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Colon Cancer Screening with Image-Enhanced Endoscopy.

Clinical Endoscopy.2014;47(6):504-508. doi:10.5946/ce.2014.47.6.504

Colorectal cancer (CRC) is a major cause of cancer mortality worldwide, and this has led to an increased use of screening colonoscopy. This screening has resulted in long-term risk reduction in asymptomatic individuals. However, endoscopists may fail to detect advanced adenomas or colon cancer during screening. The reasons that adenomas or cancers are missed are thought to be associated with the location of the lesions or the skills of the endoscopist. To address the limitations of white light endoscopy (WLE) for adenoma detection, advanced endoscopic images have recently been used. Image-enhanced endoscopies (IEEs), including the use of topical dyes, optical filtering, and ultramagnification, allow for gastrointestinal lesion analysis. Many studies have compared the adenoma detection rate (ADR) obtained by using WLE and IEE, but with different results. IEE can be used to help the endoscopist to improve their ADR in screening colonoscopy. This review examines the possible roles of image-enhanced colonoscopy in CRC screening.
Adenoma ; Colonic Neoplasms* ; Colonoscopy ; Colorectal Neoplasms ; Coloring Agents ; Endoscopy* ; Image Enhancement ; Mass Screening* ; Mortality ; Risk Reduction Behavior

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Endoscopic Gastric Cancer Screening and Surveillance in High-Risk Groups.

Il Ju CHOI

Clinical Endoscopy.2014;47(6):497-503. doi:10.5946/ce.2014.47.6.497

Gastric cancer remains a major cancer problem world-wide and future incidence will likely increase due to rapidly aging population demographics. Population-based screening is being undertaken in Korea and Japan, where gastric cancer incidence rates are high, and seems to be effective in reducing mortality from gastric cancer. However, such strategies are difficult to implement in countries with a low incidence or limited resources. Thus, screening strategies should be directed towards high-risk population subgroups. Gastric cancer has a relatively long mean sojourn time, and prognosis of early-stage disease is excellent. In general population, screening at 2-year interval in Korea seems to be effective for early-stage diagnosis. In subjects with atrophic gastritis or intestinal metaplasia, surveillance is recommended at 1 to 3 years intervals according to European and Japanese recommendation. Screening intervals for family members with sporadic gastric cancer has not yet been adequately evaluated, but 1-year interval is recommended for hereditary diffuse gastric cancer family-members. Gastric cancer patients treated by endoscopic resection are the highest-risk group, and 1-year interval surveillance can detect most metachronous gastric cancers at an early stage. Future gastric cancer surveillance strategies using endoscopy should be guided by risk-stratification assessment, and further refinement of optimal surveillance intervals is needed.
Aging ; Asian Continental Ancestry Group ; Demography ; Diagnosis ; Endoscopy ; Gastritis, Atrophic ; Humans ; Incidence ; Japan ; Korea ; Mass Screening* ; Metaplasia ; Mortality ; Prognosis ; Stomach Neoplasms*

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Screening for Gastric Cancer: The Usefulness of Endoscopy.

Kui Son CHOI ; Mina SUH

Clinical Endoscopy.2014;47(6):490-496. doi:10.5946/ce.2014.47.6.490

Gastric cancer screening is common in countries with high prevalence rates of gastric cancer. However, data supporting the effectiveness of gastric cancer screening are lacking. Thus, the aim of this review was to examine the current evidence on gastric cancer screening. Herein, we reviewed radiographic and endoscopic tests as methods of gastric cancer screening. Previous cohort studies and case-control studies have demonstrated reduced gastric cancer mortality in study populations that had undergone gastric cancer screening with radiographic tests. Recently, a case-control study in Japan reported a 30% reduction in gastric cancer mortality when screening was undertaken via endoscopy. Also, endoscopic screening for gastric cancer exhibited higher sensitivity and specificity than radiographic screening. Moreover, most cost-effectiveness analyses on the best strategy for detecting early gastric cancer have generally concluded that endoscopy is more cost-effective than radiographic testing. Although data on the impact of endoscopy screening programs on gastric cancer mortality are limited, recent study results suggest that gastric cancer screening by endoscopy in average-risk populations performs better than radiography screening. Further evaluation of the impact of these screening methods should take into account cost and any associated reduction in gastric cancer mortality.
Case-Control Studies ; Cohort Studies ; Endoscopy* ; Japan ; Mass Screening* ; Mortality ; Prevalence ; Radiography ; Sensitivity and Specificity ; Stomach Neoplasms*

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Prevention Strategies for Gastric Cancer: A Global Perspective.

