BACKGROUND/AIMS: The landscape of sedation for gastrointestinal (GI) endoscopic procedures and the nature of the procedures themselves have changed over the last decade. In this study, an attempt is made to analyze the frequency and etiology of all major adverse events associated with GI endoscopy. METHODS: All adverse events extracted from the electronic database and local registry were analyzed. Although the data analysis was retrospective, the adverse events themselves were documented prospectively. These events were evaluated after subdivision into propofol-based anesthesia and intravenous conscious sedation groups. RESULTS: Cardiorespiratory events, including cardiac arrest, were the most common adverse events during esophagogastroduodenoscopy, while bleeding was more frequent in patients undergoing colonoscopy. Pancreatitis was the most frequent adverse event in patients undergoing endoscopic retrograde cholangiopancreatography. The frequencies of most adverse events were significantly higher in patients anesthetized with propofol. Automatic regression modeling showed that the type of sedation, the American Society of Anesthesiologists physical status classification, and the procedure type were some of the predictors of immediate life-threatening complications. CONCLUSIONS: Clearly, our regression modeling suggests a strong association between the type of sedation as well as various patient factors and the frequency of adverse events. The possible reasons for our results are the changing demographics, the worsening comorbidities of the patient population, and the increasing technical complexity of these procedures. Although extensive use of propofol has increased patient satisfaction and procedure acceptability, its use is also associated with more frequent adverse events.
Anesthesia ; Cholangiopancreatography, Endoscopic Retrograde ; Classification ; Colonoscopy ; Comorbidity ; Conscious Sedation ; Demography ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Heart Arrest ; Hemorrhage ; Humans ; Pancreatitis ; Patient Satisfaction ; Propofol ; Prospective Studies ; Retrospective Studies ; Statistics as Topic

Obscure gastrointestinal bleeding (OGIB) refers to gastrointestinal (GI) bleeding of unclear origin that persists or recurs after negative findings on esophagogastroduodenoscopy and colonoscopy. OGIB accounts for approximately 5% of all types of GI bleeding. More than 80% of OGIB cases originate in the small bowel. The ability to detect OGIB in the small bowel has significantly advanced and been revolutionized since the introduction of the capsule endoscopy and double-balloon enteroscopy techniques in 2000 and 2001, respectively. With these new methods for small-bowel evaluation, new guidelines have been proposed for the diagnosis and management of OGIB. However, some issues remain unsolved. The purpose of this article is to review the various modalities used for evaluating OGIB, including capsule endoscopy and double-balloon enteroscopy, and to help guide clinicians in their decisions on which modality will be the most effective.
Capsule Endoscopy* ; Colonoscopy ; Diagnosis ; Double-Balloon Enteroscopy ; Endoscopy, Digestive System ; Gastrointestinal Hemorrhage ; Hemorrhage*

BACKGROUND: Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions. METHODS: We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight. RESULTS: From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals. CONCLUSIONS Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.
Humans ; Colonoscopy/methods* ; Endoscopy, Gastrointestinal ; Endoscopy, Digestive System/methods* ; Surveys and Questionnaires ; Adenoma ; China

Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors that arise in the wall of the gastrointestinal tract. We report a case of obscure gastrointestinal bleeding due to a GIST of the jejunum successfully documented by videocapsule endoscopy (VCE) and single-balloon enteroscopy (SBE). A 36-year-old man with hematochezia was referred for further evaluation of no evidence of bleeding focus on esophagogastroduodenoscopy and colonoscopy. A VCE showed a suspicious ulcerative hyperemic mass that located in about 1 hour apart from duodenal second portion. SBE revealed a nonbleeding 4x2 cm mass with an ulcer at the proximal jejunum. The patient underwent laparoscopic resection without complication. Histological examination revealed a well circumscribed, dumbbell-shaped firm mass comprised of spindle cells. Immunohistochemical staining for CD 117 was diffusely positive, whereas staining for S-100, CD 34 and MIB-1 was all negative. It was confirmed to be a low-grade GIST at the proximal jejunum.
Capsule Endoscopy ; Colonoscopy ; Endoscopy ; Endoscopy, Digestive System ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Jejunum ; Ulcer

Endoscopic ultrasonography (EUS)-a combination of endoscopy a.nd ultrasonography was one of the most useful tools for diagnosis of digestive system diseases. This technique was known to be very effective in the assessment of depth of invasion in gastric cancer and in pancreatico-biliary diseases. We performed EUS in 589 patients with upper gastrointestinal and pancreatico-biliary tract lesion prior to surgery for past 22 months and examined the diagnostic accuracy of EUS, respectively. The results were compared to surgical histology in esophagus and stomach cancer,to concordance witb endoscopic retrograde cholangiopancreatography(ERCP) results for pancreaticobiliary diseases. 1) In 589 patients diagnosed with EUS, the mean age of the patients was 55.9 years with a male to female ratio of 1.7: 1. 2) Patients were divided into three groups; post-upper gastrointestinal endoscopy, post ERCP and undiagnosed with other diagnostic tools. 3) Among post-upper gastrointestinal endoscopy, 64 cases were operated due to esophageal and gastric cancer and then compared to surgical histology. After compared, EUS accuracy on depth of invasion was 78.1% and sensitivity and specificity on lymph node metastasis in gastric cancer were 76.9% and 74.3%, respectively. 4) In post-ERCP cases, EUS results were compared to ERCP results and then concordance rate was 95.4%. 5) In undiagnosed cases, EUS was performed and results were reported.
Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Digestive System Diseases ; Endoscopy ; Endoscopy, Gastrointestinal ; Endosonography ; Esophagus ; Female ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Sensitivity and Specificity ; Stomach ; Stomach Neoplasms ; Ultrasonography* ; Upper Gastrointestinal Tract*

OBJECTIVETo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the removal of small gastrointestinal stromal tumor (GIST).

