinal endoscopy. Methods: Thirty patients scheduled for upper gastrointestinal endoscopy were randomized into the modified N95 (n=15) or control (n=15) group. The mask was placed on the patient after anesthesia administration and particles were counted every minute before (baseline) and during the procedure by a TSI AeroTrak particle counter (9306-04; TSI Inc.) and categorized by size (0.3, 0.5, 1, 3, 5, and 10 ㎛). Differences in particle counts between time points were recorded. Results: During the procedure, the modified N95 group displayed significantly smaller overall particle sizes than the control group (median [interquartile range], 231 [54-385] vs. 579 [213-1,379]×10³/m³; p=0.056). However, the intervention group had a significant decrease in 0.3-㎛ particles (68 [-25 to 185] vs. 242 [72-588] ×10³/m³; p=0.045). No adverse events occurred in either group. The device did not cause any inconvenience to the endoscopists or patients. Conclusions: This modified N95 respirator reduced the number of particles, especially 0.3-㎛ particles, generated during upper gastrointestinal endoscopy.

• Clinical and Experimental Pediatrics
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• v.53 no.9
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• pp.817-823
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• 2010

Gastrointestinal and colonic endoscopic examinations have been performed in pediatric patients in Korea for 3 decades. Endoscopic procedures are complex and may be unsafe if special concerns are not considered. Many things have to be kept in mind before, during, and after the procedure. Gastrointestinal endoscopy is one of the most frequently performed procedure in children nowadays, Since the dimension size of the endoscopy was modified for pediatric patients 15 years ago, endoscopic procedures are almost performed routinely in pediatric gastrointestinal patients. The smaller size of the scope let the physicians approach the diagnostic and therapeutic endoscopic procedures. But this is an invasive procedure, so the procedure itself may provoke an emergence state. The procedure-related complications can more easily occur in pediatric patients. Sedation-related or procedure-related respiratory, cardiovascular complications are mostly important and critical in the care. The endoscopists are required to consider diverse aspects of the procedure - patient preparation, indications and contraindications, infection controls, sedation methods, sedative medicines and the side effects of each medicine, monitoring during and after the procedure, and complications related with the procedure and medicines - to perform the procedure successfully and safely. This article presents some important guidelines and recommendations for gastrointestinal endoscopy through literature review.

• Clinical Endoscopy
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• v.57 no.3
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• pp.329-331
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• 2024

• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.2
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• pp.113-124
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• 2024

Purpose: Alarm symptoms (red flag signs) are crucial indications for management decisions on pediatric gastrointestinal endoscopy. We aimed to identify items in the alarm symptoms and pre-endoscopic investigations that predict abnormal endoscopy results. Methods: A retrospective descriptive study was conducted among children aged under 18 years undergoing endoscopy. The patients were classified into normal and abnormal endoscopic groups. The incidence of alarm symptoms and pre-endoscopic investigations were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for abnormal endoscopy. Results: Of 148 participants, 66 were classified in the abnormal endoscopy group. Compared with the normal group, the abnormal group had a significantly higher prevalence of alarm symptoms. Moreover, hematemesis/hematochezia, anemia, low hemoglobin level, hypoalbuminemia, rising erythrocyte sedimentation rate, increased serum lipase, and blood urea nitrogen/creatinine ratio were significantly higher in the abnormal endoscopy group than in the normal group. Multivariate logistic regression analysis indicated that hematemesis/hematochezia and low hemoglobin level were independent risk factors for abnormal endoscopy. Conclusion: The alarm symptoms and pre-endoscopic investigations were evaluated using predictive factors for abnormal pediatric endoscopic findings. According to multivariate logistic regression analysis, hematemesis/hematochezia and low hemoglobin levels were independent risk factors for abnormal endoscopy.