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RISS 인기검색어
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- 저자 : Clement C H Wu (검색결과 6 건)
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Clement C H Wu,James W Li,Keng Sin Ng,Daphne S Ang 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.1
Percutaneous endoscopic gastrostomy (PEG) is commonly performed for feeding diffculties, in patients suffering from complicationsof nasopharyngeal carcinoma (NPC) and its treatment, namely radiotherapy and surgery. This case report describes the challenges inhemostasis and subsequent re-establishment of enteral access for feeding, in an elderly patient with a history of NPC, treated surgically,followed by radiotherapy, who presented with massive hematemesis following reinsertion of her PEG shortly after an accidentaldislodgement. Her previous nasopharyngectomy, wide field radiation therapy, and radical neck dissection precluded nasogastric tubefeeding, and the presence of a large hiatus hernia made reinsertion of a new PEG technically challenging. This case highlights themethods used to overcome the above challenges.
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Clement Chun Ho Wu,Samuel Jun Ming Lim,Christopher Jen Lock Khor 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.4
Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.
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The Role of Endoscopic Management in Afferent Loop Syndrome
Wu Clement Chun Ho,Brindise Elizabeth,Abiad Rami El,Khashab Mouen A. 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.3
Afferent loop syndrome (ALS) is a morbid complication that may occur after gastrectomy and gastrojejunostomy reconstruction. The aim of this article is to review the different endoscopic treatment options of ALS. We describe the evolution of the endoscopic treatment of ALS and its limitations despite the overall propitious profile. We analyze the advantages of endoscopic ultrasound-guided entero-enterostomy (EUS EE) over enteroscopy-guided intervention, and the clinical outcomes of EUS EE. We expound on pre-procedural considerations, intra-procedural techniques and post-procedural care following EUS EE. We conclude that given the simplification of the technique and the ability to place a stent away from the tumor, EUS EE is a promising technique that will likely be established as the treatment of choice for ALS.
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Collision-avoidance trajectory planning for a virtual kinesthetic feedback system
Kun Wang,Clement Gosselin,Xuan Wu,Qiu-Ju Zhang,Ke Li,Yi Cao 대한기계학회 2016 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.30 No.7
This paper proposes the collision-avoidance trajectory design and simulation of a virtual kinesthetic feedback system. The system has two sliders driven in two tracks, respectively, and produces virtual masses when the user holds and moves the system. Trajectory planning considering both the ideal and constrained scenarios in applications is carried out. A collision-avoidance trajectory is designed based on the quintic polynomial, and the influence of the time interval and the switching point is discussed. Simulations were performed to verify the function of the system. The results show that without constraints, the system can produce prescribed virtual masses. The displacements of the slider are affected by the error between the prescribed virtual mass and the real mass of the system. With the constraints of the tracks' lengths, the produced virtual masses are altered from the prescribed. Adjusting the time interval and the switching point could optimize the performance of the system when the geometric parameters of the system are set.
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Yung Ka Chin,Clement Chun Ho Wu,Damien Meng Yew Tan 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1
The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominalimaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs thatrequire surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriatelyaggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopicexamination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE andhistological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed thehigh diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown toimprove the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity andmortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes forpancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate managementhave resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantlyimproved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of thepancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.
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