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Bonnichsen MH, Djajakusuma A, Wu CCH, Khor CJL, Tan DMY. Clip-and-line traction method for difficult ERCP cannulation due to choledochocoele. VideoGIE 2023; 8:418-419. [PMID: 37849779 PMCID: PMC10577484 DOI: 10.1016/j.vgie.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Video 1Clip-and-line traction method for difficult ERCP cannulation due to choledochocoele.
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Affiliation(s)
| | - Angela Djajakusuma
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- Division of Internal Medicine, National Kidney and Transplant Institute, Manila, Philippines
| | - Clement C H Wu
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Christopher J L Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Damien M Y Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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2
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Affiliation(s)
- Ennaliza Salazar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Eliza I Sin
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Yee Low
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Christopher J L Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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3
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Liao WC, Angsuwatcharakon P, Isayama H, Dhir V, Devereaux B, Khor CJL, Ponnudurai R, Lakhtakia S, Lee DK, Ratanachu-Ek T, Yasuda I, Dy FT, Ho SH, Makmun D, Liang HL, Draganov PV, Rerknimitr R, Wang HP. International consensus recommendations for difficult biliary access. Gastrointest Endosc 2017; 85:295-304. [PMID: 27720741 DOI: 10.1016/j.gie.2016.09.037] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/28/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Wei-Chih Liao
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Phonthep Angsuwatcharakon
- Department of Anatomy and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Global Hopsitals, Parel, Mumbai, India
| | - Benedict Devereaux
- University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Christopher J L Khor
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Ryan Ponnudurai
- Division of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Dong-Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Thawee Ratanachu-Ek
- Department of Surgery, Rajavithi Hospital, Rangsit Medical College, Bangkok, Thailand
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | | | - Shiaw-Hooi Ho
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Dadang Makmun
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Peter V Draganov
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Murdani A, Kumar A, Chiu HM, Goh KL, Jang BI, Khor CJL, Lau J, Mostafa I, Ramchandani M, Ratanalert S, Tajiri H, Yuen M, Zhang ST, Duforest-Rey D, Rey JF. WEO position statement on hygiene in digestive endoscopy: Focus on endoscopy units in Asia and the Middle East. Dig Endosc 2017; 29:3-15. [PMID: 27696514 DOI: 10.1111/den.12745] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/21/2016] [Indexed: 12/14/2022]
Abstract
The aim of this position statement is to reinforce the key points of hygiene in digestive endoscopy. The present article details the minimum hygiene requirements for reprocessing of endoscopes and endoscopic devices, regardless of the reprocessing method (automated washer-disinfector or manual cleaning) and the endoscopy setting (endoscopy suite, operating room, elective or emergency procedures). These minimum requirements are mandatory for patient safety. Both advanced diagnostic and therapeutic endoscopies should be carried out in an environment that is safe for patients and staff. Particular attention is given to contaminants. Procedural errors in decontamination, defective equipment, and failure to follow disinfection guidelines are major factors contributing to transmission of infection during endoscopy. Other important risk factors include inadequate cleaning, use of older endoscopes with surface and working channel irregularities, and contamination of water bottles or irrigating solutions. Infections by multidrug-resistant organisms have become an increasing problem in health-care systems worldwide. Since 2010, outbreaks of multidrug-resistant bacteria associated with endoscopic retrograde cholangiopancreatography have been reported from the USA, France, Germany, and The Netherlands. In many endoscopy units in Asia and the Middle East, reprocessing procedures have lagged behind those of Western countries for cultural reasons or lack of financial resources. This inconsistency in standards is now being addressed, and the World Endoscopy Organization has prepared this position statement to highlight key points for quality assurance in any endoscopy unit in any country.
