Performance and Cost of Disposable Biopsy Forceps in Upper Gastrointestinal Endoscopy: Comparison with Reusable Biopsy Forceps

Lim, Chul-Hyun,Choi, Myung-Gyu,Kim, Won Chul,Kim, Jin Soo,Cho, Yu Kyung,Park, Jae Myung,Lee, In Seok,Kim, Sang Woo,Choi, Kyu Yong,Chung, In-Sik The Korean Society of Gastrointestinal Endoscopy 2012 Clinical Endoscopy Vol.45 No.1

<P><B>Background/Aims</B></P><P>It is believed that disposable biopsy forceps are more costly than reusable biopsy forceps. In this study, we evaluated performance and cost of disposable forceps versus reusable forceps in esophagogastroduodenoscopic biopsy.</P><P><B>Methods</B></P><P>Between October 2009 and July 2010, we enrolled 200 patients undergoing esophagogastroduodenoscopic biopsy at Seoul St. Mary's Hospital. Biopsies were performed with 100 disposable or 5 reusable forceps by random assignment. Seventy-five additional patients were studied to estimate durability of reusable forceps. The assisting nurses estimated the performance of the forceps. The evaluation of costs included purchase prices and reprocessing costs. The adequacy of the sample was estimated according to the diameter of the obtained tissue.</P><P><B>Results</B></P><P>Performance of disposable forceps was estimated as excellent in 97.0%, good in 2.0% and adequate in 1.0%. Reusable forceps were estimated as excellent in 36.0%, good in 36.0%, adequate in 25.1% and inadequate in 2.9%. The performance of reusable forceps declined with the number of uses. The reprocessing cost of reusable forceps for one biopsy session was calculated as ₩8,021. The adequacy of the sample was excellent for both forceps.</P><P><B>Conclusions</B></P><P>Disposable forceps showed excellent performance. Considering the reprocessing costs of reusable forceps, usage of disposable forceps with a low price should be considered.</P>

Korean Society of Gastrointestinal Endoscopy Guidelines for Endoscope Reprocessing

Son, Byoung Kwan,Kim, Byung-Wook,Kim, Won Hee,Myung, Dae-Sung,Cho, Young-Seok,Jang, Byung Ik Korean Society of Gastrointestinal Endoscopy 2017 Clinical Endoscopy Vol.50 No.2

<P>The Korean Society of Gastrointestinal Endoscopy (KSGE) issued guidelines for endoscope reprocessing for the first time in 1995, and the version of the guidelines was updated in August 2009, August 2012, and March 2015. Guidelines for endoscope reprocessing should be revised continuously, because new disinfectants and devices are developed and introduced. The current official version of the KSGE guidelines for endoscope reprocessing is explained herein to assist the reader in understanding the KSGE requirements for cleaning and disinfecting endoscopes.</P>

Recent Trends in Endoscopic Bariatric Therapies

Choi, Hyuk Soon,Chun, Hoon Jai Korean Society of Gastrointestinal Endoscopy 2017 Clinical Endoscopy Vol.50 No.1

<P>Obesity and its associated metabolic diseases including diabetes mellitus are severe medical problems that are increasing in prevalence worldwide and result in significant healthcare expenses. While behavioral and pharmacological treatment approaches are partly effective in the short term, their effects are not long-lasting. Although previous studies have described bariatric surgery as the most effective treatment for obesity, it is associated with morbidity, mortality, and economic burden. Endoluminal interventions performed entirely using gastrointestinal flexible endoscopy offer alternative approaches to the treatment of obesity that are safer and more cost-effective than current surgical approaches. The use of endoluminal techniques in the field of metabolic obesity disease has diverse promising applications including endoscopic gastroplasty, intragastric balloon, endoluminal malabsorptive bariatric procedures, and gastric electrical stimulation (GES) for the modulation of gastric emptying. This review discusses recent trends and roles in endoscopic bariatric therapies using the currently available endoluminal and transgastric technologies.</P>

Comparison of Endoscopic Submucosal Dissection and Surgery for Differentiated Type Early Gastric Cancer within the Expanded Criteria

Shin, Dong Woo,Hwang, Hee Young,Jeon, Seong Woo Korean Society of Gastrointestinal Endoscopy 2017 Clinical Endoscopy Vol.50 No.2

<P><B>Background/Aims</B></P><P>Endoscopic submucosal dissection (ESD) is a novel alternative treatment for differentiated early gastric cancer (EGC) without lymph node metastasis. We conducted this study to verify the therapeutic usefulness of ESD for treating differentiated EGC compared to that of surgery.</P><P><B>Methods</B></P><P>This is a retrospective cohort study of 382 patients treated with differentiated EGC from March 2006 to May 2010. The propensity score yielded 275 matched patients. They were divided into an ESD group of 175 people and a gastrectomy group of 100 people. The patient demographics, pathologic characteristics, length of hospital stay, complication rate and survival rate were compared.</P><P><B>Results</B></P><P>The complication rate was higher for the gastrectomy group than for the ESD group (15.0% vs. 5.1%, <I>p</I>=0.007). The average length of patient hospitalization was longer after gastrectomy than after ESD (8.6 days vs. 2.4 days, <I>p</I><0.001). There were two cases of mortality in the surgery group within 30 days of procedure. The 5-year survival rates of the two groups did not show a statistically significant difference (92.0% vs. 93.3%, <I>p</I>=0.496).</P><P><B>Conclusions</B></P><P>The long-term survival rates of ESD and gastrectomy were not significantly different. The complication rate was lower for ESD than for gastrectomy, and the length of hospital stay was shorter after ESD than after gastrectomy.</P>

