Unfortunately, a “Backlight System” As a Global Positioning System Failed to Guide the Route in 25-G Fine-Needle Aspiration

Rungsun Rerknimitr,Phonthep Angsuwatcharakon 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.4

Practical Approaches for High-Risk Surgical Patients with Acute Cholecystitis: The Percutaneous Approach versus Endoscopic Alternatives

Rungsun Rerknimitr,Khanh Cong Pham 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6

In high-risk surgical patients with acute cholecystitis who are not candidates for early laparoscopic cholecystectomy, gallbladder (GB) drainage is an alternative treatment option. Percutaneous transhepatic gallbladder drainage (PTGBD) is a recommended first line intervention because of its high efficacy and feasibility in most centers. However, with the advent of endoscopic accessories and technology, endoscopic GB drainage has been chosen as a more favorable choice by endoscopists. Endoscopic transpapillary gallbladder drainage (ETGBD) can be performed under either fluoroscopic or peroral cholangioscopic guidance via endoscopic retrograde cholangiopancreatography by the transpapillary placement of a long double-pigtail stent. In a patient with common bile duct stones, this procedure is accompanied with stone removal. ETGBD is especially useful for acute cholecystitis patients who are contraindicated for PTGBD or those with severe coagulopathy, thrombocytopenia, and abnormal anatomy. Moreover, the advantage of ETGBD is its preservation of the external GB structure. Thereby it would not disturb the future cholecystectomy. Recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using plastic, fully covered metallic, or lumen-apposing metal stents transmurally has emerged as a modality for GB drainage with higher technical and clinical success rates. EUS-GBD can provide a more permanent GB drainage than PTGBD and ETGBD.

Endoscopic Transmural Necrosectomy: Timing, Indications, and Methods

Rungsun Rerknimitr 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.1

Walled-off necrosis is considered one of the most severe complications after an episode of severe acute pancreatitis. Traditionally,percutaneous drainage is selected as the first treatment step, while open surgery can be planned as a secondary option if necrosectomyis required. In recent years, endoscopic necrosectomy has evolved as a more favorable approach. To date, a step-up treatment strategyis recommended, particularly when a plastic stent is selected as the drainage device. Multi-gateway endoscopic therapy may be usedin a step-up fashion if only one stent fails to clear debris. Over many years, there has been an evolution in stent selection, from plasticto metallic stents. Within a few years of its clinical usage, lumen-apposing stents are gaining more popularity as they offer directendoscopic necrosectomy and only require a few sessions.

Cell block created from pancreatic duct lavage is another jigsaw puzzle to diagnose early pancreatic ductal adenocarcinoma

Rungsun Rerknimitr 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.3

EDITORIAL

Identification of Pancreatic Cancer in Biliary Obstruction Patients by FRY Site-specific Methylation

Angsuwatcharakon, Phonthep,Rerknimitr, Rungsun,Kongkam, Pradermchai,Ridtitid, Wiriyaporn,Ponauthai, Yuwadee,Srisuttee, Ratakorn,Kitkumthorn, Nakarin,Mutirangura, Apiwat Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.9

Background: Methylation at cg 16941656 of FRY is exclusively found in normal pancreatic tissue and has been proven to be specific for pancreatic-in-origin among several adenocarcinomas. Here, we investigated methylated DNA in the bile as a biomarker to differentiate the cause of obstruction between pancreatic cancer and benign causes. Materials and Methods: Bile samples of 45 patients with obstructive jaundice who underwent ERCP were collected and classified into pancreatic cancer (group 1) and benign causes (group 2) in 24 and 21 patients, respectively. DNA was extracted from bile and bisulfite modification was performed. After, methylation in cg 16941656 of FRY was identified by real-time PCR, with beta-actin used as a positive control. Results: Methylated DNA was identified in 10/24 (41.67%) and 1/21 (4.8%) of cases in groups 1 and 2, respectively (P= 0.012). The sensitivity, specificity, positive predictive value and negative predictive value to differentiate pancreatic cancer from benign causes were 42%, 95%, 91%, and 59%, respectively. Conclusions: Detecting a methylation at cg 16941656 of FRY in bile has high specificity, with an acceptable positive likelihood rate, and may therefore be helpful in distinguish pancreatic cancer from benign strictures.

