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Background/Aims: Several attempts have been made to incorporate smart glasses in the medical field. We applied wearable display glasses to show the position of an observer during endoscopy and compared students’ responses between the conventional and new methods.Methods: We surveyed 28 medical students regarding the use of wearable display devices. The students used wearable display glasses to observe an endoscopic procedure and answered the prepared questionnaire. Their collected responses were analyzed for statistical correlations between each variable.Results: The survey of medical students revealed disadvantages including dizziness (dissatisfied and very dissatisfied: 21.5%) and eye fatigue (25% dissatisfied) and advantages including concentration (satisfied and very satisfied: 57.2%) and securing patient rights (71.4%). The students showed more positive than negative reviews regarding the new devices (32.1% vs. 21.5%).Conclusions: We investigated the advantages and disadvantages of viewing the endoscope image with new wearable display glasses compared to the conventional method using the survey to record user experience. The results revealed relatively positive responses from the medical students in the survey. If the new device compensates for some shortcomings, its use in the endoscopy room will be feasible.

Background/Aims: The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19).Methods: This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages.Results: A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period.Conclusions: The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.

Background/Aims: In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions. Methods: We surveyed the staff of institutional endoscopic units via e-mail. Results: Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program. Conclusions: Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program. Clin Endosc 2016;49:542-547

Obesity and metabolic syndrome are known to have an impact on the economy. Obesity and metabolic syndrome affect about 40% population in the America alone, and with about 400 million obese adults in the world, obesity is a global concern. Moreover, the prevalence of overweight children is increasing. Bariatric surgery remains the gold standard for the treatment of obesity; however, endoscopic approaches may have a significant role in the management of metabolic syndrome and obesity. Until recently, many endoscopic methods have been introduced; however, few methods are used in practice, whereas others are under experimental research. Endoscopists have an important role in the treatment of obesity because endoscopic therapies have demonstrated their safety and efficacy over the past few years. Endoscopic bariatric therapies can be categorized as follows: space occupying, malabsorption, and gastric volume reduction. In this review, we summarize the currently available non-balloon type endoscopic procedure.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.

Regardless of outstanding developments in the endoscopic field, laryngopharyngeal lesions are generally considered as a field of otolaryngology, and thus it is thought that not a lot of gastrointestinal endoscopists commonly take interest in these lesions during the upper gastrointestinal endoscopic examinations. Therefore, here in this thesis, I reviewed the availability of upper gastrointestinal endoscopy in laryngopharyngeal area, normal structures of laryngopharynx, and the lesions that can be observed with the standard upper gastrointestinal endoscopic procedure.

Patient evaluation and preparation is the first and mandatory step to ensure safety and quality of endoscopic procedures. This begins and ends with identifying the patient, procedure type, and indication. Every patient has the right to be fully informed about risks and benefits of what is to be performed on them, and the medical personnel should respect the decision made by the patients. Thoroughly performed history taking and physical examination will guide the endoscopists to better stratify risk and plan sedation. Special attention should be given to higher-risk patients with higher-risk condition undergoing higher-risk procedures. Making preparations to monitor the patients and being ready to handle emergency situations throughout the endoscopic procedure are sine qua non to warrant safe endoscopy.

As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.

