• Journal of Digestive Cancer Research
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• 제11권3호
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• pp.125-129
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• 2023

Appropriate sedation and analgesia are crucial for successful endoscopic procedures, patient safety, and satisfaction. Endoscopic resection for upper gastrointestinal tumors requires a deep sedation level because the procedure is lengthy and induces moderate to severe pain. Continuous patient consciousness assessment and vigilant vital signs monitoring are required for deep sedation. General anesthesia may unintentionally occur even during deep sedation for endoscopic tumor resection, which may cause unexpected complications, especially in high-risk patients. Previous studies have revealed that general anesthesia increases the en bloc resection rate and decreases the procedure time. Complications, such as perforation, aspiration pneumonia, and cardiopulmonary instability, including hypoxemia, hypotension, and arrhythmia, occurred more frequently in patients with sedation compared to those with general anesthesia. Therefore, general anesthesia demonstrated potential benefits in endoscopic treatment results and patient safety. General anesthesia should be considered a useful alternative for sedation in patients undergoing endoscopic gastrointestinal tumor resection. However, more high-quality prospective studies are required to determine the safety and effectiveness of general anesthesia in endoscopic upper gastrointestinal tumor resection because most studies comparing general anesthesia and sedation in these procedures have been retrospectively conducted and the results were inconsistent.

• Journal of Digestive Cancer Research
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• 제10권1호
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• pp.1-8
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• 2022

The incidence of gastric neuroendocrine tumors (NET) has been increased with the improvement of endoscopy accessibility. The World Health Organization classified NET of low (G1), intermediate (G2), high (G3) grade and neuroendocrine carcinoma with poor differentiation by mitotic count and Ki-67 labeling index. Gastric NET are divided into three subtypes based on the pathophysiology, and treatment is determined according to the subtype and prognostic factors of tumor. For diagnosis, endoscopy with biopsy, endoscopic ultrasonography, abdominal pelvis computed tomography, and serum gastrin level measure are required. In general, type 3, size > 2 cm, deep submucosal infiltration, high histological grade, lymphovascular invasion and metastasis are poor prognostic factors. Type 1 or 2 without these factors are treated by endoscopic resection, and other tumors needs surgery. Endoscopic resection of early type 3 or type 1 and 2 tumors with poor prognostic factors still remains a challenge.

• 대한후두음성언어의학회지
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• 제25권1호
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• pp.27-30
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• 2014

Objectives : The purpose of this study was to investigate the endoscopic evidence of esophagitis in laryngopharyngeal reflux disease (LPRD) patients using transnasal esophagoscopy (TNE) and to correlate these findings with treatment response. Methods : Fifty patients underwent TNE at Korea University Anam Hospital from July 2007 to Feb 2009. Participants were selected from patients that presented with various laryngeal symptoms. One experienced otolaryngologist assessed esophagitis according to the Los Angeles classification system using the TNE findings. Results : Fifteen of 50 LPR patients (30%) were found to have esophagitis (12 patients with Grade A, 3 patients with Grade B, no patients with grade C/ D esophagitis). Among the 15 patients positive for esophagitis based on the endoscopic findings, 12 (80%) showed symptom improvement after pharmacological therapy. Symptom improvement was correlated with evidence of esophagitis (p=0.002) but not with RFS (p=0.749). Conclusion : Endoscopic evaluation of esophagitis using TNE is a potentially valuable tool for predicting treatment response in LPRD patients.

• 대한기관식도과학회지
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• 제17권1호
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• pp.23-28
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• 2011

Diagnosis of early esophageal cancer has become more frequent as a result of improved endoscopic technology, surveillance programmes, and increasing experience and awareness on the part of endoscopists. In early esophageal cancer, squamous cell carcinoma and early adenocarcinoma must be managed differently because they have different origins, pathogenesis. and clinical characteristics. The current treatment options vary widely, from extended resection with lymphadenectomy to endoscopic mucosal resection (EMR) or ablation. None of these treatment options can be recommended universally. Instead, an individualized strategy should be based on the depth of tumor infiltration into the mucosa or submucosa, the presence or absence of lymph node metastases, the multicentricity of tumor growth, the length of the segment of intestinal metaplasia, and comorbidities of the patient. EMR has become increasingly important, both as a diagnostic tool for the staging of esophageal carcinomas and as a method of carrying out definitive treatment when the cancer meets certain criteria in which the risk of lymph-node metastasis is negligible. EMR may be sufficient in a subset of patients who have m1 or m2 squamous cell carcinoma and in patients who have isolated foci of high-grade intraepithelial neoplasia or mucosal cancer.