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Affiliation(s)
- Abdullah Murdani
- Department of Internal Medicine, Universitas Indonesia, Jakarta Timur, Indonesia
| | - Ajay Kumar
- Fortis Escorts Liver and Digestive Diseases Institute, New Delhi, India
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Khean-Lee Goh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Christopher J L Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - James Lau
- Endoscopy Center, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ibrahim Mostafa
- Endoscopy Unit, Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | | | - Siriporn Ratanalert
- NKC Institute of Gastroenterology, Songklanagarind Hospital, Songkhla, Thailand
| | - Hisao Tajiri
- Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Minghwa Yuen
- Cantel Medical Asia/Pacific Pte. Ltd, Singapore, Singapore
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Kim TH, Kim JH, Seo DW, Lee DK, Reddy ND, Rerknimitr R, Ratanachu-Ek T, Khor CJL, Itoi T, Yasuda I, Isayama H, Lau JYW, Wang HP, Chan HH, Hu B, Kozarek RA, Baron TH. International consensus guidelines for endoscopic papillary large-balloon dilation. Gastrointest Endosc 2016; 83:37-47. [PMID: 26232360 DOI: 10.1016/j.gie.2015.06.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/11/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Tae Hyeon Kim
- Department of Gastroenterology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jin Hong Kim
- Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nageshwar D Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rungsun Rerknimitr
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Christopher J L Khor
- Department of Gastroenterology and Hepatology, National University Health System, Tan Tock Seng Hospital, Singapore
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - James Y W Lau
- Department of Surgery, Endoscopic Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Hsiu-Po Wang
- Endoscopic Division, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Hoi-Hung Chan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bing Hu
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
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Goh BKP, Lin Z, Tan DMY, Thng CH, Khor CJL, Lim TKH, Ooi LLPJ, Chung AYF. Evaluation of the Fukuoka Consensus Guidelines for intraductal papillary mucinous neoplasms of the pancreas: Results from a systematic review of 1,382 surgically resected patients. Surgery 2015; 158:1192-202. [PMID: 26032832 DOI: 10.1016/j.surg.2015.03.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/26/2015] [Accepted: 03/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND International consensus guidelines to guide management of intraductal papillary mucinous neoplasms (IPMN) were revised in Fukuoka and published in 2012. However, despite widespread acceptance of the Fukuoka Consensus Guidelines (FCG), the utility of these guidelines have not been well-validated. This systematic review was performed to evaluate the clinical utility of the FCG. DESIGN A computerized search of the PubMed and Scopus databases was performed to identify all studies evaluating the utility of the FCG in surgically resected IPMN. IPMN were stratified according to the FCG as high risk (HR), worrisome risk (WR), and low risk (LR). HR and WR IPMN were termed FCG+ve and LR IPMN were termed FCG-ve. RESULTS Seven studies analyzing 1,382 patients were included. There were 402 malignant neoplasms (29%), including 242 invasive IPMNs. There were 1,000 IPMN classified as FCG+ve. The FCG+ve group had a positive predictive value (PPV) ranging from 27 to 62% and the FCG-ve group had negative predictive value ranging from 82 to 100%. Pooled analysis demonstrated that there was 362 of 1,000 (36%) malignant FCG+ve IPMN and 342 of 382 (90%) benign FCG-ve IPMN. PPV of the HR group and the WR groups alone were 104 of 158 (66%) and 75 of 261 (29%), respectively. Forty of 382 (11%), including 22 (6%) invasive FCG-ve IPMN, were malignant. Twenty-six malignant including 18 invasive FCG-ve IPMN were reported from a single study. When the results from this study were excluded, there were only 14 of 241 malignant neoplasms (6%), including 4 of 241 (2%) invasive FCG-ve IPMN in the remaining 6 studies. CONCLUSION The FCG+ve criteria had a similarly low PPV compared with the 2006 consensus criteria. Stratification of IPMN into HR and WR groups resulted in a higher PPV in the HR group. Some malignant and even invasive IPMN may be missed by the FCG criteria.
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Affiliation(s)
- Brian K P Goh
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore.
| | - Zhimin Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Damien M Y Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Choon-Hua Thng
- Department of Oncologic Imaging, National Cancer Center Singapore, Singapore
| | - Christopher J L Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Tony K H Lim
- Department of Pathology, Singapore General Hospital, Singapore
| | - London L P J Ooi
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore
| | - Alexander Y F Chung
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
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Lim LG, Lakhtakia S, Ang TL, Vu CKF, Dy F, Chong VH, Khor CJL, Lim WC, Doshi BK, Varadarajulu S, Yasuda K, Wong JYY, Chan YH, Nga ME, Ho KY. Factors determining diagnostic yield of endoscopic ultrasound guided fine-needle aspiration for pancreatic cystic lesions: a multicentre Asian study. Dig Dis Sci 2013; 58:1751-7. [PMID: 23314918 DOI: 10.1007/s10620-012-2528-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/03/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The purpose of this study was to determine (1) the diagnostic yield for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with pancreatic cystic lesions, (2) additional value of EUS-FNA over EUS alone in the diagnosis of pancreatic cysts, and (3) diagnostic sensitivity and specificity of EUS and EUS-FNA in the subset of patients where histopathology of surgical specimens were available. METHODS All patients who underwent EUS examination for the evaluation of pancreatic cystic lesions in six Asian centres were included in the study. RESULTS Of 298 patients with pancreatic cysts who underwent EUS, 132 (44.3 %) underwent FNA. In the entire cohort, pseudocysts and intraductal papillary mucinous neoplasm (IPMN) were the predominant cystic lesions. The cytologic yield of EUS-FNA was 47 %. On univariate analysis, factors associated with higher cytologic yield included vascular involvement on EUS, presence of solid cystic component, and increased number of needle passes during EUS-FNA. On multivariate analysis, presence of solid cystic components and increased number of needle passes during EUS-FNA were associated with higher diagnostic yield of EUS-FNA. For pancreatic cysts with a solid component, the diagnostic yield of EUS-FNA increased significantly from 44 % with one pass to 78 % with more than one pass (p = 0.016). In the absence of a solid component, the diagnostic yield was 29 % with one pass and was not significantly different from the diagnostic yield of 50 % with more than one pass, p = 0.081. CONCLUSION The cytologic yield of EUS-FNA was 47 %. When a solid component was present in the cyst, doing more than one pass during EUS-FNA increased its diagnostic yield.