Cracking Difficult Biliary Stones

Phonthep Angsuwatcharakon,Rungsun Rerknimitr 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5

Apart from difficult biliary cannulation, biliary stone removal is considered one of the hurdles in endoscopic retrogradecholangiopancreatography. Generally, simple common bile duct (CBD) stones can be removed either with an extraction balloon or abasket. However, there are difficult stones that cannot be removed using these standard methods. The most difficult stones are largeCBD stones and impacted stones in a tapering CBD. A few decades ago, mechanical lithotripsy was usually required to manage thesestones. At present, endoscopic papillary large balloon dilation (EPLBD) of the biliary orifice has become the gold standard for largeCBD stones up to 1.5 cm. EPLBD can reduce the procedural time by shortening the stone removal process. It can also save the costof the devices, especially multiple baskets, used in mechanical lithotripsy. Unfortunately, very large CBD stones, stones impacted ina tapering CBD, and some intrahepatic duct stones still require lithotripsy. Peroral cholangioscopy provides direct visualization ofthe stone, which helps the endoscopist perform a probe-based lithotripsy either with an electrohydraulic probe or a laser probe. Thistechnique can facilitate the management of difficult CBD stones with a high success rate and save procedural time without significanttechnical complications.

Endoscopic Ultrasound-guided Radio-frequency Ablation for Pancreatic Cancer

Pradermchai Kongkam,Rungsun Rerknimitr 대한췌장담도학회(구 대한췌담도학회) 2021 대한췌담도학회지 Vol.26 No.2

Prognosis of unresectable pancreatic cancer is poor with the rate of surviving more than 5 years is less than 10% despite multi-modalities treatment. The American Society of Clinical Oncology suggested that all patients with metastatic pancreatic cancer should be offered information about clinical trials. Endoscopic ultrasound guided radio frequency ablation has been recently used in patients with advanced stage pancreatic cancer in a few studies. This article has reviewed information from published articles using endoscopic ultrasound guided radio frequency ablation for advanced pancreatic cancer.

A New Paradigm Shift in Gastroparesis Management

( Parit Mekaroonkamol ),( Kasenee Tiankanon ),( Rungsun Rerknimitr ) 대한소화기학회 2022 Gut and Liver Vol.16 No.6

Gastroparesis, once regarded as a rare disease, is difficult to diagnose and challenging to treat; there were many breakthrough advances in the 2010s, shifting the paradigm of the understanding of this complex entity and its management. Similar to diabetes, its increasing prevalence reflects increased accessibility to diagnostic modalities and suggests that gastroparesis was underacknowledged in the past. Major developments in the three main aspects of the disease include the discovery of smooth muscle cells, interstitial cells of Cajal, PDGFRα+ cells syncytium, rather than interstitial cells of Cajal alone, as the main gastric pacemaker unit; the development of validated point-of-care diagnostic modalities such as a wireless motility capsule, the carbon 13-labeled breath test, and impedance planimetry; and the introduction of novel minimally invasive therapeutic options such as newer pharmacologic agents and gastric peroral endoscopic pyloromyotomy. All aspects of these advances will be discussed further in this review. (Gut Liver 2022;16:825-839)

Flexible Spectral Imaging Color Enhancement and Probe-based Confocal Laser Endomicroscopy in Minimal Change Esophageal Reflux Disease

( Rapat Pittayanon ),( Surasak Aumkaew ),( Rungsun Rerknimitr ),( Naruemon Wisedopas ),( Pinit Kullavanijaya ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.1

Background/Aims: Although flexible spectral imaging color enhancement (FICE) can facilitate the diagnosis of minimal change esophageal reflux disease (MERD), the complicated diagnostic criteria cause suboptimal inter-observer agreement. Confocal laser endomicroscopy (CLE) yields good diagnostic results but its inter-observer agreement has never been explored. This study compares the diagnostic value of magnifying FICE and probe-based CLE (pCLE) for MERD and evaluates the inter-observer agreement of both techniques. Methods: Thirty-six patients with suspected MERD and 18 asymptomatic controls were recruited. Magnifying FICE was used for evaluation of distal esophagus. pCLE counted the number of intrapapillary capillary loops (IPCLs) using more than five IPCLs in 500×500 micron area as a criterion for MERD diagnosis. The validity scores and interobserever agreement of both FICE and pCLE were assessed. Results: For FICE vs. pCLE, the accuracy was 79% vs. 87%, sensitivity 94% vs. 97%, specificity 50% vs. 66%, positive predictive value 79% vs. 85%, and negative predictive value 82% vs. 92%. Interobserver agreement of FICE was fair to substantial, whereas pCLE had substantial to almost perfect agreement. Conclusions: Both FICE and pCLE have good operating characteristics and can facilitate the MERD diagnosis. However, among different observers, pCLE is more consistent on MERD diagnosis. (Korean J Gastroenterol 2016;68:29-35)

Current Status of Colorectal Cancer and Its Public Health Burden in Thailand

Kasenee Tiankanon,Satimai Aniwan,Rungsun Rerknimitr 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4

Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalentcancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program asa response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, whilethere are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage ofendoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel,reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemicaltest (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FITcutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify thepriority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies andthe current status of the Thailand CRC screening program.