• Journal of Chest Surgery
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• 제31권7호
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• pp.697-702
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• 1998

손바닥, 액와부의 다한증은 많은 사람에서 생활의 질에 강한 부정적인 영향을 준다. 기존의 비수술적 치료방법은 이상적이지 못하고 확실한 치료는 상흉부 교감신경절(T2-4) 절제로 얻을 수 있다. 과거에는 전통적인 흉부개방창에 의한 수술이 주요한 방법이었으나 최근에 흉강내시경을 이용해 교감신경절제술을 시행하고 있다. 1995년 1월부터 1997년 8월까지 흉강내시경을 이용해 양측 교감신경절제술을 40명의 환자에서 시행하여서 사망이나 생명을 위협하는 합병증은 없었고 유일한 부작용은 보상성 다한증이었으나 모든 환자에서 만족스러운 증세의 호전을 얻을 수 있었다. 결론적으로 흉강내시경하 제 2, 3, 4 흉부 교감신경절제술은 수장부, 액와부의 다한증 치료에 있어서 효과적이고 안전하며, 경제적인 최소한의 침습성 수술방법이다.

• Journal of Gastric Cancer
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• 제13권1호
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• pp.51-57
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• 2013

Purpose: Additional gastrectomy is needed after endoscopic resection for early gastric cancer when pathology confirms any possibility of lymph node metastasis or margin involvement. No studies depicted the optimal type of surgery to apply in these patients. We compared the short-term and long-term outcomes of laparoscopic gastrectomy with those of open gastrectomy after endoscopic resection to identify the optimal type of surgery. Materials and Methods: From 2003 to 2010, 110 consecutive patients who underwent gastrectomy with lymphadenectomy either by laparoscopic (n=74) or by open (n=36) for gastric cancer after endoscopic resection were retrospectively analyzed. Postoperative and oncological outcomes were compared according to types of surgical approach. Results: Clinicopathological characteristics were comparable between the two groups. Laparoscopic group showed significantly shorter time to gas passing and soft diet and hospital day than open group while operation time and rate of postoperative complications were comparable between the two groups. All specimens had negative margins regardless of types of approach. Mean number of retrieved lymph nodes did not differ significantly between the two groups. During the median follow-up of 47 months, there were no statistical differences in recurrence rate (1.4% for laparoscopic and 5.6% for open, P=0.25) and in overall (P=0.22) and disease-free survival (P=0.19) between the two groups. Type of approach was not an independent risk factor for recurrence and survival. Conclusions: Laparoscopic gastrectomy after endoscopic resection showed comparable oncologic outcomes to open approach while maintaining benefits of minimally invasive surgery. Thus, laparoscopic gastrectomy can be a treatment of choice for patients previously treated by endoscopic resection.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.613-618
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• 2010

Purpose: The coronal approach for repair of frontal sinus fractures is associated with significant adverse sequelae including a long scar, alopecia, paresthesias, and, uncommonly, facial nerve injury. To minimize these complications, an endoscopic approach for repair of frontal sinus fractures was developed. The authors now present the results of an endoscopy-assisted approach for the treatment of frontal sinus fractures. Methods: From 2002 to 2009, five patients with frontal sinus fracture underwent endoscopic repair. Two slit incisions were placed in the scalp, and one or two stab incisions directly over the fractures were placed in the forehead. After subperiosteal dissection, fracture segments were reduced under direct vision and fixed with microplates or fibrin glue. Results: All patients had good cosmetic results and remained free of sinus complaints. There were no perioperative complications reported. Conclusion: Endoscopic repair of frontal sinus fractures is an efficacious technique that significantly reduces patient morbidity. A relatively wide range of anterior table fractures can be reduced using an endoscope. In cases of complicated comminuted fractures, fibrin glue helps to achieve satisfactory endoscopic reduction. Endoscopic repair is an alternative treatment for various anterior table fractures of the frontal sinus.

• Journal of Gastric Cancer
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• 제10권4호
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• pp.182-187
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• 2010

Purpose: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. Materials and Methods: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. Results: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). Conclusions: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.

• Journal of Gastric Cancer
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• 제24권1호
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• pp.108-121
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• 2024

Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.

• Journal of Digestive Cancer Research
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• 제7권2호
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• pp.57-60
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• 2019

Definitive chemoradiotherapy (CRT) with its significant efficacy and safety in esophageal cancer is reserved for patients with unresectable tumor or those who decline surgery. However, the incidence of locoregional failure or recurrence after definitive CRT remains high. Although esophagectomy is the standard treatment for locoregional failure or recurrence, this approach is associated with high mortality and morbidity. A 56-year-old man diagnosed with esophageal squamous cell carcinoma who refused to undergo surgery received definitive CRT. An endoscopy for response assessment performed after 2 months revealed a residual lesion, which was completely resected by salvage endoscopic submucosal dissection. To the best of our knowledge, endoscopic resection in locoregional failure or recurrence after definitive CRT is very rarely reported, and there are no guidelines or consensus to date. Here, we report a case of successful salvage endoscopic resection of residual lesion after definitive CRT.