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Affiliation(s)
- Lee Guan Lim
- Department of Gastroenterology and Hepatology, National University Health System, 10 Kent Ridge Crescent, Singapore, 119260, Singapore
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Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, Khor CJL, Ponnudurai R, Moon JH, Seo DW, Pantongrag-Brown L, Sangchan A, Pisespongsa P, Akaraviputh T, Reddy ND, Maydeo A, Itoi T, Pausawasdi N, Punamiya S, Attasaranya S, Devereaux B, Ramchandani M, Goh KL. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol 2013; 28:593-607. [PMID: 23350673 DOI: 10.1111/jgh.12128] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 12/13/2022]
Abstract
Hilar cholangiocarcinoma (HCCA) is one of the most common types of hepatobiliary cancers reported in the world including Asia-Pacific region. Early HCCA may be completely asymptomatic. When significant hilar obstruction develops, the patient presents with jaundice, pale stools, dark urine, pruritus, abdominal pain, and sometimes fever. Because no single test can establish the definite diagnosis then, a combination of many investigations such as tumor markers, tissue acquisition, computed tomography scan, magnetic resonance imaging/magnetic resonance cholangiopancreatography, endoscopic ultrasonography/intraductal ultrasonography, and advanced cholangioscopy is required. Surgery is the only curative treatment. Unfortunately, the majority of HCCA has a poor prognosis due to their advanced stage on presentation. Although there is no survival advantage, inoperable HCCA managed by palliative drainage may benefit from symptomatic improvement. Currently, there are three techniques of biliary drainage which include endoscopic, percutaneous, and surgical approaches. For nonsurgical approaches, stent is the most preferred device and there are two types of stents i.e. plastic and metal. Type of stent and number of stent for HCCA biliary drainage are subjected to debate because the decision is made under many grounds i.e. volume of liver drainage, life expectancy, expertise of the facility, etc. Recently, radio-frequency ablation and photodynamic therapy are promising techniques that may extend drainage patency. Through a review in the literature and regional data, the Asia-Pacific Working Group for hepatobiliary cancers has developed statements to assist clinicians in diagnosing and managing of HCCA. After voting anonymously using modified Delphi method, all final statements were determined for the level of evidence quality and strength of recommendation.
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Affiliation(s)
- Rungsun Rerknimitr
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Abstract
In the Endoscopic Forum Japan 2011 (EFJ 2011), we focused on the management of biliary strictures derived from chronic pancreatitis and surgical intervention. We concluded that regardless of causes of strictures, a large bore single plastic stent is better as a first choice of stenting. As a next step, multiple plastic stents may be preferable compared to a covered self-expandable metallic stent in case of unexpected adverse events and cost of stent. In the near future, we believe that not only progress of treatment technique and accessories but also good understanding of the pathology of biliary strictures will lead to the best management.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
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Lim LG, Yeoh KG, Salto-Tellez M, Khor CJL, Teh M, Chan YH, So JBY, Rajnakova A, Shen E, Srivastava S, Ho KY. Experienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images. Gastrointest Endosc 2011; 73:1141-7. [PMID: 21492850 DOI: 10.1016/j.gie.2011.01.068] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/29/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) may be used to diagnose gastric cancer and intestinal metaplasia, but the impact of CLE experience on the accuracy of confocal diagnosis of gastric cancer and intestinal metaplasia is not clear. OBJECTIVE To establish the sensitivity, specificity, and intragroup interobserver agreement of CLE image interpretation by 3 experienced (group 1) and 3 inexperienced (group 2) CLE endoscopists for diagnosing gastric intestinal metaplasia (GIM) and adenocarcinoma. DESIGN Blinded review of CLE images for the diagnosis of gastric cancer or intestinal metaplasia. SETTING Tertiary care hospital. PATIENTS CLE images obtained ex vivo from gastrectomy specimens with proven gastric cancer and CLE images obtained in vivo from Chinese subjects older than 50 years of age by using matched biopsy specimens as reference standards. MAIN OUTCOME MEASUREMENTS Sensitivity, specificity, and intragroup interobserver agreement of CLE image interpretation. RESULTS Interpretation of in vivo images by group 1 was associated with higher sensitivity (95.2% vs 61.9%, P = .039) and higher specificity (93.3% vs 62.2%, P < .001) for GIM than interpretation by group 2. The agreement between interpretation by group 1 and histology for GIM was higher than that for group 2 (κ = 0.864 vs 0.217). The sensitivity (93.3% for group 1 vs 86.7% for group 2, P = 1.000) and specificity (87.7% for group 1 vs 80.7% for group 2, P = .344) of interpretation of ex vivo CLE images for the diagnosis of gastric adenocarcinoma was similar for groups 1 and 2. LIMITATIONS Single-center study. CONCLUSIONS Experience in CLE was associated with greater accuracy in the diagnosis of intestinal metaplasia.
