Joon-Soo Hahm

International transmission of uncompressed endoscopic surgery images via superfast broadband Internet connections

BackgroundAlthough telecommunication is increasing in popularity, poor-quality images sent through a narrowband network limit its use in the medical field.MethodsKyushu University Hospital in Japan and four hospitals in Korea were linked via superfast broadband Internet connection. The digital video transfer system, which can transmit digital videos without loss of image quality, was used, and the bandwidth was 30 Mbps per line.ResultsOf the 16 teleconferences conducted, 6 demonstrated real-time endoscopic surgery. In addition to the surgical images, preoperative diagnostic images, images of the operating room, and images of the staff in the conference room were transmitted to facilitate discussion. The network remained stable, and the sound delay was restricted to less than 0.3 s. In the other 10 teleconferences, recorded video images were used for discussion.ConclusionsThe authors have established a high-quality, practical teleconference system that is economical and easy to use in clinical practice. This system shows promise for remote education beyond geographic borders.

Teleteaching endoscopy: the feasibility of real-time, uncompressed video transmission by using advanced-network technologies

BACKGROUNDnTeleteaching of endoscopy has been limited by the exorbitant cost and time inherent in high-quality digital endoscopy video transmission. The Digital Video Transport System (DVTS) transmitted over advanced networks, such as Internet2 and the Asia-Pacific Advanced Network (APAN), provides a unique infrastructure for sharing uncompressed digital videos of endoscopy. This may allow high-quality, real-time, international training of diagnostic and therapeutic endoscopy techniques at a low cost.nnnOBJECTIVEnTo test the proof of concept of long-distance teaching through live, interactive, high-resolution video transmission by using advanced networks and the DVTS. We used teleteaching of image-enhanced endoscopy techniques as a model.nnnDESIGNnProspective multicenter pilot study.nnnSETTING AND PARTICIPANTSnTrainees, faculty, and staff at 3 international endoscopy units.nnnINTERVENTIONnAn image-enhanced endoscopy video lecture with advanced-network technologies.nnnMAIN OUTCOME MEASUREMENTSnWe compared image-based prelecture and postlecture test scores and secondarily assessed technical feasibility and quality.nnnRESULTSnThe DVTS transmitted over advanced networks successfully transmitted uncompressed, high-resolution, digital lectures with endoscopic video (digital video format 720 x 480 pixels). Postsession scores improved. Participants highly rated the technical and informational quality. The majority reported a definite interest in participating in future sessions, with a mean rating (out of 5 [scale 1-5]) of 4.7 +/- 0.5.nnnLIMITATIONSnPilot study with a limited number of participants and sessions.nnnCONCLUSIONnThe DVTS transmitted over advanced networks such as Internet2 and APAN can provide the infrastructure for transmission of high-resolution, uncompressed video endoscopy for the purpose of teleteaching endoscopy.

Colonic lymphangiomatosis associated with protein-losing enteropathy.

Most lymphangiomas are considered to be lymph vessel anomalies. They can occur anywhere in the body and only rarely affect the intestinal tract. However, as endoscopic examination has become more widespread, gastrointestinal lymphangiomas have been reported more frequently. The overwhelming majority of lymphangiomas are solitary; only several cases of multiple lymphangiomas of the colon have been reported so far (1‐3). Here we report multiple colonic and abdominal lymphangiomas in a young Korean woman who presented with protein-losing enteropathy.

Percutaneous endoscopic gastrostomy using 10-cc syringe tubes for amyotrophic lateral sclerosis patients with limited mouth opening.

Percutaneous endoscopic gastrostomy (PEG) is the most common method of delivering long-term enteral feeding to patients who are unable to take adequate nutrition by mouth [1]. We sometimes encounter patients for whom it is difficult to install the mouthpiece because of limitations of their mouth opening, such as in patients with neuromuscular disorders. In such cases we had tried transnasal insertion of the PEG, nasogastric feeding, or laparoscopic gastrostomy tube placement [2–4]. However, transoral insertion of PEG has many advantages over the other procedures [2–5]. For that reason, we tested the feasibility of using a 10-cc syringe instead of a conventional mouthpiece during PEG in patients with limited mouth opening. A total of 12 cases (7 women, 5 men; mean age 63.5 years old) were enrolled from September 2010 to September 2011. All were patients with amyotrophic lateral sclerosis (ALS) and limited mouth opening. The 10-cc syringe was cut to a length of 4.5cm with a compass saw, and the cut surface (1.5cm wide) was smoothed with sandpaper (● Fig.1). PEG was performed using a standard upper endoscope (GF-260; Olympus, Tokyo, Japan) and gastrostomy set (PEG-24PULL-S; Cook Medical, Bloomington, Indiana, USA). The median procedure time was 10.66± 3.64 minutes. The endoscope and PEG tube easily passed through the mouthpiece of the 10-cc syringe without any resistance. Also, the syringe could be inserted into the side of the mouth in patients with difficulty biting in the middle of themouth (● Fig.2). There were no difficulties in handling the endoscope during the procedures. No damage to the endoscope or PEG tube was noted in any of the cases. Therewere no PEG procedure-relatFig.1 10-cc syringe tube compared with conventional mouthpiece.

