Greetings from the Guest Editor

Successful endoscopic closure of an esophageal leak after endoscopic ultrasound-guided hepaticoesophagostomy by using n-butyl-2 cyanoacrylate

Renma Ito, Yusuke Hashimoto *, and Masafumi Ikeda

Abstract : Endoscopic ultrasound-guided hepaticoesophagostomy (EUS-HES) refers to EUS-guided biliary access from the abdominal part of the esophagus, an uncommon choice of route for biliary drainage. In the patient reported herein, an esophageal laceration and leakage at the site of placement of a metal stent occurred a few days after EUS-HES. To plug the laceration, 0.5 mL of n-butyl-2 cyanoacrylate mixed with 1 mL of lipiodol was injected through an endoscopic retrograde cholangiopancreatography catheter. We performed EUS-guided transgastric drainage for drainage of the peritoneal fluid collection. The procedures were successful and the laceration eventually healed, with no further leakage.

Endoscopic submucosal dissection in the West

Alexander Podboy and Shai Friedland

Abstract : Endoscopic resection has emerged as the first line therapy for pre-malignant conditions throughout the gastrointestinal (GI) tract. Resection techniques have evolved from forceps avulsion and snare polypectomy to endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). While ESD was originally developed in Japan for resection of early gastric neoplasia, its use in the East has expanded rapidly to all types of superficial neoplasia throughout the GI tract. Despite the widespread use of ESD in the East, Western adoption of the ESD technique has been lukewarm. The hesitancy to adopt ESD is multifactorial, likely secondary to concern about the increased risk of complications, procedure duration and reimbursement, as well as the long learning curve of ESD. Despite this initial hesitancy, preliminary reports of the use of ESD for the resection of superficial neoplastic lesions in the West have been encouraging. The aim of this review is to highlight the current use of ESD for superficial neoplastic lesions throughout the GI tract in the West.

Endoscopic management of ampullary neoplasm

Sunguk Jang *

Abstract : Neoplastic lesions of ampulla, although infrequent, represent a significant portion of precancerous lesions arising within duodenum. Occurring either as sporadic, solitary lesion, or as a part of multiple adenomas within duodenum, due to its potential for malignant transformation, ampullary adenoma warrants a careful evaluation with the intention of curative resection when possible. The removal of ampullary lesion can be accomplished either surgically, or endoscopically if feasible. Here, we provide a brief review of endoscopic management of ampullary neoplasm.

Management of antithrombotic agents and current issues in patients undergoing endoscopic submucosal dissection

Chan Hyuk Park *

Abstract : Postoperative bleeding is a common adverse event in endoscopic submucosal dissection (ESD) and may be life-threatening. Postoperative bleeding occurs frequently in patients treated with antithrombotic agents, including aspirin, antiplatelet agents, warfarin, and non-vitamin K-dependent oral anticoagulants. Due to the aging population and the increase in the risk of thromboembolic disease, the number of patients who require antithrombotic therapy has increased. To date, several clinical studies have been conducted and several global guidelines have been updated. Nevertheless, determining the optimal use of antithrombotic agents in patients undergoing ESD is still challenging, and recommendations for the use of these agents vary slightly across different guidelines. In this review, I summarized the current guidelines and discussed several ongoing issues with the management of antithrombotic agents in patients undergoing ESD.

Bleeding complication after endoscopic submucosal dissection of gastric neoplasm

Ji Yong Ahn *

Abstract : Endoscopic submucosal dissection (ESD) is recognized as an effective treatment for superficial gastric neoplasm without metastasis because results of ESD show the high en bloc resection rate and low local recurrence rate. Recently, the indications for ESD have been broadened in the field of therapeutic endoscopy with regard to its safety and efficacy. However, complications can be happened after procedure and post-ESD bleeding is one of the major adverse events which may lead to serious clinical situation of patient. The mechanism of post-ESD ulcer which is made by iatrogenic procedure is different from peptic ulcer which is created under low pH, therefore, the risk factors and treatment methods of post-ESD bleeding is somewhat different from peptic ulcer bleeding. With these reasons, endoscopist should know about the definitions and influencing factors of post-ESD bleeding before and after procedure, and should manage using proper hemostatic methods when post-ESD bleeding is happened. In this review, I try to overview about the post-ESD bleeding and to know the methods of treatment and prevention of bleeding.

Endoscopic closure devices: A review of technique and application for hemostasis

Jennifer Wellington, Andrew Canakis, and Raymond Kim

Abstract : Acute gastrointestinal bleeding is a common, yet challenging, and potentially problematic medical emergency for clinicians to manage. Given its significantly high health care associated costs and increased morbidity and mortality rate, new endoscopic techniques for managing gastrointestinal bleeding has gained considerable attention. While conventional methods (i.e., injection, cautery, and hemostatic clips) have been widely used, their efficacy and reliability for initial hemostasis has been hindered by high rebleeding and variable success rates. Thus, this review sets out to characterize recent advancements with the clinical application of endoscopic closure devices as the alternatives in achieving hemostasis. Such devices include hemostatic clips, also known as through-the-scope clips, over-the-scope-clips, endoscopic detachable snare ligation devices, and endoscopic suturing system.

Endovascular hemostasis for endoscopic procedure-related gastrointestinal bleeding

Minho Park, Jong Woo Kim, and Ji Hoon Shin *

Abstract : Gastrointestinal (GI) bleeding is a common complication of various endoscopic procedures. In most cases, GI bleeding responds to conservative management. And if indicated, endoscopic hemostasis is performed. However, if endoscopic hemostasis fails due to massive bleeding or hemodynamically unstable patients, alternative treatment options, such as endovascular hemostasis or surgery, should be considered. As endoscopic procedures have become more diverse, there have been reports of interventional treatment of endoscopic, procedure-related GI bleeding. In this article we will discuss the endovascular diagnosis and treatment of endoscopic, procedure-related GI bleeding.

Technical review of gastric per-oral endoscopic myotomy

Alexander Podboy and Joo Ha Hwang *

Abstract : Gastroparesis, or symptomatic delayed gastric emptying, has seen a startling increase in prevalence of over last decade. Efficacy of initial dietary and medical therapies remain limited and patients that fail these first line remedies represent a significant therapeutic challenge. Recent procedural and technological advancements have led to the development of a promising endoscopic therapy for gastroparesis via an endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy (G-POEM) or per-oral endoscopic pyloromyotomy (POP). While initial preliminary reports of G-POEM or POP for the treatment of gastroparesis are encouraging, there is not a consensus standardized procedural approach and published practice patterns at each stage of the G-POEM procedure can vary wildly. The aim of our review is to provide an overview of the technical aspects of the G-POEM procedure framed within our current practice patterns and that of the published literature.

Interventional radiology for post-gastrectomy complications

Suyoung Park, Ji Hoon Shin , and Kichang Han

Abstract : Complications following gastrectomy can be life-threatening, but, they are commonly managed by interventional radiology. This review describes possible complications after gastrectomy by dividing them into vascular and non-vascular categories. Vascular complications are mostly arterial bleeding and varix bleeding. Non-vascular complications comprise abscess, fistula, benign anastomotic stricture, and malignant obstruction, e.g. afferent loop syndrome, by tumor recurrence. Interventional managements for treatment of post-gastrectomy complications are safe, effective, and less invasive compared with surgery.