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Nonthalee Pausawasdi,Penprapai Hongsrisuwan,Lubna Kamani,Kotchakon Maipang,Phunchai Charatcharoenwitthaya 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1
Background/Aims: Endoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct(CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation ofunknown etiology. Methods: Retrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017. Results: A total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormalliver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve(AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture (BBS), was 0.98(95% confidence interval [CI], 0.95-1.00). The AUROC of EUS for detecting malignancy, choledocholithiasis, and BBS was 0.91(95% CI, 0.85-0.97), 1.00 (95% CI, 1.00-1.00), and 0.93 (95% CI, 0.87-0.99), respectively. Male sex, alanine aminotransferase ≥3× theupper limit of normal (ULN), alkaline phosphatase ≥3× the ULN, and intrahepatic duct dilatation were predictors for pathologicalobstruction, with odds ratios of 5.46 (95%CI, 1.74-17.1), 5.02 (95% CI, 1.48-17.0), 4.63 (95% CI, 1.1-19.6), and 4.03 (95% CI, 1.37-11.8), respectively. Conclusions: EUS provides excellent diagnostic value in identifying the etiology of CBD dilatation detected by cross-sectionalimaging.
Nonthalee Pausawasdi,Chotirot Angkurawaranon,Tanyaporn Chantarojanasiri,Arunchai Chang,Wanchai Wongkornrat,Somchai Leelakusolvong,Asada Methasate 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.3
Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed asa less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC)appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complexcase of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.
Nonthalee Pausawasdi,Kotchakon Maipang,Tassanee Sriprayoon,Phunchai Charatcharoenwitthaya 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2
Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtainingtissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance ofEUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominallymphadenopathy of unknown etiology. Methods: The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed. Results: A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The finaldiagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis(n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%,negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosisof lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. Thediagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. Noprocedure-related complications occurred. Conclusions: EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especiallymalignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.
( Julajak Limsrivilai ),( Nonthalee Pausawasdi ) 대한장연구학회 2021 Intestinal Research Vol.19 No.1
Differentiating Crohn’s disease (CD) from intestinal tuberculosis (ITB) is a diagnostic dilemma, particularly in regions where ITB is prevalent and CD incidence is increasing, because both diseases can present quite similarly, and diagnostic tests to identify Mycobacterium tuberculosis in tissue samples have rather poor sensitivity. Studies that were conducted to determine the factors that differentiate CD from ITB identified some significant characteristics, but none of those characteristics are exclusive to either ITB or CD. Many diagnostic models or scoring systems that use one to several diagnostic parameters have been proposed to help distinguish these two intestinal diseases. Early models consisted of parameters common to routine clinical practice, such as clinical features, and endoscopic and pathologic findings. The later models also include more advanced diagnostic parameters like high-resolution imaging and serological testing. However, the number and types of parameters differ among diagnostic models, and the systems used to calculate scoring also vary from model to model. Enhanced awareness and understanding of the currently available diagnostic models will help physicians determine which model(s) is/are most suitable for differentiating CD from ITB in their clinical practice. (Intest Res 2021;19:21-32)
( Satimai Aniwan ),( Julajak Limsrivilai ),( Supot Pongprasobchai ),( Nonthalee Pausawasdi ),( Piyapan Prueksapanich ),( Natanong Kongtub ),( Rungsun Rerknimitr ) 대한장연구학회 2021 Intestinal Research Vol.19 No.2
