• The Journal of Internal Korean Medicine
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• v.35 no.3
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• pp.274-287
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• 2014

Objectives: This study was aimed to figure out an agreement between the diagnosis of nasal endoscopy and a preexisting questionnaire focusing on Cold-Heat pattern. Methods: 52 patients with cough who met the criteria filled out a pattern questionnaire and the examiner looked at their nasal cavities through nasal endoscopy. According to the checked questionnaire results, the subjects were identified by 6 patterns. After examining subject's mucous membrane of oropharynx and nasal cavity through nasal endoscopy, we classified each to the Cold or Heat group. Correlation between questionnaire and nasal endoscopy results was analyzed. Results: In diagnosing Cold-Heat, there was no significant difference by McNemar test (p=0.227) between nasal endoscopy and the questionnaire, and the two methods agreed moderately (${\kappa}=0.428$). The color of mucous membrane of oropharynx and the Cold-Heat pattern on questionnaire agreed slightly (${\kappa}=0.133$). The color of mucous membrane of nasal cavity and the Cold-Heat pattern on questionnaire agreed fairly (${\kappa}=0.384$). In the patients with cough related to upper respiratory tract, they got higher diagnosis accuracy than the patients with cough related to lower respiratory tract did. Similarly, external cough patients got higher diagnosis accuracy than internal cough patients did. Conclusions: To identify Cold or Heat, examining oropharynx and nasal cavity using nasal endoscopy is a meaningful method in patients with cough, showing that two diagnosis methods which use nasal endoscopy and questionnaire agreed moderately. Especially, it is more useful diagnosing patients with cough related to the upper respiratory tract than diagnosing the patients with cough related to the lower respiratory tract.

• Journal of Gastric Cancer
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• v.21 no.2
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• pp.203-212
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• 2021

Purpose: The impact of the interval between previous endoscopy and diagnosis on the treatment modality or mortality of undifferentiated (UD)-type gastric cancer is unclear. This study aimed to investigate the effect of endoscopic screening interval on the stage, cancer-related mortality, and treatment methods of UD-type gastric cancer. Materials and Methods: We reviewed the medical records of newly diagnosed patients with UD gastric cancer in 2013, in whom the interval between previous endoscopy and diagnosis could be determined. The patients were classified into different groups according to the period from the previous endoscopy to diagnosis (<12 months, 12-23 months, 24-35 months, ≥36 months, and no history of endoscopy), and the outcomes were compared between the groups. In addition, patients who underwent endoscopic and surgical treatment were reclassified based on the final treatment results. Results: The number of enrolled patients was 440, with males representing 64.1% of the study population; 11.8% of the participants reported that they had undergone endoscopy for the first time in their cancer diagnosis. The percentage of stage I cancer at diagnosis significantly decreased as the interval from the previous endoscopy to diagnosis increased (65.4%, 63.2%, 64.2%, 45.9%, and 35.2% for intervals of <12 months, 12-23 months, 24-35 months, ≥36 months, and no previous endoscopy, respectively, P<0.01). Cancer-related mortality was significantly lower for a 3-year interval of endoscopy (P<0.001). Conclusions: A 3-year interval of endoscopic screening reduces gastric-cancer-related mortality, particularly in cases of UD histology.

• Korean Journal of Radiology
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• v.25 no.3
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• pp.243-256
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• 2024

Objective: We aimed to investigate whether 2-[¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[¹⁸F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. Materials and Methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[¹⁸F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in earlyphase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy. Conclusion: Adding 2-[¹⁸F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.4
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• pp.258-265
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• 2024

