Highlights from the 52nd Seminar of the Korean Society of Gastrointestinal Endoscopy

김은정,최일주,권광안,류지곤,함기백 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.4

In this July issue of Clinical Endoscopy, state-of-the-art articles selected from the lectures delivered during the 52nd Seminar of the Korean Society of Gastrointestinal Endoscopy (KSGE) on March 29, 2015 are covered, focusing on highlighted educational contents relevant to either diagnostic or therapeutic gastrointestinal (GI) endoscopy. Our society, the KSGE, has continued to host this opportunity for annual seminars twice a year over the last 26 years and it has become a large-scale prestigious seminar accommodating over 4,000 participants. Definitely, the KSGE seminar is considered as one of the premier state-of-the-art seminars dealing with GI endoscopy, appealing to both the beginner and advanced experts. Lectures, live demonstrations, hands-on courses, as well as an editor school, which was an important consensus meeting on how to upgrade our society journal, Clinical Endoscopy, to a Science Citation Index (Expanded) designation were included in this seminar. The 52nd KSGE seminar consisted of more than 20 sessions, including special lectures, concurrent sessions for GI endoscopy nurses, and sessions exploring new technologies. This is a very special omnibus article to highlight the core contents divided into four sessions: upper GI tract, lower GI tract, pancreatobiliary system, and other specialized sessions.

Safety of Gastroenterologist-Guided Sedation with Propofol for Upper Gastrointestinal Therapeutic Endoscopy in Elderly Patients Compared with Younger Patients

( Masaya Nonaka ),( Takuji Gotoda ),( Chika Kusano ),( Masakatsu Fukuzawa ),( Takao Itoi ),( Fuminori Moriyasu ) 대한소화기학회 2015 Gut and Liver Vol.9 No.1

Background/Aims: Propofol sedation for elderly patients during time-consuming endoscopic procedures is controversial. Therefore, we investigated the safety of using propofol in elderly patients during upper gastrointestinal therapeutic endoscopy. Methods: The medical records of 160 patients who underwent therapeutic endoscopic procedures under gastroenterologist- guided propofol sedation at a single institution were retrospectively reviewed. The subjects were divided into two groups: a younger group, patients <75 years old; and an elderly group, patients ≥75 years old. The two groups were compared with respect to the therapeutic regimen, circulatory dynamics, and presence/absence of discontinuation of propofol treatment. Results: Although the number of patients with liver dysfunction was higher in the elderly group, there were no other significant differences in the baseline characteristics, including the American Society of Anesthesiologists classification, between the elderly and younger groups. The average maintenance rate of continuous propofol infusion was lower in the elderly patients. No statistically significant differences were found in the occurrence of adverse events between the elderly and younger groups. None of the patients returned to a resedated state after the initial recovery from sedation. Conclusions: Gastroenterologist-guided propofol sedation in elderly patients can be safely achieved in the same manner as that in younger patients, even for timeconsuming upper gastrointestinal therapeutic endoscopic procedures. (Gut Liver 2015;9:38-42)

Candidiasis 를 동반한 식도 bezoar 1 예

김영용(Yeong Yong Kim),안기석(Ki Seok Ahn),민귀환(Kwi Hwan Min),김기중(Ki Joong Kim),정준성(Joon Seong Jung),이진웅(Jin Woong Lee),윤태용(Tae Yong Yoon),박찬웅(Chan Woong Park),김지운(Ji Woon Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.5

Bezoars are persistent concretions of indigestible matter, usually in the stomach, But very rarely have bezoars been reported in the esophagus. Most esophageal bezoars are either phytobezoars or medication bezoars occuring usually in the middle aged & elderly associated with underlying anatomical or functional abnormalities of esophagus, A variety of techniques has been developed recently in diagnostic and therapeutic endoscopy. So endoscopic management is safe and successful in most cases those required surgical management. We experienced an esophageal bezoar consisted with esophageal candidiasis in a patient who underwent esophago-gastric anastomosis and proximal gastrectomy due to early gastric cancer. The bezoar was removed by endoscopy and the esophago-gastric stenosis was treated with balloon dilator without any significant complication.

십이지장 궤양 출혈의 내시경 지혈술 후 발생한 급성 췌장염 동반의 십이지장 벽내 혈종 1예

송민근 ( Min Keun Song ),신준범 ( Joon Beom Shin ),박하나 ( Ha Na Park ),김은진 ( Eun Jin Kim ),정기천 ( Ki Cheun Jeong ),김동환 ( Dong Hwan Kim ),정재복 ( Jae Bock Chung ),김도영 ( Do Young Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.5

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery. (Korean J Gastroenterol 2009;53:311-314)

Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding

Ari Garber,Sunguk Jang 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.5

Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical), EndoClot (EndoClot Plus Inc.), and Ankaferd Blood Stopper (Ankaferd Health Products), in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

일차 및 이차 의료기관에서 내시경 절제술은 가능한가?

