• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.3
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• pp.273-278
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) is a safe method to feed patients with feeding difficulty. This study aimed to compare the outcomes of conventional PEG and laparoscopic-assisted PEG (L-PEG) placement in high-risk pediatric patients. Methods: In our tertiary pediatric department, 90 PEG insertions were performed between 2014 and 2019. Children with severe thoracoabdominal deformity (TAD), previous abdominal surgery, ventriculoperitoneal (VP) shunt, and abdominal tumors were considered as high-risk patients. Age, sex, diagnosis, operative time, complications, and mortality were compared among patients who underwent conventional PEG placement (first group) and those who underwent L-PEG placement (second group). Results: We analyzed the outcomes of conventional PEG placement (first group, n=15; patients with severe TAD [n=7], abdominal tumor [n=6], and VP shunts [n=2]) and L-PEG placement (second group, n=10; patients with VP shunts [n=5], previous abdominal surgery [n=4], and severe TAD [n=1]). Regarding minor complications, 1 (6.6%) patient in the first group underwent unplanned PEG removal and 1 (10%) patient in the second group had peristomal granuloma. We observed three major complications: colon perforation (6.6%) in a patient with VP shunt, gastrocolic fistula (6.6%) in a patient with Fallot-tetralogy and severe TAD, and pneumoperitoneum (6.6%) caused by early tube dislodgement in an autistic patient with severe TAD. All the three complications occurred in the first group (20%). No major complications occurred in the second group. Conclusion: In high-risk patients, L-PEG may be safer than conventional PEG. Thus, L-PEG is recommended for high-risk patients.

• Clinical Endoscopy
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• v.56 no.4
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• pp.391-408
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• 2023

With an aging population, the number of patients with difficulty in swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. However, the long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach that is aided endoscopically and may be an alternative to a nasogastric tube when enteral nutritional is required for four weeks or more. This paper is the first Korean clinical guideline for PEG developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tube removal for PEG based on the currently available clinical evidence.

• Clinical Endoscopy
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• v.55 no.6
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• pp.793-800
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• 2022

Background/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group. Methods: This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events. Results: Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events. Conclusions: FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

• Journal of Veterinary Clinics
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• v.24 no.4
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• pp.622-626
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• 2007

A 1.6-year-old, intact male beagle dog was presented with three day history of odynophagia and anorexia. According to the history and radiographic findings, the patient was diagnosed with esophageal and gastric foreign body due to ingesting fishhooks. Gastroesophagoscopy revealed that one fishhook located in the thoracic esophagus cranial to the heart base and the other located in the cardia region were connected with a single fishing line. Gastrotomy was performed to remove the fishhook in the cardia region and to sever the connecting fishing line. After gastrotomy, endoscopic attempts to remove the esophageal fishhook with a three, five pronged endoscopic grasping forceps, and a biopsy were unsuccessful because the fishhook was embedded deeply in the mucosa membrane. A handmade cerclage wire(16G) shaped like a snare forceps was advanced into the esophagus while visualizing the fishhook endoscopically. The cerclage wire was used to hang and retract the foreign body. The fishhook was retracted orally, resulting in successful removal. Ten days after the operation, the patient fully recovered and was discharged.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.35-43
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• 2000

Objective : Percutaneous lumbar approaches such as arthroscopic discectomy, laser discectomy, and nucleotome remain controversial and have technical limitations to free fragment disc, bony pathology and access to L5-S1, The purpose of this study was to determine efficacy of this new endoscopic system and to report techniques and tactics. Methods : From July 1997 to May 1998, we treated 40 consecutive patients(43 levels) with the MED system. Mean age was 32 years(range ; 18 to 62). There were 30 males and 10 females. All patients had sciatica with SLRT limitation. There were 23 patients with disc herniation at L4-5 and 14 patients at L5-S1. Three patients had 2 level disc herniations. There was one far lateral disc herniation at L4-5. Results : Using modified MacNab criteria, there were 37 excellent results and 3 good result. Most patients were discharged within 3-4 days except 2 patients with dural tearing. There were no other complications. Mean operation time was 1.5 hours(range : 40 minutes to 2.5 hours). Conclusion : The MED system is a reliable approach to lumbar disc herniations. This system combines the advantages of conventional open surgery and a minimally invasive technique. As tactics for the doctors who wish to attempt, "palpate" the lamina by first dilator, identification of interlaminar space by removal of overlying soft tissue and confirmation of the shoulder portion of nerve root before discectomy are important to this procedure. We conclude that lumbar disc herniations can be successfully treated with MED approach.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.136-142
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• 2002

