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Gastrointestinal Endoscopy-Assisted Minimally Invasive Surgery for Superficial Cancer of the Uvula.

Hiroyuki ODAGIRI ; Toshiro IIZUKA ; Daisuke KIKUCHI ; Mitsuru KAISE ; Hidehiko TAKEDA ; Kenichi OHASHI ; Hideo YASUNAGA

Clinical Endoscopy.2016;49(3):289-293. doi:10.5946/ce.2015.092

Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions.
Anesthesia, General ; Deglutition ; Endoscopy, Gastrointestinal ; Gastrointestinal Tract ; Humans ; Hypopharynx ; Male ; Minimally Invasive Surgical Procedures* ; Pharyngeal Neoplasms ; Respiration ; Uvula*

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Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation.

Dae Kyu SHIN ; Sun Young SHIN ; Chi Young PARK ; Sun Mi JIN ; Yang Hyun CHO ; Won Hee KIM ; Chang Il KWON ; Kwang Hyun KO ; Ki Baik HAHM ; Pil Won PARK ; Jong Woo KIM ; Sung Pyo HONG

Clinical Endoscopy.2016;49(3):282-288. doi:10.5946/ce.2015.046

BACKGROUND/AIMS: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. METHODS: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. RESULTS: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. CONCLUSIONS: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.
Colonoscopy ; Delayed Diagnosis ; Humans ; Korea ; Laparoscopy ; Laparotomy ; Medical Records ; Methods* ; Mortality ; Peritonitis ; Retrospective Studies

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Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection.

Duk Su KIM ; Yunho JUNG ; Ho Sung RHEE ; Su Jin LEE ; Yeong Geol JO ; Jong Hwa KIM ; Jae Man PARK ; Il Kwun CHUNG ; Young Sin CHO ; Tae Hoon LEE ; Sang Heum PARK ; Sun Joo KIM

Clinical Endoscopy.2016;49(3):273-281. doi:10.5946/ce.2015.086

BACKGROUND/AIMS: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy. METHODS: Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients. RESULTS: DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size ≥40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and non-hemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438; IIb, p=0.397; IIc, p=0.773) during second-look endoscopy. CONCLUSIONS: The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.
Classification* ; Endoscopy* ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Multivariate Analysis ; Risk Factors ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer*

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Job Stress and Job Satisfaction among Health-Care Workers of Endoscopy Units in Korea.

Seung Joo NAM ; Hoon Jai CHUN ; Jeong Seop MOON ; Sung Chul PARK ; Young Jae HWANG ; In Kyung YOO ; Jae Min LEE ; Seung Han KIM ; Hyuk Soon CHOI ; Eun Sun KIM ; Bora KEUM ; Yoon Tae JEEN ; Hong Sik LEE ; Chang Duck KIM

Clinical Endoscopy.2016;49(3):266-272. doi:10.5946/ce.2015.085

BACKGROUND/AIMS: The management of job-related stress among health-care workers is critical for the improvement of healthcare services; however, there is no existing research on endoscopy unit workers as a team. Korea has a unique health-care system for endoscopy unit workers. In this study, we aimed to estimate job stress and job satisfaction among health-care providers in endoscopy units in Korea. METHODS: We performed a cross-sectional survey of health-care providers in the endoscopy units of three university-affiliated hospitals in Korea. We analyzed the job stress levels by using the Korean occupational stress scale, contributing factors, and job satisfaction. RESULTS: Fifty-nine workers completed the self-administered questionnaires. The job stress scores for the endoscopy unit workers (46.39±7.81) were relatively lower compared to those of the national sample of Korean workers (51.23±8.83). Job stress differed across job positions, with nurses showing significantly higher levels of stress (48.92±7.97) compared to doctors (42.59±6.37). Job stress and job satisfaction were negatively correlated with each other (R2=0.340, p<0.001). CONCLUSIONS: An endoscopy unit is composed of a heterogeneous group of health-care professionals (i.e., nurses, fellows, and professors), and job stress and job satisfaction significantly differ according to job positions. Job demand, insufficient job control, and job insecurity are the most important stressors in the endoscopy unit.
Cross-Sectional Studies ; Delivery of Health Care ; Endoscopy* ; Job Satisfaction* ; Korea*

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Fecal Microbiota Transplantation: Current Applications, Effectiveness, and Future Perspectives.

