• Clinical Endoscopy
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• v.55 no.1
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• pp.15-21
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• 2022

Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist's skill.

• Clinical Endoscopy
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• v.57 no.4
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• pp.501-507
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• 2024

Background/Aims: Polyps greater than 30 mm are classified as "giants". Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes. Methods: From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery. Results: We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo-looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications. Conclusions: We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.1
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• pp.15-22
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• 2023

Purpose: Total colonoscopy is recommended if colorectal polyps are clinically suspected. This study aimed to investigate the performance status of pediatric colonoscopic polypectomy in Korea. Methods: We surveyed pediatric endoscopic specialists who perform colonoscopic polypectomy in Korea using a questionnaire of 13 questions on pediatric colonoscopic polypectomy performance status. Results: The survey was conducted at 45 institutions, and 32 specialists (71.1%) responded. Among the respondents, 31.2% (10/32) said colonoscopy was performed in all age groups, while 12.5% (4/32) said sigmoidoscopy was performed in all age groups. Meanwhile, 56.2% (18/32) said that sigmoidoscopy was performed in young children, while colonoscopy was performed in older children. Among them, 38.9% (7/18) believe that 4-6 years were young, and 44.5% (8/18) believe that 7-9 years were young. Regarding surveillance examinations, 21.9% (7/32) said they would perform a surveillance colonoscopy or sigmoidoscopy in the future if less than five juvenile polyps were found in the colon. Meanwhile, if less than five adenomatous polyps were found in the colon, 93.8% (30/32) said they would perform surveillance colonoscopy or sigmoidoscopy in the future. Conclusion: More than half of the pediatric endoscopic specialists in Korea choose between a colonoscopy and sigmoidoscopy depending on the patient's age, contrary to the generally accepted recommendation of total colonoscopy if colorectal polyps are suspected in children and adolescents. In this survey, most pediatric endoscopists used the age range of 4-9 years as the reference age.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.10 no.1
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• pp.86-90
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• 2007

Carcinoid tumors are derived from the enterochromaffin cells of neural crest origin. Most are commonly found in the gastrointestinal (GI) tract. The rectum is the third most common site for GI carcinoids. Rectal carcinoid tumors make up 13.7% of all carcinoid tumors and the vast majority occurs in the sixth decade of life. Approximately 80% of rectal carcinoid tumors are less than 1 cm in size, limited to the submucosa without metastasis and can be safely treated by local excision. We report a case of rectal carcinoid tumor in a 13 year-old child that was successfully treated by endoscopic polypectomy.

• Journal of Digestive Cancer Research
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• v.9 no.2
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• pp.50-56
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• 2021

In patients having long-standing ulcerative colitis (UC), the risk of colorectal cancer (CRC) increased compared with general population. Dysplasia is a precancerous lesion of colitic patients, and traditionally total proctocolectomy was considered as a standard therapy to prevent colorectal cancer in UC patients. However, even with ileal pouch-anal anastomosis (IPAA), patients who underwent total proctocolectomy may experience early and late postoperative complications, such as ileus, bleeding, pouchitis, and so on. In addition, the bowel movement after proctocolectomy with IPAA reaches a median of seven times per day, and a considerable proportion of patients require daytime and nighttime pads. Change in the strategy for managing dysplasia started from two early studies, which suggested polypectomy for polypoid dysplasia to prevent CRC in colitic patients. After that, many studies supported that polypectomy should be the first option for the management of polypoid dysplasia. Moreover, recent studies suggested the feasibility of endoscopic submucosal dissection as a therapeutic option for non-polypoid dysplasia, although long term, large studies should be followed.

• Journal of Yeungnam Medical Science
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• v.23 no.2
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• pp.247-251
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• 2006

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract; they usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. Recently, the efficacy of nasogastric lavage or endoscopic infusion of Coca-Cola for the dissolution of phytobezoar have been reported. We report a case of phytobezoar successfully treated by oral administration and endoscopic injection of Coca-Cola. A 62-year-old woman was referred to Yeungnam University Hospital for epigastric pain. Upper gastrointestinal endoscopy revealed one very large, dark-greenish, solid bezoar in the stomach with gastric ulcer and duodenal bulb deformity. We performed endoscopic injection of Coca-Cola into the bezoar. The patient was instructed to drink four liters of Coca-Cola per day. At endoscopy two days later, the phytobezoar was easily broken into pieces. At endoscopy on the $11^{th}$ day of admission, the phytobezoar was decreased in size and removed by endoscopic fragmentation with a polypectomy snare. At follow up endoscopy after 13 days, the bezoar was completely dissolved.