Background/Aims: The incidence of ulcerative colitis (UC) in Thailand (crude incidence rate of 0.28 per 100,000 persons) is much lower than in the West. The burden of UC varies in different populations. The aim of this study was to evaluate the natural history of UC over the two decades in Bangkok, Thailand. Methods: This retrospective study included patients who were diagnosed with UC between 2000 and 2018 in 2 university hospitals. To evaluate changes in the disease course, we stratified patients into 2000-2009 cohort and 2010-2018 cohort. The cumulative probability of endoscopic healing, UC-related hospitalization and colectomy was estimated using the Kaplan-Meier method. Results: A total of 291 UC patients were followed for total of 2,228 person-years. Comparison between 2 cohorts, there were no differences in disease pattern and severity whereas an increase in the combination use of oral and topical mesalamine and the early use of thiopurine was observed. Only 1% of patients for each cohort required biologic agent at 5 years. The rate of achieving mucosal healing increased from 15% to 46% at 3 years (P<0.01). The rate of UC-related hospitalization decreased from 30% to 21% at 5 years (P<0.05). The rate of colectomy decreased from 6% to 2% at 5 years (P<0.05). Conclusions: The natural history of UC in a low incidence country was less aggressive than the West. Over the past two decades, the rates of UC-related hospitalization and colectomy have been decreasing which were similar to the West. (Intest Res 2021;19:186-193)
Pornpayom Numpraphrut,Sorachat Niltwat,Thammawat Parakonthun,Nonthalee Pausawasdi 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3
Patients with symptomatic gastrointestinal stromal tumor (GIST) typically present with gastrointestinal bleeding and abdominal pain. This report presents an unusual case of fundic GIST complicated by gastroduodenal intussusception, manifesting as acute pancreatitis. The patient presented with epigastric pain and pancreatic enzyme elevation; thus, he was diagnosed with acute pancreatitis. Computedtomography showed evidence of pancreatitis and a 4×4.7 cm well-defined hyperdense lesion in the 2nd part of the duodenum, compressingthe pancreatic head and pancreatic duct. Esophagogastroduodenoscopy revealed invagination of the gastric folds into the duodenum,causing pyloric canal blockage consistent with gastroduodenal intussusception. Spontaneous reduction of the lesion duringendoscopy revealed a 4 cm pedunculated subepithelial mass with central ulceration originating from the gastric fundus. Endoscopicultrasound demonstrated a heterogeneous hypoechoic lesion originating from the 4th layer of the gastric wall. Laparoscopic-endoscopicintragastric wedge resection of the fundic lesion was subsequently performed, and surgical histology confirmed GIST.
What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy
Tanyaporn Chantarojanasiri,Thawee Ratanachu-ek,Nonthalee Pausawasdi 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. WhenERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guidedbiliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BDoffers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guidedhepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation,tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGShave been developed to improve the technical success rate and reduce complications. This technical review focuses on the essentialpractical points at each step of EUS-HGS.
Parit Mekaroonkamol,Kasenee Tiankanon,Rapat Pittayanon,Wiriyaporn Ridtitid,Fariha Shams,Ghias Un Nabi Tayyab,Julia Massaad,Saurabh Chawla,Stanley Khoo,Siriboon Attasaranya,Nonthalee Pausawasdi,Qiang C 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2
Background/Aims: The Thai Association for Gastrointestinal Endoscopy published recommendations on safe endoscopyduring the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the practicality and applicability of therecommendations and the perceptions of endoscopy personnel on them. Methods: A validated questionnaire was sent to 1290 endoscopy personnel globally. Of these, the data of all 330 responders (25.6%)from 15 countries, related to the current recommendations on proper personal protective equipment (PPE), case selection, scopecleaning, and safety perception, were analyzed. Ordinal logistic regression was used to determine the relationships between thevariables. Results: Despite an overwhelming agreement with the recommendations on PPE (94.5%) and case selection (95.5%), theirpracticality and applicability on PPE recommendations and case selection were significantly lower (p=0.001, p=0.047, p<0.001, andp=0.032, respectively). Factors that were associated with lower sense of safety in endoscopy units were younger age (p=0.004), lessworking experience (p=0.008), in-training status (p=0.04), and higher national prevalence of COVID-19 (p=0.003). High prevalentcountries also had more difficulty implementing the guidelines (p<0.001) and they considered the PPE recommendations lesspractical and showed lower agreement with them (p<0.001 and p=0.008, respectively). A higher number of in-hospital COVID-19patients was associated with less agreement with PPE recommendations (p=0.039). Conclusions: Using appropriate PPE and case selection in endoscopic practice during a pandemic remains a challenge. Resourceavailability and local prevalence are critical factors influencing the adoption of the current guidelines.