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Affiliation(s)
- Lee Guan Lim
- Department of Gastroenterology and Hepatology, National University Health System, Singapore
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Itoi T, Sofuni A, Itokawa F, Irisawa A, Khor CJL, Rerknimitr R. Current status of diagnostic endoscopic ultrasonography in the evaluation of pancreatic mass lesions. Dig Endosc 2011; 23 Suppl 1:17-21. [PMID: 21535194 DOI: 10.1111/j.1443-1661.2011.01132.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Endoscopic ultrasonography (EUS) is currently well established as a diagnostic method for the evaluation of pancreatic mass lesions. Diagnostic EUS might be divided into two broad categories; it is an imaging method, and also a device for obtaining cytopathology and histopathology. EUS as an imaging method has seen the introduction of newer intravenous contrast agents that enable the characterization of the pancreatic masses. EUS elastography enables real-time graphical representation of differential tissue hardness within a lesion. Contrast-enhanced EUS and/or elastography provide information additional to the fundamental images, leading to more accurate diagnosis. EUS-guided fine needle aspiration (EUS-FNA) has been shown to be a highly accurate method for distinguishing benign from malignant pancreatic masses. Several investigators have reported the usefulness of EUS-FNA samples obtained from pancreatic masses for genetic analysis, e.g. p53, K-ras. Genetic analysis of EUS-FNA samples to characterize chemo-sensitivity has recently been attempted in patients with unresectable pancreatic cancers. Although further improvement of EUS technology is desired to render it an even more convenient and reliable procedure, EUS at its current level of advancement is of proven utility in the diagnosis of pancreatic masses.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
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12
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Ang TL, Khor CJL, Gotoda T. Diagnosis and endoscopic resection of early gastric cancer. Singapore Med J 2010; 51:93-100. [PMID: 20358145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The overall prognosis of gastric cancer is generally poor due to late presentation and diagnosis. When detected early, the prognosis for gastric cancer is excellent, and curative endoscopic resection may be possible, without the need for surgery. Careful endoscopic examination is important so as to avoid missed lesions. Endoscopic resection, especially with the technique of endoscopic submucosal dissection, is a viable alternative to surgery for the curative treatment of early gastric cancer, with similar long term results, as long as strict inclusion criteria are adhered to.
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Affiliation(s)
- T L Ang
- Department of Gastroenterology, Changi General Hospital, Singapore.
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Tan SH, Wong ASC, Thamboo TP, Chang SKY, Khor CJL. Pancreas-only metastasis from nasopharyngeal carcinoma. Ann Acad Med Singap 2008; 37:444-445. [PMID: 18536839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Affiliation(s)
- Benjamin Y S Chuah
- Department of Haematology-Oncology, National University Hospital, Singapore
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Tan TW, Khor CJL, Chang SKY. Stenting before laparoscopic common bile duct exploration: a helpful strategy. Singapore Med J 2007; 48:e224-6. [PMID: 17657371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We describe a 43-year-old man who had a difficult endoscopic retrograde cholangiopancreatography, allowing only placement of a stent without removal of the common bile duct stone. He subsequently underwent laparoscopic cholecystectomy with laparoscopic common bile duct exploration and primary closure after laparoscopic choledochotomy.
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Affiliation(s)
- T W Tan
- Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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Wai CT, Lau G, Khor CJL. Clinics in diagnostic imaging (105): Sigmoid volvulus causing intestinal obstruction, with successful endoscopic decompression. Singapore Med J 2005; 46:483-7; quiz 488. [PMID: 16123835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
An 89-year-old woman was admitted for intestinal obstruction. Her abdominal radiograph showed typical features of sigmoid volvulus. Decompression was done successfully through careful flexible sigmoidoscopy with minimum air insufflation. The patient's symptoms were relieved and she was discharged two days post-procedure. No recurrence was noted at extended follow-up. Rapid diagnosis and early decompression are key to optimal management of sigmoid volvulus.
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Affiliation(s)
- C T Wai
- Department of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
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Affiliation(s)
- Chun Tao Wai
- Division of Gastroenterology, Department of Medicine, National University Hospital, Singapore
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