전성우,정민규,김성국,김태년,장병익,이시형,김경옥,김은수,조광범,박경식,김은영,정진태,권중구,양창헌,이중현,박창근,서향은 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.6

Background/Aims: Endoscopic mucosal resection (EMR) has been gaining popularity with the advances in the technique and the accumulating experience. The objectives of this study are to assess the current situation of endoscopic resection (ER) in primary clinics and community-based hospitals and to suggest an affordable training program. Methods: A questionnaire about the indications to perform ER for gastric or colonic lesions was sent to the doctors working in the non-tertiary hospitals by mail. Results: The responders who were performing EMR or polypectomy for gastric lesions accounted for 43% (31/72) and 44.8% (47/101), respectively, of the total responders. The percentage of responders who had experience with performing EMR or polypectomy for colonic lesions accounted for 56.6% (30/53) and 87.3% (62/71), respectively, of the total responders. The indication for ER for treating gastric and colonic lesions was restricted to the size of 1∼2 cm irrespective of the type or location of lesion. Most of the responders assumed that ER should be performed in their clinics and they wanted to have a chance to improve these techniques. Conclusions: The infrastructure for therapeutic endoscopy, such as ER, should be progressively expanded. Therefore, well designed schematic training programs are currently needed to advance using ER more commonly in clinical practice. 목적: 내시경점막절제술 및 내시경점막하박리술은 기술적 측면에서 발전을 거듭하면서 현재 위장 및 대장의 조기암이나 전암성 병변의 치료 영역에 널리 쓰이고 있다. 그러나 대부분의 경우 삼차 의료기관에서 시행되는 경우가 많다. 이 연구는 일차 및 이차 의료기관에서 내시경절제술에 대한 현황을 알아보고, 실제 진료에 적용하기 위해 필요한 체계적 교육에 대한 틀을 마련하기 위하여 진행하였다. 대상 및 방법: 대구경북지역 내과, 외과 및 가정의학과 계열 개원의와 봉직의를 대상으로 위 및 대장의 내시경절제술 경험과 적응증에 대한 설문지를 보낸 후 회수하였다. 결과: 총 1,631명 중 112명이 응답하여 수거율은 6.8%였다. 내시경 전문의가 79명으로 75.2%를 차지하였고 내과의가 82명으로 78.1%를 차지하였다. 위 병변에 대한 EMR 또는 용종절제술은 43%(31/112)와 44.8%(47/101)에서 시행하였다. 위 병변에 대한 EMR의 적응증으로는 모양이나 위치에 상관없이 크기가 1∼2 cm일 때 시행하는 경우가 많았다. 대장 병변에 대한 EMR 또는 용종절제술의 경험은 각각 응답자의 56.6%(30/53)와 87.3%(62/71)에서 있었다. 대장 병변에 대한 내시경절제의 적응증 역시 모양이나 위치에 상관없이 크기가 1∼2 cm일 때 시행하는 경우가 많았다. 대부분의 응답자들은 내시경절제술을 일차 및 이차 의료기관에서도 시행하는 것이 좋다고 답하였으며 동물모델 등을 이용한 교육에 적극적으로 참석하겠다는 답변이 많았다. 결론: 내시경절제술과 같은 치료 내시경의 저변을 점진적으로 확대해나가는 것은 필요하다. 이를 위해서는 체계적인 교육과 지속적인 배움의 기회를 제공하는 것이 중요하다.

소화기 내시경 합병증 예방과 대처

정윤호 대한소화기학회 2019 대한소화기학회지 Vol.73 No.6

Because gastrointestinal (GI) endoscopy examinations are being performed increasingly frequently, the rate of detection of cancer and of precancerous lesions has increased. Moreover, development of more advanced endoscopic technologies has expanded the indications for, and thus frequency of, therapeutic endoscopic procedures. However, the incidence of complications associated with diagnostic or therapeutic GI endoscopy has also increased. The complications associated with GI endoscopy can be ameliorated by endoscopic or conservative treatment, but caution is needed as some of the more serious complications, such as perforation, can lead to death. In this chapter, we review the possible complications of GI endoscopy and discuss methods for their prevention and treatment.

Robotics for Advanced Therapeutic Colonoscopy

Jennie Y Y Wong,Khek Yu Ho 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6

Although colonoscopy was originally a diagnostic imaging procedure, it has now expanded to include an increasing range of therapeuticinterventions. These procedures require precise maneuvers of instruments, execution of force, effcient transmission of force from theoperator to the point of application, and suffcient dexterity in the mobilization of endoscopic surgical instruments. The conventionalendoscope is not designed to support technically demanding endoscopic procedures. In case of colonoscopy, the tortuous anatomyof the colon makes inserting, moving, and orientating the endoscope diffcult. Exerting excessive pressure can cause looping of theendoscope, pain to the patient, and even perforation of the colon. To mitigate the technical constraints, numerous technically enhancedsystems have been developed to enable better control of instruments and precise delivery of force in the execution of surgical tasks suchas apposing, grasping, traction, counter-traction, and cutting of tissues. Among the recent developments are highly dexterous roboticmaster and slave systems, computer-assisted or robotically enhanced conventional endoscopes, and autonomously driven locomotiondevices that can effortlessly traverse the colon. Developments in endoscopic instrumentations have overcome technical barriers andopened new horizons for further advancements in therapeutic interventions. This review describes examples of some of these systemsin the context of their applications to advanced therapeutic colonoscopy.

Endoscopic Ultrasound-Guided Treatment beyond Drainage:Hemostasis, Anastomosis, and Others

Jessica L. Widmer,Michel Kahaleh 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.5

Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.

Omental Patching and Purse-String Endosuture Closure after Endoscopic Full-Thickness Resection in Patients with Gastric Gastrointestinal Stromal Tumors

Faisal Inayat,Aysha Aslam,Mathew D. Grunwald,Qulsoom Hussain,Abu Hurairah,Shahzad Iqbal 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily arisingfrom the stomach. With the widespread utilization of and technical advancements in endoscopy, gastric GISTs are being increasinglydetected at an early stage, enabling complete endoscopic resection. Endoscopic full-thickness resection (EFTR) is an advancedtechnique that has been recognized as a treatment tool for neoplasms in the digestive tract in selected patients. Although a numberof methods are available, closing large iatrogenic defects after EFTR can be a concern in clinical practice. If this potential problem isappropriately solved, patients with gastric GISTs would be suitable candidates for resection utilizing this technique. To our knowledge,this is the first study to propose omental patching and purse-string endosuture closure following EFTR as a feasible endoscopic optionin patients with gastric GISTs.