Jin Young PARK ; Lawrence VON KARSA ; Rolando HERRERO

Clinical Endoscopy.2014;47(6):478-489. doi:10.5946/ce.2014.47.6.478

Despite the substantial burden of gastric cancer worldwide, population strategies for primary prevention have not been introduced in any country. Recognizing the causal role of Helicobacter pylori infection, there is increasing interest in population-based programs to eradicate the infection to prevent gastric cancer. Nonetheless, the paucity of available evidence on feasibility and effectiveness has prevented implementation of this approach. There are very few secondary prevention programs based on screening with endoscopy or radiography, notably in the Republic of Korea and Japan, two of the countries with the highest incidence rates of gastric cancer. In Korea, where the organized screening program is in place, survival rate of gastric cancer is as high as 67%. More research is needed to quantify the specific contribution of the screening program to observed declines in mortality rates. Gastric cancer screening is unlikely to be feasible in many Low-Middle Income Countries where the gastric cancer burden is high. Prevention strategies are still under development and the optimal approach may differ depending on local conditions and societal values. The present review gives an overview of the etiology and burden of the disease, and possible prevention strategies for countries and regions confronted with a significant burden of disease.
Endoscopy ; Helicobacter pylori ; Incidence ; Japan ; Korea ; Mass Screening ; Mortality ; Primary Prevention ; Radiography ; Republic of Korea ; Secondary Prevention ; Stomach Neoplasms* ; Survival Rate

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Diagnosis of Immunoglobulin G4-Related Sclerosing Cholangitis.

Ji Kon RYU

Clinical Endoscopy.2014;47(6):476-477. doi:10.5946/ce.2014.47.6.476

No abstract available.
Cholangitis, Sclerosing* ; Diagnosis* ; Immunoglobulins*

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Endoscopic Submucosal Dissection for Gastric Neoplasm at an Outpatient Clinic: Efficacy and Safety.

Hwoon Yong JUNG ; Ji Yong AHN

Clinical Endoscopy.2014;47(6):473-475. doi:10.5946/ce.2014.47.6.473

No abstract available.
Ambulatory Care Facilities* ; Stomach Neoplasms*

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Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections (with Video).

Mark TOPAZIAN

Clinical Endoscopy.2012;45(3):337-340.

Endoscopic ultrasound (EUS) is often used to guide drainage of pancreatic fluid collections (PFCs). EUS enhances the diagnosis of cystic pancreatic lesions and enables real-time image-guided control of PFC drainage. EUS may facilitate the endoscopic treatment of patients with pancreatic necrosis and patients with disconnected pancreatic duct syndrome.
Drainage ; Humans ; Necrosis ; Pancreatic Ducts

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Usefulness of Intraductal Ultrasonography in the Diagnosis of Cholangiocarcinoma and IgG4-Related Sclerosing Cholangitis.

Takahiro NAKAZAWA ; Itaru NAITOH ; Kazuki HAYASHI

Clinical Endoscopy.2012;45(3):331-336.

The technique of intraductal ultrasonography (IDUS) of the bile duct with a thin-caliber probe and a ropeway system has provided excellent images of the bile duct and periductal structures and is an easy transpapillary approach. In addition, once the guide wire is inserted into the bile duct, IDUS and transpapillary biopsy after endoscopic retrograde cholangiopancreatography can be performed in a single session. Here, we review the usefulness of IDUS in the diagnosis of cholangiocarcinoma and IgG4-related sclerosing cholangitis.
Bile Ducts ; Biopsy ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing

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Endoscopic Ultrasonography in the Evaluation of Indeterminate Biliary Strictures.

Mark TOPAZIAN

Clinical Endoscopy.2012;45(3):328-330.

Biliary strictures may be due to a variety of benign and malignant processes. Imaging with endoscopic ultrasonography (EUS) often suggests the diagnosis, but is usually not definitive. EUS-guided fine needle aspiration (FNA) facilitates the diagnosis of extrahepatic biliary strictures, although peritioneal metastases due to needle tract seeding may occur after EUS-FNA of cholangiocarcinoma. In addition to diagnosis of strictures, EUS may play an important role in staging of cholangiocarcinoma.
Bile Ducts ; Biopsy, Fine-Needle ; Cholangiocarcinoma ; Constriction, Pathologic ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Needles ; Neoplasm Metastasis ; Seeds

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Usefulness of Endoscopic Ultrasound in Esophagogastric Varices.

Jae Jun SHIM

Clinical Endoscopy.2012;45(3):324-327.

Endoscopic ultrasound (EUS) is a useful diagnostic tool for evaluation of esophagogastric varices and guidance of endoscopic therapy. EUS can visualize not only collateral veins around the esophagus but also perforating veins that connect esophageal varices with collateral veins. They are associated with high risk of bleeding and early recurrence after initial variceal eradication. Isolated gastric varices can be easily diagnosed using EUS that mimic thickened gastric folds or subepithelial tumors. EUS-guided endoscopic therapy is a challenging field of variceal bleeding. It has a potential role for assistance of interventions and evaluation of treatment outcome.
Endosonography ; Esophageal and Gastric Varices ; Esophagus ; Hemorrhage ; Hydrazines ; Hypertension, Portal ; Recurrence ; Treatment Outcome ; Varicose Veins ; Veins

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