• Title/Summary/Keyword: Upper gastrointestinal endoscopy

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Complications of endoscopic resection in the upper gastrointestinal tract

  • Takeshi Uozumi;Seiichiro Abe;Mai Ego Makiguchi;Satoru Nonaka;Haruhisa Suzuki;Shigetaka Yoshinaga;Yutaka Saito
    • Clinical Endoscopy
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    • v.56 no.4
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    • pp.409-422
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    • 2023
  • Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

Endoscopy Finding of Patients Who Complained of the Upper Digestive Symptoms after Taking Oriental Herb Decoctions

  • Kim, Dong-Woung
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.22 no.4
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    • pp.987-992
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    • 2008
  • This study was carried out to understand the macroscopic aspects of the digestive system symptoms occurring after taking oriental herb complex decoction as observing morphological changes in esophagus, stomach and duodenal bulb by endoscopy of upper gastrointestinal tract when these symptoms developed. The subjects of this study were 46 patients (male 22, female 24, mean age : $54.72{\pm}14.26$ years) who were chosen among ones who took oriental herb complex decoction for medical care and developed symptoms related to the gastrointestinal tract while taking an oriental herb decoction, which were assumed that the digestive symptoms were newly developed because of administration. The subjects were given morphological examination by endoscopy of the upper gastrointestinal tract. As a result of the endoscopy operated due to the digestive symptoms developed during the administration of oriental herb decoction, there were 2 cases of esophagitis, 5 cases of acute gastritis, 1 case of chronic gastritis A type, 15 cases of chronic gastritis B type, 1 case of duodenitis, 1 case of gastric ulcer, 1 case of gastric polyp, 2 cases of intestinal metaplasia, 1 case of gastric ptosis and 17 cases of normal findings which didn't have any abnormality macroscopically with endoscopy. With regards to the patients who complained of the digestive symptoms after taking oriental herb decoction, it has been found that the symptoms occurred as the oriental herbal medicine taken by the patients who had the digestive symptoms at ordinary times influenced on the gastrointestinal tract. Especially, many of them were had chronic gastritis and functional dyspepsia in the past. The disease accompanying macroscopic lesions at endoscopy which occurred due to the oriental herb decoction as direct cause, was acute gastritis, and it was the prescription to cure the pains and inflammations of skeletomuscular disease.

Sex/gender differences in gastrointestinal endoscopy from the perspective of patients and gastroenterologists

  • Nayoung Kim
    • Clinical Endoscopy
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    • v.56 no.3
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    • pp.268-282
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    • 2023
  • The sex/gender of gastroenterologists impact patients' satisfaction, compliance, and clinical outcomes. For instance, female gastrointestinal (GI) endoscopist-patient gender concordance improves health-related outcomes. This finding suggests that it is important to increase the number of female GI endoscopists. While the number of women in the field of gastroenterology is increasing in the United States and Korea by over 28.3%, it is not enough to account for the gender preferences of female patients. GI endoscopists are at a high risk of endoscopy-related injuries. However, there is a different distribution of muscle and fat; male endoscopists are more affected in their back, while females are more affected in the upper extremities. Women are more susceptible to endoscopy-related injuries than men. There is a correlation between the number of colonoscopies performed and musculoskeletal pain. Job satisfaction is lower in young female gastroenterologists (30' and 40') than in the opposite gender and other ages. Thus, it is important to address these issues in the development of GI endoscopy.

