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Jin Young Yoon,Román Turró Arau,The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointe 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1
Endoscopic sleeve gastroplasty (ESG) is a therapeutic endoscopic technique for reducing the size of the gastric reservoir in obesepatients, using a full-thickness endoscopic suturing device. The effectiveness of ESG in weight loss is significantly greater than that ofhigh-intensity diet and lifestyle therapy and lower than that of laparoscopic sleeve gastrectomy (LSG). The efficacy at 12 months afterESG in terms of percentage of total body weight loss and excess body weight loss was approximately 16% and 60%, respectively. Thewell-known predictive factors for increased weight loss by ESG are good compliance with regular monitoring and post-procedurecare involving a multidisciplinary team approach. Although the underlying mechanism of weight loss induced by ESG is debatable,delayed gastric emptying and early satiation are some of the proposed mechanisms. The pooled rate of adverse events after ESGreported in several meta-analysis studies ranged from 1.5% to 2.3% and the incidence of new-onset gastroesophageal reflux diseaseafter ESG was negligible, indicating that ESG has a superior safety profile to LSG. Moreover, ESG reduced the risk of obesity-relatedmetabolic comorbidities, evidenced by the reduction in HbA1c level, systolic blood pressure, triglyceride level, and risk of hepaticsteatosis and fibrosis; it even improved the quality of life. ESG could be considered safe and qualify as an alternative treatment toLSG.
Si Hyung Lee,김민철,Seong Woo Jeon,Kang Nyeong Lee,Jong-Jae Park,홍수진,Korean Society of Gastrointestinal Endoscopy Endoscopic Submucosal Dissection Research Group 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.2
Background/Aims: The purpose of this study was to investigate the risk factors and long-term clinical outcomes of non-curativeresection (NCR) in a large-scale patient population. Methods: We retrospectively analyzed the clinical data of 3,094 patients who underwent endoscopic submucosal dissection (ESD) ofearly gastric cancer from March 2005 to March 2018 at 13 institutions in Korea. We analyzed the risk factors for NCR and the survivalbetween patients with curative resection and those with NCR with no additional treatment. Results: The NCR rate was 21.4% (661/3,094). In multivariate regression analysis, the risk factors affecting NCR with ESD were oldage, undifferentiated tumor, tumor location in the upper body, tumor size ≥2 cm, and presence of an ulcer. In Cox proportional hazardregression analysis, tumor size ≥2 cm, submucosal invasion, positive horizontal margin, and lymphovascular invasion were risk factorsfor local recurrence. In Kaplan-Meier analysis, there was no statistically significant difference in the overall survival between the twogroups (log-rank p=0.788). However, disease-specific survival was significantly lower in the NCR group (log-rank p=0.038). Conclusions: Clinicians should be aware of the risk factors for NCR and local recurrence after ESD for early gastric cancer, and shouldconsider providing additional treatment after NCR.
Seon-Young Park,이준규,Jung-Wook Kim,Tae Hee Lee,Chang-Hwan Park,Jae-Yong Jang,Byung-Wook Kim,Byung Ik Jang,Quality management and Endoscopic sedation committee of Korean Society of Gastrointestinal Endo 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: This study aimed to determine the current status of facilities, equipment, and personnel for endoscopic sedationfrom endoscopy units of representative hospitals in South Korea. Methods: A questionnaire survey was conducted on 50 qualified endoscopy units accredited by the Korean Society of GastrointestinalEndoscopy. Results: All included endoscopy units had regulations and educational programs regarding sedation training for endoscopists andnursing personnel. There present one assisting nurse during endoscopy in 35 units (70%) and at least two nurses in 12 units (24.0%). All endoscopy units had examination rooms equipped with oxygen supply and suction systems. Endoscopist-directed sedationwas performed in 48 units (96.0%). Propofol-based sedation was the most used sedation method. All units had a separate recoverybay. The daily number of patients per bed was greater than 10 in 17 units (34.0%). In 26 (52.0%) units, a single nurse cared for ≥10patients per day. All the units fulfilled the discharge criteria. Conclusions: This study presents data regarding endoscopic sedation clinical practice in 50 endoscopy units in South Korea. Thisstudy presents the current status of endoscopic sedation clinical practice in 50 qualified endoscopy units accredited by the KSGE,which provide excellent quality management.
Sun Moon Kim,Eun Young Kim,Jin Woong Cho,Seong Woo Jeon,Ji Hyun Kim,Tae Hyeon Kim,Jeong Seop Moon,Jin-Oh Kim,Research Group for Endoscopic Ultrasound of the Korean Society of Gastrointestinal Endoscop 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs)and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs andleiomyomas. Methods: We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) andleiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logisticregression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs fromleiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance inthe development and internal validation sets. Results: Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06)as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors(homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity,0.908; specificity, 0.782) in the development and internal validation sets, respectively. Conclusions: The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, andpresence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.
New sedatives and analgesic drugs for gastrointestinal endoscopic procedures
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 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.5
Procedural sedation has become increasingly common in endoscopy. Sedatives and analgesics induce anxiolysis and amnesia. In addi- tion, 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 in- creased 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.
Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments
Hee Kyong Na,Diogo Turiani Hourneaux De Moura,The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointe 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1
Obesity, along with its comorbidities, has become a significant public health concern worldwide. Bariatric surgery is considered themost effective treatment modality; however, only 2% of patients with obesity undergo bariatric surgery. Endoscopic bariatric andmetabolic therapies (EBMTs) are emerging alternatives to traditional bariatric surgery for patients who are not eligible for or donot prefer surgical treatment. EBMTs are generally categorized as space-occupying, gastric restrictive, aspiration, and small boweltherapies. We aimed to review various non-balloon and non-gastroplasty devices with available clinical data and discuss the possiblemechanisms of action, efficacy, and safety profile of these EMBTs.
Joon Hyun Cho,Mohammad Bilal,Min Cheol Kim,Jonah Cohen,The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointe 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1
Obesity is becoming increasingly prevalent worldwide, and its metabolic sequelae lead to a significant burden on healthcareresources. Options for the management of obesity include lifestyle modification, pharmacological treatment, surgery, and endoscopicbariatric therapies (EBTs). Among these, EBTs are more effective than diet and lifestyle modification and are less invasive thanbariatric surgery. In recent years, there have been significant advances in technologies pertaining to EBTs. Of all the available EBTs,there is a significant amount of clinical experience and published data regarding intragastric balloons (IGBs) because of theircomparatively long development period. Currently, the United States Food and Drug Administration (FDA) has approved threeIGBs, including Orbera (Apollo Endosurgery, Austin, TX, USA), ReShape Duo (ReShape Medical, San Clemente, CA, USA), andObalon (Obalon Therapeutics, Carlsbad, CA, USA). The aim of this review is to summarize the available literature on the efficacy ofIGBs in weight loss and their impact on obesity-related metabolic diseases.