The Value of Peracetic Acid (SCOTELIN®) for Endoscopic Disinfection

Background/Aims: Two percent glutaradehyde has been the reference disinfectant for high-level disinfection, but often requires long period of exposure up to 45 minutes. The aims of this study were to evaluate the effectiveness of a new endoscope disinfectant that uses 0.2% peracetic acid, and to compare the culture-positive rate in each different endoscopes and washers used. Methods: Three endoscopes and two washers that differed in purchase year were used. They were cleansed manually and disinfected with peracetic acid for 10 minutes. A total of 86 gastroduodenal endoscopic sessions were included in the study. Results: Overall culture-positive rate was 37.2%, majority of which came from washings of biopsy channel. There was a significant difference in culture-positive rate according to the machine used. Culture positive rate was 11.4% in recently purchased endoscope and washer used. Of the 28 Helicobactor pylori positive cases, there was one Helicobactor pylori DNA PCR positive case, but no Helicobactor pylori was found. Conclusions: When new endoscope and washer is used, peracetic acid is effective as a disinfectant. Significant difference in culture rate according to the different machine used might come from the aging effect and difference of cleansing power of the washer/

Prevalence and impact of upper gastrointestinal symptoms in Korean population-A population-based survey using ROME II criteria

Background & Aims: Various reports on the prevalence of gastroesophageal reflux disease (GERD) and functional dyspepsia have been conducted according to countries, survey methods and diagnosis criteria. However, detailed population-based data in Korea are lacking. The aim of this study was to determine the prevalence of upper gastrointestinal (GI) symptoms such as GERD and dyspeptic symptoms in Korea, as well as the impact of these symptoms on quality of life. Methods: The telephone survey, conducted by Galhip Korea, targeted a stratified probability random sample of the Republic of Korea. A reliable and valid questionnaire was asked about upper GI symptoms according to ROME II criteria, soeiodemographic association, physician visit and quality of life. In measuring quality of life, the Korean version o[ the EQ-SD, which underwent cross-cultural adaptation and validation, was used. Results: A total of 3,600 people were selected, and among them, 1,044 people responded to all questions. The response rate was 29%. 3.5% of the responders experienced heartburn more than twice a week, 3.4% once a week, 5.8% once a month, and 12.3% once in two momhs. And 2.6% of the responders experienced acid regurgitation more than twice a week, 1.9% once a week, 5.5% once a month, and 14.3% once in two months. A statistically significant difference was found in the quality of life according to the frequency of heartburn and acid regurgitation (p<0.001). As frequency of heartburn and acid regurgitation increased, quality of life significantly decreased. 12.2% of the respondents experienced abdominal discomfort and pain at least for three months during the past one year, and prevalence of functional dyspepsia based on the Rome II criteria was estimated 8.4% (95% confidence imerval, 6.710.1). Of the subjects presumed to have functional dyspepsia, dysmotility-like dyspepsia (56.8%) was the most common subtype, and 61.4% of subjects visit a clinic or hospital due to abdominal discomfort and pain. Quality of life did not show a significant difference between individuals presumed to have dyspepsia and individuals who do not manifest any symptom. Conclusions: This is the population-based survey on prevalence of upper GI symptoms such as GERD and dyspepsia in Korea. Upper GI symptoms are very prevalent in general Korean population. The most common subtype of functional dyspepsia was dysmotfiity-like type. As frequency of GERD symptoms increased, quality of life significantly decreased.

Relationship between bile acid and H. pylori in cholecystectomized patients

Purpose: Patients with gallstones may complain biliary colic or various kinds of dyspepsia, which may be relieved or persist after cholecystectomy. We tried to assess the prevalence of H. pylori and the incidence of bile reflux in cholecystectomized patients to identify the cause of dyspepsia associated with gallstones.

4652 The effectiveness of preoperative drainage for malignant biliary obstruction.

Background :Malignant biliary obstruction carries a very poor prognosis. Preoperative biliary drainage provides a better surgical condition, but some reports show various adverse effects of this procedure.We evaluated the effectiveness of preoperative drainage with the assessment of several factors which might influence clinical outcome. Methods :Forty-four patients with malignant biliary obstruction who underwent Whipples operation from January, 1996 to March, 1999 were analyzed. The patients were divided into 3 groups: no drainage, PTBD and ENBD groups.We analyzed patient chracteristics, laboratory findings, operating factors, hospital courses and complications. Statistical evaluation was performed using Kruskal-Wallis one-way ANOVA test and Mann-Whitney U-Wilcoxon Rank Sum W test by SPSS programe. Results :There were no differences of basic characteristics, initial or preoperative laboratory data, tumor size and invasiveness. Significant difference couldnt be found between complications, operating factors and hospital courses, however, the duration of jaundice in PTBD group were longer than in ENBD group. The drain itself was well functioning because there was no difference of preoperative bilirubin. To divide the patients according to initial bilirubin >or ≤9.0 mg/dl, there was also no difference of hospital courses and operating factors except day of jaundice, initial bilirubin and alkaine phosphatase expressed a biliary obstructive data. Conclusion :The preoperative biliary drainage in malignant biliary obstruction did not affect postoperative complications, operative difficulty and hospital courses. Careful patient selection could be recommended.