Performance of disposable endoscopic forceps according to the manufacturing techniques

권창일,김광일,문종필,윤호,고원진,조주영,홍성표 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.3

Background/Aims: Recently, to lower the production costs and risk of infection, new disposable biopsy forceps made using simple manufacturing techniques have been introduced. However, the effects of the manufacturing techniques are unclear. The aim of this study was to evaluate which types of biopsy forceps could obtain good-quality specimens according to the manufacturing techniques. Methods: By using an in vitro nitrile glove popping model, we compared the popping ability among eight different disposable biopsy forceps (one pair of biopsy forceps with cups made by a cutting method [cutting forceps], four pairs of biopsy forceps with cups made by a pressing method [pressing forceps], and three pairs of biopsy forceps with cups made using a injection molding method [molding forceps]). Using an in vivo swine model, we compared the penetration depth and quality of specimen among the biopsy forceps. Results: In the in vitro model, the molding forceps provided a significantly higher popping rate than the other forceps (cutting forceps, 25.0%; pressing forceps, 17.5%; and molding forceps, 41.7%; p = 0.006). In the in vivo model, the cutting and pressing forceps did not provide larger specimens, deeper biopsy specimen, and higher specimen adequacy than those obtained using the molding forceps (p = 0.2631, p = 0.5875, and p = 0.2147, respectively). However, the molding forceps showed significantly more common crush artifact than the others (cutting forceps, 0%; pressing forceps, 5.0%; and molding forceps, 43.3%; p = 0.0007). Conclusions: The molding forceps provided lower performance than the cutting and pressing forceps in terms of crush artifact.

췌장암에 의하여 발생되는 폐쇄의 호전

권창일 대한소화기학회 2019 대한소화기학회지 Vol.74 No.2

Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient’s condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous biliary drainage has been also recommended. During ERCP, self-expandable metal stent could be recommended instead of a plastic stent for the purpose of long stent patency and minimizing stent-induced complications. In this review, several points of view regarding the relief of obstruction in patients with pancreatic cancer, and optimal techniques are being discussed.

Bowel Obstruction Caused by an Intramural Duodenal Hematoma: A Case Report of Endoscopic Incision and Drainage

권창일,고광현,홍성표,황성규,박필원,임규성,김효영 대한의학회 2009 Journal of Korean medical science Vol.24 No.1

Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10×5 ㎝ in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient’s condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.

Endoscopic Submucosal Dissection (ESD) Training and Performing ESD with Accurate and Safe Techniques

권창일,김재선,박영태,이범재 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.4

Introduction of endoscopic submucosal dissection (ESD) has brought about a renaissance in therapeutic endoscopy. For the globalization and universalization of ESD, the number of physicians who can perform ESD has rapidly increased with general ex vivo and in vivo training using animal models and hand-on courses. In this focused review series, world-renowned ESD experts described the published studies or their own precious experiences about ESD training and performing ESD with accurate and safe techniques. First, Dr. Adolfo Parra-Blanco reviewed on ex vivo and in vivo models for ESD training. Next, Dr. Joo Young Cho described detailed practical settings and current status of hands-on courses using ex vivo and in vivo models in Korea. Dr. Takashi Toyonaga described quality controlled ESD and basic techniques to prevent complications. Dr. Tsuneo Oyama reviewed recently published methods to facilitate ESD. Dr. Jae-Young Jang reviewed the usefulness of magnifying and narrow band imaging to measure the depth of invasion before ESD.

Guide-Wire Assisted Endobiliary Forceps Biopsy Sampling

권창일,김태헌,김경아 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.4

Brief report

Endoscopic Submucosal Dissection Using a Novel Versatile Knife: An Animal Feasibility Study (with Video)

권창일,김광일,정일권,김원희,고광현,홍성표,정석,이돈행 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.6

Background/Aims: In order to reduce the procedure time and the number of accessory changes during endoscopic submucosal dissection (ESD), we developed a novel versatile knife, which has the combined advantages of several conventional knives. The aim of this study was to compare the efficacy, safety, and histological quality of ESD performed using this novel versatile knife and a combination of several conventional knives. Methods: This was an in vivo animal study comparing two different modalities of ESD in mini-pigs. Completion time of each resection was documented, and the resected specimens were retrieved and evaluated for completeness. To assess the quality control of the procedures and adverse events, detailed histopathological examinations were performed. Results: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives). All resections were completed as en bloc resections. There was no significant difference in procedure time between the 2 modalities (456 seconds vs. 355 seconds, p=0.258) and cutting speed (1.983 mm2/sec vs. 1.57 mm2/sec, p=1.000). The rate of adverse events and histological quality did not statistically differ between the modalities. Conclusions: ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

Long-Term Outcome of Endoscopic Papillary Large Balloon Dilatation

권창일 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.6

Commentary

Functional Self-Expandable Metal Stents in Biliary Obstruction

권창일,고광현,함기백,강대환 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.5

Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each stent type for benign biliary stricture and describes newly introduced FSEMSs according to their functional categories.

Anisotropic superconductivity of high quality FeSe1-x Single crystal

권창일,옥종목,김준성 한국초전도.저온공학회 2014 한국초전도저온공학회논문지 Vol.16 No.4

We investigate the upper critical field anisotropy ΓH and the magnetic penetration depth anisotropy Γλ of a high-quality FeSe1-xsingle crystal using angular dependent resistivity and torque magnetometry up to 14 T. High quality single crystals of FeSe1-x weresuccessfully grown using KCl-AlCl3 flux method, which shows a sharp superconducting transition at TC ~ 9 K and a high residualresistivity ratio of ~ 25. We found that the anisotropy ΓH near TC is a factor of two larger than found in the poor-quality crystals,indicating anisotropic 3D superconductivity of FeSe1-x. Similar to the 1111-type Fe pnictides, the anisotropies Γλ and ΓH showdistinct temperature dependence; ΓH decreases but Γλ increases with lowering temperature. These behaviors can be attributed tomulti-band superconductivity, but different from the case of MgB2. Our findings suggest that the opposite temperature dependenceof Γλ and ΓH is the common properties of Fe-based superconductors.

Balloon Catheter Assisted Biliary Stent Insertion

권창일,고광현 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.2

BRIEF REPORT