• Journal of Yeungnam Medical Science
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• v.27 no.2
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• pp.150-154
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• 2010

The gastrointestinal tract(GI) is the most frequently involved site of mucosa associated lymphoid tissue(MALT) lymphoma. Stomach is the most common site of involvement among the GI tract. In some case of MALT lymphoma, it is detected in colon. Almost all diagnosis is established by pathological examination of the surgical or endoscopic specimens. We reported a case of rectal MALT lymphoma by colonoscopic polypectomy.

• Clinical Endoscopy
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• v.55 no.1
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• pp.113-121
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• 2022

Background/Aims: We have been developing artificial intelligence based polyp histology prediction (AIPHP) method to classify Narrow Band Imaging (NBI) magnifying colonoscopy images to predict the hyperplastic or neoplastic histology of polyps. Our aim was to analyze the accuracy of AIPHP and narrow-band imaging international colorectal endoscopic (NICE) classification based histology predictions and also to compare the results of the two methods. Methods: We studied 373 colorectal polyp samples taken by polypectomy from 279 patients. The documented NBI still images were analyzed by the AIPHP method and by the NICE classification parallel. The AIPHP software was created by machine learning method. The software measures five geometrical and color features on the endoscopic image. Results: The accuracy of AIPHP was 86.6% (323/373) in total of polyps. We compared the AIPHP accuracy results for diminutive and non-diminutive polyps (82.1% vs. 92.2%; p=0.0032). The accuracy of the hyperplastic histology prediction was significantly better by NICE compared to AIPHP method both in the diminutive polyps (n=207) (95.2% vs. 82.1%) (p<0.001) and also in all evaluated polyps (n=373) (97.1% vs. 86.6%) (p<0.001) Conclusions: Our artificial intelligence based polyp histology prediction software could predict histology with high accuracy only in the large size polyp subgroup.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.2 no.2
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• pp.250-255
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• 1999

Isolated rectal adenomatous polyp without genetic background is rarely found in children. A 4-year and 5 month-old girl was admitted for intermittent bloody stools lasting 4 months. A $1.5{\times}1.2\;cm$ sized rectal polyp was found by air contrast barium enema. Endoscopic polypectomy was performed without complications. In histopathologic examination, it was found to be a tubulovillous adenoma. Typical radiologic, colonoscopic, and pathological pictures are presented.

• Journal of Gastric Cancer
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• v.5 no.3 s.19
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• pp.169-173
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• 2005

Background: Gastric polyps encompass a wide variety of lesions that most commonly arise from the gastric epithelium. However, coincidental gastric carcinomas have rarely been reported, being found in $1.5{\sim}2.1%$ of patients with hyperplastic polyps. The sizes and the pathologies of polyps seem to be important in the application of treatment. Therefore, it is necessary to classily gastric polypoid lesions after a gastrectomy. Materials and Methods: During a follow-up endoscopy study, 23 patients were found to have developed gastric polyps after a gastrectomy. Most of those polyps were removed by using an endoscopic polypectomy. We performed clinical and pathologic evaluations of the gastric polyps in the remainding in the stomach after a gastrectomy, Results: The mean age of the patients was 64.5 years old with the incidence of polyps remainding in the stomach after a gastrectomy increasing after the first year following the gastrectomy. The sizes of the polyps ranged from 0.3cm to 3.5cm in diameter and the numbers of polyps below 1.0cm were 19 (82.6%). The anastomotic site was the most prevalent place 10 (43.2%), followed by the cardia 6 (26.0%) and the body 4 (17.3%). Among 23 gastric polypoid lesions Yamada types of gastric polyps in the remainding in the stomach were as follows: 1 case in type I, 12 cases in type II, 9 cases in type III, 1 case in type IV. The pathologic diagnoses of the polyps were hyperplastic polyps in 6 cases, tubular adenomas in 2 cases and inflammatory polyps in 15 cases. Conclusion: Endoscopic polypectomy is believed to be important in assessing the precise diagnosis of gastric polyps remainding in the stomach. In this study, hyperplastic polyps were found to have no malignant potential, despite their sizes. As a result aggressive biopsy with a polypectomy of gastric polyp afier gastrectomy is recommended and frequent follow-up be performed.