Purpose: Foreign body swallowing is common in children. Most of foreign bodies passed upper esophagus are removed spontaneously. But recently, therapeutic endoscopy in children is widely used. In this study, we reviewed gastric foreign bodies regarding types, location, interval from swallowing, complications, and treatment or method of removal. Methods: We reviewed medical records of 96 cases with foreign bodies in gastrointestinal tract at Department of Pediatrics in Gyeongsang National University Hospital (GNUH) from Feb 1987 to Feb 2002. Results: The peak age of patients (male=60, female=36) with foreign bodies in gastrointestinal tract was 2 to 5 years of age. Sixty two patients (64.5%) were asymptomatic. The location of foreign bodies in gastrointestinal tract were detected by simple X-ray in eighty one patients (86.0%), barium study (1 case), and gastroduodenoscopy in 37 cases. The most common location was stomach (63.5%). The most common foreign body was coin (41.7%). In thirty seven cases (38.5%), foreign bodies were removed with flexible gastroduodenoscopy. Fifty four patients (56.3%) visited GNUH in 24 hours after swallowing foreign bodies. The long interval (over 24 hours) of swallowing of foreign bodies is related with high frequency of endoscopic removal. Conclusion: The flexible gastroduodenoscopy was effective in diagnosis and removal of foreign bodies. Further studies for indication and validity of endoscopic removal of foreign bodies in upper gastrointestinal tract are needed.

• Journal of Veterinary Clinics
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• v.29 no.6
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• pp.506-508
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• 2012

A 5-year-old, intact female, Pomeranian was presented with a persistent vomiting for 5 days after swallowing a chicken bone. The dog was diagnosed with an esophageal foreign body, and a small perforation was found after the endoscopic removal of the chicken bone. The dog was determined to be treated with a non-operative management, and a complete closure of the perforation was confirmed by a flexible endoscopy 3 weeks after removal of a chicken bone. This paper reports the case of esophageal perforation caused by foreign body in esophagus managed with the non-operative therapy instead of surgical correction.

• Archives of Craniofacial Surgery
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• v.16 no.1
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• pp.17-23
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• 2015

Background: Treatment of skull base tumors is challenging due to limited access and presence of important neurovascular structures nearby. The success of a complete tumor resection depends on the extent of tumor exposure and secure field of view. While these tumors are often removed by transcranial endoscopic access, transfacial approach is sometimes required depending on the location and size of the tumor. This study describes various transfacial approaches in patients undergoing skull base tumor resection. Methods: From March to November 2013, 15 patients underwent skull base tumor resection via transfacial accesses at a tertiary institution. Data were reviewed for patient demographics, type of access used, completeness of tumor resection, surgical outcome, and postoperative complications. Results: Two clivus tumor patients underwent transmaxillary approach; three tuberculum-sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach; three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomatic approach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wing tumor patients underwent zygomatic approach. In all cases, the upper and lower margins of the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumor removal in 5. There were no immediate major complications observed for the transfacial portion of the operations. The overall cosmetic results were satisfactory. Conclusion: Plastic surgeons can use various transfacial approaches according to the location and size of skull base tumors to secure a sufficient field of view for neurosurgeons.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.434-436
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• 2014

Left ventricular thrombus is a common complication related to acute myocardial infarction. Removing this with an incision of the free wall of the left ventricle may cause fatal cardiac dysfunction or arrhythmias. Furthermore, performing incision and suture on the fragile myocardium of an acute myocardial infarction patient may cause serious bleeding complications. If there is a patient with left ventricular thrombus who needs thoracotomy for another reason, the case is attempted with the thought that if effective intraventricular visualization and manipulation can be done, fatalities caused by incision and suture may be reduced. For patients undergoing cardiopulmonary bypass, if intracardiac manipulation is required, an endoscope can be used, and given the potential complications after the incision and suturing of the infarcted tissue, the benefits are deemed sufficient.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.2
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• pp.134-137
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• 2017

Gastric hemangioma in the neonatal period is a very rare cause of upper gastrointestinal bleeding. We present a case of hemangioma limited to the gastric cavity in a 10-day-old infant. A huge, erythematous mass with bleeding was observed on the lesser curvature side of the upper part of the stomach. Surgical resection was ruled out because the location of the lesion was too close to the gastroesophageal junction. Medical treatment with intravenous $H_2$ blockers, octreotide, packed red blood cell infusions, local epinephrine injection at the lesion site, application of hemoclip, and gel-form embolization of the left gastric artery did not significantly alter the transfusion requirement. Hemostasis was achieved with endoscopic argon plasma coagulation (APC). After two sessions of APC, complete removal of the lesion was achieved. APC was a simple, safe and effective tool for hemostasis and the ablation of gastric hemangioma without significant complications.