Hyun Ho CHOI ; Young Seok CHO

Clinical Endoscopy.2016;49(3):257-265. doi:10.5946/ce.2015.117

Fecal microbiota transplantation (FMT) is the infusion of liquid filtrate feces from a healthy donor into the gut of a recipient to cure a specific disease. A fecal suspension can be administered by nasogastric or nasoduodenal tube, colonoscope, enema, or capsule. The high success rate and safety in the short term reported for recurrent Clostridium difficile infection has elevated FMT as an emerging treatment for a wide range of disorders, including Parkinson's disease, fibromyalgia, chronic fatigue syndrome, myoclonus dystopia, multiple sclerosis, obesity, insulin resistance, metabolic syndrome, and autism. There are many unanswered questions regarding FMT, including donor selection and screening, standardized protocols, long-term safety, and regulatory issues. This article reviews the efficacy and safety of FMT used in treating a variety of diseases, methodology, criteria for donor selection and screening, and various concerns regarding FMT.
Autistic Disorder ; Clostridium difficile ; Colitis, Ulcerative ; Colonoscopes ; Crohn Disease ; Donor Selection ; Enema ; Fatigue Syndrome, Chronic ; Fecal Microbiota Transplantation* ; Feces ; Fibromyalgia ; Humans ; Insulin Resistance ; Irritable Bowel Syndrome ; Mass Screening ; Multiple Sclerosis ; Myoclonus ; Obesity ; Parkinson Disease ; Tissue Donors

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Esophageal Stricture Prevention after Endoscopic Submucosal Dissection.

Deepanshu JAIN ; Shashideep SINGHAL

Clinical Endoscopy.2016;49(3):241-256. doi:10.5946/ce.2015.099

Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed.
Barrett Esophagus ; Esophageal Neoplasms ; Esophageal Stenosis* ; Humans ; Incidence ; Polyglycolic Acid ; Prospective Studies ; Stents ; Steroids ; Ultrasonography

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Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors.

Jin Woong CHO

Clinical Endoscopy.2016;49(3):235-240. doi:10.5946/ce.2015.096

Subepithelial tumors are frequently found in asymptomatic patients in Japan and Korea where cancer screening tests routinely include endoscopy. Most lesions are asymptomatic and clinically insignificant. However, carcinoid tumors, lymphomas, glomus tumor and gastrointestinal stromal tumors (GISTs) are malignant or have the potential to become malignant. Inflammation due to parasitic infestation by Anisakis and poorly differentiated adenocarcinomas in the stomach rarely present as subepithelial lesions. In contrast to the frequency of gastric GIST in the gastrointestinal system, they are uncommon in the duodenum and very rare in the esophagus. The prognosis of patients with GISTs in the stomach is relatively good compared with GISTs in other organs. Along with the location of the tumor, its size and mitotic count are major factors that determine the malignant potential of GIST. Small (<2 cm) asymptomatic GISTs usually have benign clinical course. GIST is the most common subepithelial tumor to occur in the stomach. Although various methods are employed to diagnose GISTs, the risk of GIST metastasis cannot be accurately predicted before lesions are completely resected. Recently, new endoscopic diagnostic methods and treatment techniques have been developed that allow the diagnosis and resection of lesions located in the muscularis propria, without any complications. These endoscopic methods have different indications depending on regions where they are performed.
Adenocarcinoma ; Anisakis ; Carcinoid Tumor ; Diagnosis ; Duodenum ; Early Detection of Cancer ; Endoscopy ; Endosonography ; Esophagus ; Gastrointestinal Stromal Tumors ; Glomus Tumor ; Humans ; Inflammation ; Japan ; Korea ; Lymphoma ; Neoplasm Metastasis ; Prognosis ; Stomach ; Stomach Neoplasms

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Long-Term Outcomes after Endoscopic Treatment of Gastric Gastrointestinal Stromal Tumor.