Various Intragastric Balloons Under Clinical Investigation

Choi, Seong Ji,Choi, Hyuk Soon Korean Society of Gastrointestinal Endoscopy 2018 Clinical Endoscopy Vol.51 No.5

<P>Obesity is a chronic disease with an exponentially increasing incidence rate, and its negative effects are well documented in numerous studies. As a result, the importance of bariatric therapy cannot be overemphasized, and many bariatric treatment methods with varying mechanisms have been developed. Of the available treatment methods, intragastric balloons, introduced in the 1980s, have been shown to be a safe and effective treatment modality; various intragastric balloon products have been developed and are currently being widely used in clinical settings. However, the disadvantages of intragastric balloons, such as unclear long-term weight loss benefits and complications experienced during insertion and removal, preclude their wider use. In this review, we discuss different intragastric balloon products, focusing on those under clinical investigation, and suggest future research directions.</P>

Accessory Devices Frequently Used for Endoscopic Submucosal Dissection

Choi, Hyuk Soon,Chun, Hoon Jai Korean Society of Gastrointestinal Endoscopy 2017 Clinical Endoscopy Vol.50 No.3

<P>Endoscopic submucosal dissection (ESD) is increasingly being considered an essential component of treatment for early gastrointestinal cancers and subepithelial tumors. The ESD technique owes its popularity to the development of sophisticated instruments used for ESD. With an increase in the number of ESD procedures performed, there is rapid development in the number and types of endoscopic accessory devices used for such procedures. Despite the large numbers of new devices developed and marketed, the use of ESD instruments and accessory devices is largely determined by individual preferences and experiences. Accessory devices frequently used during ESD are important tools for ESD techniques. Each instrument possesses characteristic advantages and disadvantages associated with its use, and no one instrument is superior in all respects to others. In this article, we review the characteristics of endoscopic electrical knives, cap and hood, and hemostatic devices commonly used in ESD.</P>

Meeting Report and Special Issue Preface: International Digestive Endoscopy Network (IDEN) 2016

Lee, Sang Kil,Lee, Jong Kyun Korean Society of Gastrointestinal Endoscopy 2016 Clinical Endoscopy Vol.49 No.5

Factors Affecting Endoscopic Curative Resection of Gastric Cancer in the Population-Based Screening Era

Mun, Yoon Gwon,Choi, Myung-Gyu,Lim, Chul-Hyun,Lee, Han Hee,Kang, Dong Hoon,Park, Jae Myung,Song, Kyo Young Korean Society of Gastrointestinal Endoscopy 2018 Clinical Endoscopy Vol.51 No.5

<P><B>Background/Aims</B></P><P>Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer. </P><P><B>Methods</B></P><P>We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer. </P><P><B>Results</B></P><P>Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection. </P><P><B>Conclusions</B></P><P>Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer. </P>

Endoscopic Resection of Subepithelial Tumors

The Korean Society of Gastrointestinal Endoscopy 2012 Clinical Endoscopy Vol.45 No.3

<P>Subepithelial tumors (SETs) are often incidentally found during endoscopic examinations. Endoscopic ultrasonography (EUS) is a good method for differential diagnosis of SETs, but a definite diagnosis cannot be made based on EUS features alone in some cases. Periodic follow-up examinations by endoscopy and EUS remains the recommended management strategy, which involves issues related to patient compliance, cost-effectiveness, and the risk associated with repeated endoscopic procedures and delayed diagnosis of malignancy. Endoscopic resection of the SETs is another technique to treat them as well as to obtain tissue specimens for accurate histologic diagnosis. Herein, a various endoscopic techniques ranging from simple snare resection to endoscopic submucosal tunnel dissection for the management of SETs will be reviewed.</P>

Esophageal Cancer in Esophageal Diverticula Associated with Achalasia

Choi, Ah Ran,Chon, Nu Ri,Youn, Young Hoon,Paik, Hyo Chae,Kim, Yon Hee,Park, Hyojin The Korean Society of Gastrointestinal Endoscopy 2015 Clinical Endoscopy Vol.48 No.1

<P>The simultaneous occurrence of achalasia and esophageal diverticula is rare. Here, we report the case of a 68-year-old man with multiple esophageal diverticula associated with achalasia who was later diagnosed with early esophageal cancer. He initially presented with dysphagia and dyspepsia, and injection of botulinum toxin to the lower esophageal sphincter relieved his symptoms. Five years later, however, the patient presented with worsening of symptoms, and esophagogastroduodenoscopy (EGD) was performed. The endoscopic findings showed multifocal lugol-voiding lesions identified as moderate dysplasia. We decided to use photodynamic therapy to treat the multifocal dysplastic lesions. At follow-up EGD 2 months after photodynamic therapy, more lugol-voiding lesions representing a squamous cell carcinoma <I>in situ</I> were found. The patient ultimately underwent surgery for the treatment of recurrent esophageal multifocal neoplasia. After a follow-up period of 3 years, the patient showed a good outcome without symptoms. To manage premalignant lesions such as achalasia with esophageal diverticula, clinicians should be cautious, but have an aggressive approach regarding endoscopic surveillance.</P>