See "Peroral Endoscopic Myotomy for Treating Achalasia in an Animal Model: A Feasibility Study" by Byoung Wook Bang, Young Chul Choi, Hyung Gil Kim, et al., on page 54-58 Achalasia is an idiopathic motility disorder that results from degeneration of the myenteric plexus in the wall of the esophagus and the lower esophageal sphincter (LES).1 In esophageal manometry, achalasia is characterized by impaired relaxation of LES and loss of peristalsis in the body of the esophagus. Achalasia results in severe dysphagia for solids and liquids. Additional symptoms can also develop such as chest pain, regurgitation, aspiration, weight loss, and irreversible dilatation of the esophageal body. The therapy for achalasia focuses on the forced relaxation of the LES by endoscopic method or surgery. The treatment modalities using endoscopy or surgery have mainly included endoscopic pneumatic dilation and laparoscopic Heller myotomy (LHM). Recently, peroral endoscopic myotomy (POEM) has been introduced as a novel endoscopic procedure for the treatment of achalasia. A submucosal esophageal myotomy was first described in a porcine model by Pasricha et al.,2 and POEM was first performed to achalasia patients by Inoue et al.3 Since 2010, several small-sized case series for POEM have shown safety and excellent short-term outcomes.4-6 The advantages of POEM are theoretically based on those of endoscopic operation such as no skin incisions, decreased pain, and less blood loss. Furthermore, POEM incorporates the advantage of LHM consisted of durable surgical myotomy and single procedure. A recent porcine study showed that the preservation of longitudinal muscle layer does not compromise the effectiveness of the myotomy.7 In a paper published in Clinical Endoscopy, Bang et al.8 reported a study that evaluated the feasibility of POEM in a porcine model. The authors showed successful POEM procedure and no definite perioperative complications in two mini pigs. After 2 weeks from POEM procedure, the histopathologic evaluation of the necropsy specimens revealed complete loss of the inner circular muscle and replaced fibrosis at the myotomy site. The authors concluded that POEM is a technically feasible treatment in the animal model. This study has several limitations. First, the authors used only two pigs in the study. Second, the observation period was short for follow-up after the procedure. Third, the authors did not perform esophageal manometry to analyze the difference of LES pressure before and after the procedure. However, this study seems to be a step for transition of the treatment method for achalasia in the near future. In addition, this study was the first animal study of POEM in Korea. The porcine model is the most useful animal model for training in POEM because of its anatomy being similar to that of humans, although the normal porcine esophagus is thinner than the human achalasia-affected esophagus. And the porcine esophageal submucosal space is softer and more easily dissected than in humans. However, ex vivo porcine explants are a useful model for training of POEM as well as in vivo training.9 Several clinical data for POEM in human have been recently published. They suggest that POEM may soon replace traditional esophageal myotomy as the surgical treatment of choice for achalasia. A major advantage of POEM is the ability to control myotomy length. In POEM, myotomy is usually performed more than 10 cm and may be as long as 25 cm in previous case series.10 In contrast, surgical myotomy can be performed only a maximum of 8 cm in the length. POEM also permits any myotomy length required and in any direction, without injury to surrounding structures. Therefore, POEM can be considered for surgically failed cases or previous POEM failure cases. These are very important and major advantages of POEM. In study of Bang et al.,8 the authors did not detect any evidences of complications in necropsy. However, previous human studies reported postoperative subcutaneous emphysema and pneumomediastinum on clinical grounds or computed tomography scan.9 Mild forms of pneumomediastinum or subcutaneous emphysema had no clinical consequences such as pneumomediastinum during thoracoscopic surgery. Other complications such as peritonitis, penumoperitoneum, and mucosal damage at the esophagogastric junction have been noted, too. However, most complications were ameliorated by conservative and medical treatment. Further long-term studies with a large number of patients from different centers are awaited. In Korea, few centers have performed POEM for achalasia patients since November 2011. The first Korean study of POEM in human will be published soon. However, further studies with a greater number of animals are still needed to evaluate other issues such as repeated sessions of myotomy, multiple myotomy at different sites, or training system using ex vivo or in vivo animal model.

The pancreatobiliary organ is composed of one of the most complicated structures and complex physiological functions among other digestive organs in our body. This is why endoscopic procedure in pancreaticobiliary system requires rather complicated techniques. In International Digestive Endoscopy Network (IDEN) 2012, many interesting pancreatobiliay endoscopy related topics were presented. Basic procedures like endoscopic papillary balloon dilation (EPBD), advanced techniques like endoscopic necrosectomy, prevention and management of post-ERCP pancreatitis, and spyglass system are reviewed in this highlight summary.

Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.