Jong Jae PARK

Clinical Endoscopy.2016;49(3):232-234. doi:10.5946/ce.2016.052

Endoscopic resection of gastric subepithelial tumors (SETs) has several advantages over biopsy techniques, such as superior diagnostic yield and definite diagnosis. Removal of gastric SETs and histopathologic confirmation should be considered whenever gastric SETs are highly suspected to have malignant potential such as gastrointestinal stromal tumor (GIST) or neuroendocrine tumor. According to our clinical experience, we suggest that endoscopic resection of gastric SETs is feasible for GISTs less than 3.0 cm without positive endoscopic ultrasonography findings or for hypoechoic SETs less than 3.0 cm. However, serious complications such as macroperforation may occur during endoscopic resection, and this procedure is highly dependent on endoscopists' skills. We recently reported the long-term clinical outcomes of endoscopic resection of gastric GIST, which showed a relatively low recurrence rate (2.2%) during long-term follow-up (46.0±28.5 months) despite the low R0 resection rate (25.0%). We suggest that endoscopic surveillance might be possible without additional surgical resection in completely resected GISTs without residual tumor confirmed to be lower risk, even if they show an R1 resection margin.
Biopsy ; Diagnosis ; Endoscopy ; Endosonography ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Neoplasm, Residual ; Neuroendocrine Tumors ; Recurrence

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Interpretation of Pathologic Margin after Endoscopic Resection of Gastrointestinal Stromal Tumor.

Sang Gyun KIM

Clinical Endoscopy.2016;49(3):229-231. doi:10.5946/ce.2016.035

Interpretation of the pathologic margin of a specimen from a resected tumor is important because local recurrence can be predicted by the presence of tumor cells in the resection margin. Although a sufficient resection margin is recommended in the resection of gastrointestinal adenocarcinoma, it is not usually regarded strictly in cases of mesenchymal tumor, especially gastrointestinal stromal tumor (GIST), because the tumor is usually encapsulated or well demarcated, and not infiltrative. Therefore, margin positivity is not rare in the pathological evaluation of surgically or endoscopically resected GIST, and does not always indicate incomplete resection. Although a GIST may have a tumor-positive pathologic margin, complete resection may be achieved if no residual tumor is visible, and long-term survival can be predicted as in the cases with a negative pathologic margin.
Adenocarcinoma ; Gastrointestinal Stromal Tumors* ; Neoplasm, Residual ; Recurrence

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Current Techniques for Treating Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract.

Weon Jin KO ; Joo Young CHO

Clinical Endoscopy.2016;49(3):226-228. doi:10.5946/ce.2016.061

Most gastrointestinal stromal tumors (GISTs) arise from the proper muscle layer of the upper gastrointestinal (GI) tract and have a low malignant potential. They are sometimes accompanied by symptoms, but in most cases are detected by chance. Endoscopic surgery of subepithelial tumors in the upper GI tract has been actively performed, and its merits include the need for fewer medical devices compared with other surgical procedures and post-resection organ preservation. However, because endoscopic procedures are still limited to small or pilot studies, a multidisciplinary approach combining laparoscopy and endoscopy is needed for more effective and pathologically acceptable management of GISTs. Many new endoscopic surgeries have been developed, and this review describes the current status of and the new approaches for endoscopic surgery of GISTs in the upper GI tract.
Endoscopy ; Gastrointestinal Stromal Tumors* ; Laparoscopy ; Organ Preservation ; Pilot Projects ; Upper Gastrointestinal Tract*

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