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RISS 인기검색어
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- 저자 : Michael B. Wallace (검색결과 4 건)
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Should We Resect and Discard Low Risk Diminutive Colon Polyps
Pujan Kandel,Michael B. Wallace 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3
Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection withhistological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis withouthistology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal EndoscopyPreservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplasticpolyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive valueshould be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be suffcientlyaccurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosisat least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regardto both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-qualitytraining, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose ofcolorectal polyps and its implications for colonoscopy practice.
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Recent Advance in Colon Capsule Endoscopy: What’s New?
Sung Noh Hong,Sun Hyung Kang,Hyun Joo Jang,Michael B. Wallace 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.4
Colon capsule endoscopy (CCE) is a relatively new diagnostic procedure for patients with suspected colonic diseases. This convenient,noninvasive method enables the physician to explore the entire colon without significant discomfort to the patient. However, while CCEcan be performed painlessly without bowel air insufflation, the need for vigorous bowel preparation and other technical limitationsexist. Due to such limitations, CCE has not replaced conventional colonoscopy. In this review, we discuss historical and recentadvances in CCE including technical issues, ideal bowel preparation, indications and contraindications and highlight further technicaladvancements and clinical studies which are needed to develop CCE as a potential diagnostic tool.
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Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection
Bashar Qumseya,Abraham M. Panossian,Cynthia Rizk,David Cangemi,Christianne Wolfsen,Massimo Raimondo,Timothy Woodward,Michael B. Wallace,Herbert Wolfsen 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.2
Background/Aims: Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formationhave not been well studied. Methods: We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection databasein a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophagealstrictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyzethe association between the primary outcome and predictors. Results: Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia(median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increasedodds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablativemodalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture(odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007). Conclusions: Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation includelarge mucosal resections and the resection of multiple lesions on the initial procedure.
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Do Han Kim,Somashekar G. Krishna,Emmanuel Coronel,Paul T. Kröner,Herbert C. Wolfsen,Michael B. Wallace,Juan E. Corral 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2
Background/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliarydisorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnosticperformance of confocal laser endomicroscopy (CLE). Methods: We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of thetechnique, image classification, diagnostic performance, ongoing research, and limitations. Results: Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). NeedlebasedCLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma,neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobservervariability are challenges for routine utilization. Conclusions: CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs andsimplifying image interpretation will promote utilization by advanced endoscopists.
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