Purpose: To date, there is no region-specific guideline for pediatric endoscopy training. This study aimed to illustrate the current status of pediatric endoscopy training in Asia-Pacific region and identify opportunities for improvement. Methods: A cross-sectional survey, using a standardized electronic questionnaire, was conducted among medical schools in the Asia-Pacific region in January 2024. Results: A total of 57 medical centers in 12 countries offering formal Pediatric Gastroenterology training programs participated in this regional survey. More than 75% of the centers had an average case load of <10 cases per week for both diagnostic and therapeutic endoscopies. Only 36% of the study programs employed competency-based outcomes for program development, whereas nearly half (48%) used volume-based curricula. Foreign body retrieval, polypectomy, percutaneous endoscopic gastrostomy, and esophageal variceal hemostasis, that is, sclerotherapy or band ligation (endoscopic variceal sclerotherapy and endoscopic variceal ligation), comprised the top four priorities that the trainees should acquire in the autonomous stage (unconscious) of competence. Regarding the learning environment, only 31.5% provided formal hands-on workshops/simulation training. The direct observation of procedural skills was the most commonly used assessment method. The application of a quality assurance (QA) system in both educational and patient care (Pediatric Endoscopy Quality Improvement Network) aspects was present in only 28% and 17% of the centers, respectively. Conclusion: Compared with Western academic societies, the limited availability of cases remains a major concern. To close this gap, simulation and adult endoscopy training are essential. The implementation of reliable and valid assessment tools and QA systems can lead to significant development in future programs.

• Clinical Endoscopy
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• v.55 no.2
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• pp.215-225
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• 2022

Background/Aims: The Thai Association for Gastrointestinal Endoscopy published recommendations on safe endoscopy during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the practicality and applicability of the recommendations and the perceptions of endoscopy personnel on them. Methods: A validated questionnaire was sent to 1290 endoscopy personnel globally. Of these, the data of all 330 responders (25.6%) from 15 countries, related to the current recommendations on proper personal protective equipment (PPE), case selection, scope cleaning, and safety perception, were analyzed. Ordinal logistic regression was used to determine the relationships between the variables. Results: Despite an overwhelming agreement with the recommendations on PPE (94.5%) and case selection (95.5%), their practicality and applicability on PPE recommendations and case selection were significantly lower (p=0.001, p=0.047, p<0.001, and p=0.032, respectively). Factors that were associated with lower sense of safety in endoscopy units were younger age (p=0.004), less working experience (p=0.008), in-training status (p=0.04), and higher national prevalence of COVID-19 (p=0.003). High prevalent countries also had more difficulty implementing the guidelines (p<0.001) and they considered the PPE recommendations less practical and showed lower agreement with them (p<0.001 and p=0.008, respectively). A higher number of in-hospital COVID-19 patients was associated with less agreement with PPE recommendations (p=0.039). Conclusions: Using appropriate PPE and case selection in endoscopic practice during a pandemic remains a challenge. Resource availability and local prevalence are critical factors influencing the adoption of the current guidelines.

• Journal of Korean Clinical Nursing Research
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• v.20 no.2
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• pp.189-199
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• 2014

Purpose: The purpose of this study was to investigate job stress and job satisfaction among nurses in gastrointestinal endoscopy units, and factors related to their job stress and job satisfaction. Methods: The study participants were 153 nurses working in gastrointestinal endoscopy units at eleven general hospitals. Job stress and job satisfaction were measured using nurses's job stress scale and the index of work satisfaction respectively. Results: The average job stress was 3.67 (range 1~5) and job satisfaction was 2.90 (range 1~5). Gastrointestinal endoscopy unit nurses, who were full time worker, having more than 7 years of clinical experiences, having higher incomes, having high subjective work-intensity, and having an intention to change their working units, showed greater job stresses than those of the others. There were significant differences in job satisfaction according to subjective health status, the types of employment, subjective work-intensity, subjective aptitude, intention to change working units, major nursing tasks, and the numbers of major nursing tasks. Also, the subjects's job stress showed a negative correlation with job satisfaction. Conclusion: Findings suggest that management strategies should be developed to increase job satisfaction focusing on general and job characteristics associated with job stress.

