• Journal of Digestive Cancer Research
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• v.11 no.1
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• pp.30-34
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• 2023

Since the 1990s, serrated polyps have been established to contribute to intermediate cancer development, and their importance has begun to be recognized. Serrated polyps are morphologically difficult to detect through endoscopy, and an effective resection method has not been established. Among serrated polyps, studies on sessile serrated lesions, with a relatively high risk of colorectal cancer transformation and detected with difficulty, are in progress. Studies to date describe the endoscopic features as mucus cap, surface debris or stool, attenuation of underlying vasculature, cloud-like surface, dark spots in crypts, and ill-defined irregular border. Additionally, it is expected that relatively large serrated polyps can be safely removed through cold snare resection. A plan for an effective management of serrated polyps through continuous research in the future is warranted.

• Journal of Digestive Cancer Research
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• v.2 no.1
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• pp.21-23
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• 2014

We report a bronchoesophageal fistula that treat with bronchial stent insertion and histoacryl injection. A 52-year-old man with esophagel cancer was transferred for dysphagia management. At the CT scan that underwent on admission, esophageal cancer with multiple lymph node metastasis was observed. At the gastroduodenoscopy and contrast study, bronchoesophageal fistula was observed. Recurrent stent insertion treatment was failed, and then, By the broncoscopy, covered stent was inserted to right bronchus, and By the endoscopy, fibrin glue and histoacryl was injected in the fistula opening. At the contrast study, contrast leakage was not observed, and the patient was discharged. But, at the 14 days after discharge, the patient was admitted to the emerency room because of cough symptom whenever he eat food. The patient was diagnosed with aspiration pneumonia, we were determined that it is unable to oral intake. The patient received a jejunostomy and antibiotic treatment for aspiration pneumonia. He was discharged after symptomatic improvement.

• Journal of Digestive Cancer Research
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• v.10 no.1
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• pp.39-42
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• 2022

Primary duodenal follicular lymphoma is rare and presents as multiple, small polyp-like lesions on endoscopy. If this lesion is suspected, an endoscopic biopsy is crucial for diagnosis. A watchful wait would be appropriate management as it has a fairly indolent clinical course. Herein, we present a rare case of primary duodenal follicular lymphoma.

• Journal of Gastric Cancer
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• v.19 no.2
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• pp.225-233
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• 2019

Purpose: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) was first reported as a rare adenocarcinoma found in the normal fundic mucosa. Recent studies have proposed the possibility that GA-FG-CCPs were also generated in the atrophic mucosa after Helicobacter pylori (HP) eradication therapy. However, little is known on the endoscopic findings of GA-FG-CCP generated in the atrophic mucosa due to its extreme rarity. Materials and Methods: A total of 8 patients who underwent endoscopic submucosal resection and were diagnosed with GA-FG-CCP generated in the HP-uninfected mucosa (4 cases, HP-uninfected group) or HP-eradicated atrophic mucosa (4 cases, HP-eradicated group) were retrospectively analyzed, and their endoscopic findings, including magnifying endoscopy with narrow band imaging (M-NBI), and pathological features were compared. Results: While GA-FG-CCPs in the 2 groups displayed similar macroscopic appearance, M-NBI demonstrated that characteristic microvessels (tapered microvessels like withered branches) were specifically identified in the HP-eradicated group. Pathological investigation revealed that a decreasing number of fundic glands and thinned foveolar epithelium covering tumor ducts were thought to lower the thickness of the covering layer over tumor ducts in the HP-eradicated group. Moreover, dilation of vessels just under the surface of the lesions contributed to the visualization of microvessels by M-NBI. Conclusions: The change in background mucosa due to HP infection influenced the thickness of the covering layer over the tumor ducts and M-NBI finding of GA-FG-CCP.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.1
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• pp.79-88
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• 2020

Purpose: Management of eosinophilic esophagitis (EoE) varies from center to center. In this study, we evaluated the effectiveness of a dairy-free diet (DFD) and the 6-Food Elimination Diet (SFED) as initial therapies for the treatment of EoE in our practice. Methods: This was a retrospective study of children who had been treated for EoE at Connecticut Children's Medical Center, Hartford, CT, USA. Pre- and post-treatment endoscopy findings and histology results of patients treated with DFD or SFED were examined. Results: One hundred fifty-two patients (age 9.2±5.2 years, 76.3% male, 69.7% caucasian) met the inclusion criteria for initial treatment with DFD (n=102) or SFED (n=50). Response for DFD was 56.9% and for SFED was 52.0%. Response based on treatment duration (<10, 10-12, and >12 weeks) were 81.8%, 50.0%, and 55.1% for DFD, and 68.8%, 50.0%, and 40.0% for SFED. Response based on age (<6, 6-12, and >12 years) were 59.3%, 42.9%, and 67.5% for DFD, and 36.4%, 58.8%, and 72.7% for SFED. In patients treated with DFD, concomitant proton pump inhibitor (PPI) administration resulted in improved outcomes (p=0.0177). Bivariate regression analysis showed that PPI with diet is the only predictor of response (p=0.0491), however, there were no significant predictors on multiple regression analysis. Conclusion: DFD and SFED are effective first line therapies for EoE. DFD should be tried first before extensive elimination diets. Concomitant therapy with PPI's may be helpful.

• Clinical Endoscopy
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• v.56 no.2
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• pp.169-179
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• 2023

Background/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)-guided tissue acquisition from pancreatic lesions. Methods: A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-tissue acquisition (TA) in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis. Results: Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52-0.90) and strict criteria (OR, 0.58; 95% CI, 0.46-0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76-1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents. Conclusions: The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

• Clinical Endoscopy
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• v.55 no.6
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• pp.742-750
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• 2022

Background/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP. Methods: A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP. Results: Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97-1.09), overall bleeding (RR, 0.98; 95% CI, 0.40-2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97-1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72-2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis. Conclusions: CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

• Clinical Endoscopy
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• v.55 no.5
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• pp.615-625
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• 2022

Background/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis. Methods: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs. Results: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events. Conclusions: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.4
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• pp.350-365
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• 2023

Backgrounds/Aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically. Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome. Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome. Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.

• Journal of Intelligence and Information Systems
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• v.15 no.2
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• pp.33-48
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• 2009

Capsule endoscopy is one of the most remarkable inventions in last ten years. Causing less pain for patients, diagnosis for entire digestive system has been considered as a most convenience method over a normal endoscope. However, it is known that the diagnosis process typically requires very long inspection time for clinical experts because of considerably many duplicate images of same areas in human digestive system due to uncontrollable movement of a capsule endoscope. In this paper, we propose a method for clinical diagnosticians to get highly valuable information from capsule-endoscopy video. Our software system consists of three global maps, such as movement map, characteristic map, and brightness map, in temporal domain for entire sequence of the input video. The movement map can be used for effectively removing duplicated adjacent images. The characteristic and brightness maps provide frame content analyses that can be quickly used for segmenting regions or locating some features(such as blood) in the stream. Our experiments show the results of four patients having different health conditions. The result maps clearly capture the movements and characteristics from the image frames. Our method may help the diagnosticians quickly search the locations of lesion, bleeding, or some other interesting areas.