A Case Report on the Distribution of Sasang Costitution in Dyspepsia Patients who had Undergone Upper Gastrointestinal Endoscopy (내시경 검사를 시행한 소화불량 환자 100례에 대한 사상의학적 분포 연구)

  • Jang, Bo-Hyoung;Ro, Im-Sun;Kim, Eun-Gon;Kweon, Hyug-Sung;Kweon, O-Seob;Lee, Jung-Hee
    • The Journal of Internal Korean Medicine
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    • v.25 no.4
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    • pp.337-345
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    • 2004
  • Objective : The purpose of this study is to determine a distribution of sasang constitution among dyspepsia patients, and to weigh their symptoms score. Methods : We surveyed symptoms of dyspepsia and QSCCII in one hundred dyspepsia patients who had undergone upper gastrointestinal endoscopy. Results : In distribution of sasang constitution in total dyspepsia patients group and distribution according to the result of endoscopy, ratio and symptoms score of So-Eum-tn were higher than the others. However the differences were not statistically significant. According to symptoms score by age, symptoms score of Tae-Eum-In in patients above 35 years old group was higher than the others. In patients group under 35 years old, symptoms score of So- Yang-In is higher than the others. However in neither group was this statistically significant.

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The Effect of Behavioral Relaxation Training on Distress and Cancer Screening Intention of Patients with Upper Gastrointestinal Endoscopy (행동이완훈련이 비진정 상부위장관 내시경검사자의 불편감과 수검의도에 미치는 효과)

  • Nam, Hyo Yeon;Shim, Hyung Wha
    • The Journal of Korean Academic Society of Nursing Education
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    • v.25 no.4
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    • pp.414-423
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    • 2019
  • Purpose: This study evaluates the effect of behavioral relaxation training on distress and cancer screening intention of patients with upper gastrointestinal endoscopy. Methods: The research was conducted in a non-equivalent control group posttest design. Data were collected from endoscopy subjects in B city from October to November of 2018. Fifteen minutes of behavioral relaxation training were provided to the experimental group (n=40) and traditional relaxation therapy methods were provided to the control group (n=40). Outcome measures were distress and cancer screening intention of patients with upper gastrointestinal endoscopy. Data were analyzed with a ${\chi}^2$-test, independent t-test, Fisher's exact test with SPSS/PC version 23.0. Results: The objective discomfort (t=8.81, p<.001) of the experimental group was lower than that of the control group; there were no significant differences in the subjective discomfort (t=1.73, p=.088). The cancer screening intention (t=-5.85, p<.001) of the experimental group was significantly higher than that of the control group. Conclusion: Behavioral relaxation training was effective in heightening cancer screening intention. Therefore it can be usefully applied to increase cancer screening intention.

Role of endoscopy in gastroesophageal reflux disease

  • Daniel Martin Simadibrata;Elvira Lesmana;Ronnie Fass
    • Clinical Endoscopy
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    • v.56 no.6
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    • pp.681-692
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    • 2023
  • In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pump inhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett's esophagus screening; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical anti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to medical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopy with white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (narrow-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocal laser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure, transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosectomy, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of the new endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Stereomicroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions

  • Seigo Nakatani;Kosuke Okuwaki;Masafumi Watanabe;Hiroshi Imaizumi;Tomohisa Iwai;Takaaki Matsumoto;Rikiya Hasegawa;Hironori Masutani;Takahiro Kurosu;Akihiro Tamaki;Junro Ishizaki;Ayana Ishizaki;Mitsuhiro Kida;Chika Kusano
    • Clinical Endoscopy
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    • v.57 no.1
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    • pp.89-95
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    • 2024
  • Background/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). Methods: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA's diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. Results: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. Conclusions: Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

Necessity of pharyngeal anesthesia during transoral gastrointestinal endoscopy: a randomized clinical trial

  • Tomoyuki Hayashi;Yoshiro Asahina;Yasuhito Takeda;Masaki Miyazawa;Hajime Takatori;Hidenori Kido;Jun Seishima;Noriho Iida;Kazuya Kitamura;Takeshi Terashima;Sakae Miyagi;Tadashi Toyama;Eishiro Mizukoshi;Taro Yamashita
    • Clinical Endoscopy
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    • v.56 no.5
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    • pp.594-603
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    • 2023
  • Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA- groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA- group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA-) groups were 84.0% and 72.0%, respectively. The PA- group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0-10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA- group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. Conclusions: Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.