• Clinical and Experimental Pediatrics
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• v.53 no.9
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• pp.817-823
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• 2010

Gastrointestinal and colonic endoscopic examinations have been performed in pediatric patients in Korea for 3 decades. Endoscopic procedures are complex and may be unsafe if special concerns are not considered. Many things have to be kept in mind before, during, and after the procedure. Gastrointestinal endoscopy is one of the most frequently performed procedure in children nowadays, Since the dimension size of the endoscopy was modified for pediatric patients 15 years ago, endoscopic procedures are almost performed routinely in pediatric gastrointestinal patients. The smaller size of the scope let the physicians approach the diagnostic and therapeutic endoscopic procedures. But this is an invasive procedure, so the procedure itself may provoke an emergence state. The procedure-related complications can more easily occur in pediatric patients. Sedation-related or procedure-related respiratory, cardiovascular complications are mostly important and critical in the care. The endoscopists are required to consider diverse aspects of the procedure - patient preparation, indications and contraindications, infection controls, sedation methods, sedative medicines and the side effects of each medicine, monitoring during and after the procedure, and complications related with the procedure and medicines - to perform the procedure successfully and safely. This article presents some important guidelines and recommendations for gastrointestinal endoscopy through literature review.

• Journal of Biomedical Engineering Research
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• v.26 no.1
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• pp.23-30
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• 2005

3D virtual endoscopy has been used as an alternative non-invasive procedure for visualization of hollow organs. However, due to computational complexity, this is a time-consuming procedure. In this paper, we propose a fast volume rendering algorithm based on perspective ray casting for virtual endoscopy. As a pre-processing step, the algorithm divides a volume into hierarchical blocks and classifies them into opaque or transparent blocks. Then, in the first step, we perform ray casting only for sub-sampled pixels on the image plane, and determine their pixel values and depth information. In the next step, by reducing the sub-sampling factor by half, we repeat ray casting for newly added pixels, and their pixel values and depth information are determined. Here, the previously obtained depth information is utilized to reduce the processing time. This step is recursively performed until a full-size rendering image is acquired. Experiments conducted on a PC show that the proposed algorithm can reduce the rendering time by 70- 80% for bronchus and colon endoscopy, compared with the brute-force ray casting scheme. Using the proposed algorithm, interactive volume rendering becomes more realizable in a PC environment without any specific hardware.

• Clinical Endoscopy
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• v.51 no.6
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• pp.563-569
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• 2018

Background/Aims: To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE) using the PillCam SB3 capsule endoscopy (CE) system. Methods: Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluated using the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleeding caused by PHE were treated. The correlation of the CE scores of PHE with the clinical, laboratory, and endoscopic features was determined. Results: Of the 43 patients included in the study, 41 (95.3%) showed PHE findings. These included varices (67.4%), red spots (60.5%), erythema (44.2%), villous edema (46.5%), telangiectasia (16.3%), and polyps (16.3%). The CE scores varied from 0 to 8 ($mean{\pm}standard$ deviation, $4.09{\pm}1.8$). Five patients (11.6%) showed evidence of ongoing or recent bleeding due to PHE. Three of these five patients underwent endotherapy, and one patient underwent radiological coil placement. Conclusions: The PillCam SB3 CE system revealed a high prevalence of PHE in the patients with PH. Using this system, evidence of bleeding due to PHE was found in a small but definite proportion of the patients.

• Korean Journal of Occupational Health Nursing
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• v.32 no.4
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• pp.152-163
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• 2023

Purpose: This study aimed to identify the effects of musculoskeletal symptoms and burden on presenteeism among nurses in a gastrointestinal endoscopy unit. Methods: This was an observational cross-sectional study. Data were collected through self-reported questionnaires administered to 140 nurses working in the gastrointestinal endoscopy unit of a hospital located in Busan metropolitan city. Results: The body part with the most musculoskeletal symptoms was the back (73.2%), and the most common musculoskeletal burden work was "when you have to stand or maintain the same posture for a long time in a lead apron protection clothes." The factors most related to work impairment were working hours, musculoskeletal symptoms, and musculoskeletal burden, with an explanatory power of 63.3%. Factors affecting perceived productivity were working hours and musculoskeletal symptoms, with an explanatory power of 29.2 %. Conclusion: To reduce work impairment and increase the perceived productivity of nurses in gastrointestinal endoscopy units, various programs and improved working environments are needed that can improve musculoskeletal symptoms and reduce musculoskeletal burden.