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Sneha Shaha,Yinglin Gao,Jiahao Peng,Kendrick Che,John J. Kim,Wasseem Skef 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.5
Background/Aims: We aimed to study the effects of sedation on endoscopic ultrasound-guided tissue acquisition. Methods: We conducted a retrospective study evaluating the role of sedation in endoscopic ultrasound-guided tissue acquisition bycomparing two groups: anesthesia care provider (ACP) sedation and endoscopist-directed conscious sedation (CS). Results: Technical success was achieved in 219/233 (94.0%) in the ACP group and 114/136 (83.8%) in the CS group (p=0.0086). Inmultivariate analysis, the difference in technical success between the two groups was not significant (adjusted odds ratio [aOR], 0.5;95% confidence interval [CI], 0.234–1.069; p=0.0738). A successful diagnostic yield was present in 146/196 (74.5%) in the ACP groupand 66/106 (62.3%) in the CS group, respectively (p=0.0274). In multivariate analysis, the difference in diagnostic yield between thetwo groups was not significant (aOR, 0.643; 95% CI, 0.356–1.159; p=0.142). A total of 33 adverse events (AEs) were observed. The incidenceof AEs was significantly lower in the CS group (5/33 CS vs. 28/33 ACP; OR, 0.281; 95% CI, 0.095–0.833; p=0.022). Conclusions: CS provided equivalent technical success and diagnostic yield for malignancy in endoscopic ultrasound-guided tissueacquisition. Increased AEs were associated with anesthesia for the endoscopic ultrasound–guided tissue acquisition.
Dong-Hoon Yang,Sneha John,Fujishiro Mitsuhiro,Jae Myung Cha,Jeong-Sik Byeon,Hyung Wook Kim,Hyun Gun Kim,Shai Friedland,Yon Xian Koh,Jin-Young Yoon,Min-Seob Kwak,Byong Duk Ye,Jihun Kim,Suk-Kyun Yang 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.5
Background/Aims: Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endoscopic diagnosis of “nonpedunculated” dysplasia or colitic cancer in UC patients. Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologically confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy. Results: The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the intention to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, including ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI, 57.3% to 69.1%), respectively. Conclusions: Diagnostic performance based on the endoscopist’s intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study.
Factors influencing endoscopic estimation of colon polyp size in a colon model
Koen Robert Beukema,Jaimy A. Simmering,Marjolein Brusse-Keizer,Sneha John,Rutger Quispel,Peter B. Mensink 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.4
Background/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation. Methods: Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope’s tip. Participants were asked to estimate the diameter and volume of each polyp. Results: Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62–0.71) for diameter and 0.56 (95% CI, 0.50–0.62) for volume. Polyp size estimated at 3 cm from the colonoscope’s tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size. Conclusions: Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.