METHODSGIST diagnosed by endoscopic ultrasonography (EUS) was managed by ESD with the needle knife as follows:(1)Injecting normal saline into the submucosa. (2)Pre-cutting the surrounding mucosa of the lesion. (3) Dissecting the submucosal tissue to display GIST and resecting the lesion completely.

RESULTSOf 20 GISTs, 12 located in gastric fundus, and 1 in gastric antrum, 3 in gastric body and 4 in rectum. Lesion diameter ranged from 0.5 to 3.2 cm and the mean resected size was 1.6 cm. Among 20 lesions, 19 were resected with ESD completely, and 1 received additional operation because of tumor residual in the wound after ESD. The success rate of ESD was 95.0% (19/20). The mean ESD procedure time was 87.5 min (ranging from 60 to 150 min). None of the patients had delayed bleeding after ESD. Perforations occurred in 3 cases after the dissection of the GIST, which were closed with metallic endoclips without additional surgical suture. The perforation rate of ESD was 15.0% (3/20). The follow up ranged from 2 to 12 months, and no recurrence was observed by EUS except the above-mentioned case undergone additional operation.

CONCLUSIONESD is effective and safe for small GIST, which can resect the whole lesion and provide pathological information.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Endoscopy, Gastrointestinal ; methods ; Endosonography ; Esophagoscopy ; Female ; Follow-Up Studies ; Gastric Mucosa ; surgery ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Male ; Middle Aged

No abstract available.
Endoscopy ; Endoscopy, Digestive System

Spontaneous submucosal esophageal dissection is a rare disorder, characterized by a longitudinal dissection along the axis of the esophagus between submucosa and muscle layer without an obvious cause. The diagnosis is made by typical esophagographic or endoscopic findings which are double-barreled esophagus in esophagography or mucosal defect in upper esophagus and false lumen running along the distal side of the esophagus on esophagoscopy. The condition usually follows a benign course with good prognosis requiring a supportive treatment, but rarely treated by endoscopy or surgery. A 74-year-old man was admitted to our hospital complaining of chest pain and odynophagia after upper respiratory infection. We diagnosed a case of spontaneous submucosal dissection of the esophagus and observed its healing process by series of endoscopy with a conservative treatment.
Aged ; Axis, Cervical Vertebra ; Chest Pain ; Diagnosis ; Endoscopy ; Endoscopy, Digestive System ; Esophagoscopy ; Esophagus* ; Humans ; Prognosis ; Running

Pancreatic metastasis of gastric cancer almost takes the form of direct continous invasion to the pancreas from the primary lesions or dissemination. Isolated lymphogenous pancreatic metastasis of stomach cancer is rare. A 39-year-old woman was admitted to our institution due to high serum CA 19-9 level. Abdominal computed tomography showed a diffusely enlarged pancreas, and endoscopic retrograde cholangiopancreatography revealed a segmental stricture of pancreatic duct on mid-body. Ultrasonography guided pancreatic biopsy revealed a metastatic poorly differentiated adenocarcinoma with lymphatic tumor emboli. We perfomed esophagogastroduodenoscopy and total colonoscopy. There was a ulcerative lesion at the posterior wall of high body with clubbing change of surrounding mucosal folds. Endoscopic biopsy of the stomach lesion revealed a poorly differentiated adenocarcinoma. Positron emission tomography-computed tomography scan revealed bone metastasis in the sternum. Herein, we report a case of 39 year old female with the diagnosis of gastric adenocarcinoma, with lymphogenous pancreatic metastasis and solitary sternal metastasis detected by elevated serum CA 19-9 level.
Adenocarcinoma ; Adult ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Colonoscopy ; Constriction, Pathologic ; Diagnosis ; Electrons ; Endoscopy, Digestive System ; Female ; Humans ; Neoplasm Metastasis* ; Pancreas ; Pancreatic Ducts ; Sternum ; Stomach ; Stomach Neoplasms* ; Ulcer ; Ultrasonography

Gastrointestinal endoscopy is important in diagnosis, treatment, and prevention of many diseases of the digestive tract. The ability to perform esophagogastroduodenoscopy (EGD) safely, effectively, and efficiently has become the mainstay of gastroenterology practice. In Korea, EGD education is usually imparted as a component of gastroenterology training programs during fellowship. In this review, we discuss the general principles of EGD training. Formal curriculum development with devising clear goals and effective training methods should be developed in the future.
Curriculum ; Diagnosis ; Education ; Endoscopy* ; Endoscopy, Digestive System* ; Endoscopy, Gastrointestinal ; Fellowships and Scholarships ; Gastroenterology ; Gastrointestinal Tract ; Korea