JIMT

Vol.2 No.2, November 30, 2024 Article TypeCase ReportEditorialOriginal ArticleReview Article

• Editorial 2024-11-30

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  Clinical usefulness of over-the-scope clip for peptic ulcer bleeding

  Gwang Ha Kim

  J Innov Med Technol 2024; 2(2): 29-31

  Abstract

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• Editorial 2024-11-30

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  Endoscopic transpapillary gallbladder stenting to prevent recurrent cholecystitis in deferred cholecystectomy

  Dong Woo Shin

  J Innov Med Technol 2024; 2(2): 32-34

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• Review Article 2024-11-30

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  Experience in the development of various devices for therapeutic endoscopy

  Do Hoon Kim

  J Innov Med Technol 2024; 2(2): 35-41

  Abstract

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  The remarkable advancements and innovations in the field of therapeutic endoscopy have made it possible to treat conditions that previously required surgical intervention, significantly improving the quality of life for patients. Therapeutic endoscopy is typically performed after mastering the techniques of diagnostic endoscopy. While novice practitioners initially focus on successfully completing procedures using existing devices, experienced clinicians often turn their attention to developing new tools to facilitate procedures or to explore novel treatment methods. Simulators are also developed to train beginners in these techniques. However, not all interest and ideas in this field lead to the development of new devices. It is often difficult for a clinician’s simple imagination to be realized, and even when a viable idea exists, finding a company capable of manufacturing the device can be challenging. Furthermore, collaboration between medical professionals and engineers frequently encounters obstacles due to differing perspectives on product development, making it difficult to reach a consensus. In this paper, we present our experience of successfully bringing a new device to market, despite the many challenges outlined above.

• Review Article 2024-11-30

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  Hemostatic powder for malignant gastrointestinal tumor bleeding

  Gwang Ha Kim

  J Innov Med Technol 2024; 2(2): 42-46

  Abstract

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  Malignant gastrointestinal (GI) bleeding poses a significant clinical challenge due to the friable nature of tumor surfaces and abnormal vasculature, leading to high rates of rebleeding and treatment failure. Conventional endoscopic hemostatic methods often prove insufficient in such cases, necessitating alternative strategies. Hemostatic powders, such as TC-325 (Hemospray), have emerged as a viable solution, providing immediate hemostasis by forming a physical barrier at the bleeding site and promoting coagulation. Many studies have demonstrated a high immediate hemostasis rate and reduced rebleeding incidence with hemostatic powders, even in patients where conventional therapies failed. Despite some limitations, such as residual powder interfering with further endoscopic procedures, these agents are generally safe and effective. Further research is needed to establish standardized guidelines and evaluate the long-term outcomes of hemostatic powders in malignant GI bleeding to solidify their role as a standard treatment option.

• Review Article 2024-11-30

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  Traction methods for endoscopic submucosal dissection

  Ji Hyun Kim , Sung Chul Park

  J Innov Med Technol 2024; 2(2): 47-52

  Abstract

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  Endoscopic submucosal dissection (ESD) is widely used to achieve en bloc resection of superficial neoplasms in the gastrointestinal tract. ESD is technically challenging because a “second hand” cannot be inserted to provide tissue tension and improve the visibility of the dissection plane. To overcome such difficulties and provide appropriate tension in the desired direction, various traction methods have been introduced, ranging from natural traction using gravity, buoyancy, and water pressure, to hood traction and device-assisted traction using special devices such as dental floss or clips inserted into the gastrointestinal tract. Using the traction method generally results in shorter ESD procedure time and a lower incidence of complications. Therefore, for difficult lesions, it may be helpful to utilize various traction techniques.

• Review Article 2024-11-30

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  Medical applications of endogenous fluorescence lifetime imaging

  Jeongmoo Han , Soonyong Kwon , Hongki Yoo

  J Innov Med Technol 2024; 2(2): 53-60

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  Fluorescence lifetime, the decay rate of fluorescence signals, varies among different biochemical fluorescent molecules. In biomedical imaging, endogenous fluorescent components emit autofluorescence with varying decay rates, and their fluorescence lifetimes can be utilized as biomarkers in a label-free manner. This review introduces the applications of biomedical imaging using the endogenous fluorescence lifetime imaging (FLIm) technique. As tumors exhibit distinct metabolic activities compared to normal tissues, numerous studies have been conducted to diagnose them using FLIm-based endoscopy and microscopy. Moreover, in atherosclerosis, various plaque components, such as inflammation, collagen, muscle cells, calcifications, and lipids, have been characterized with unique FLIm signatures. This review consolidates current research on medical applications of FLIm, emphasizing its advantages and potential future directions. The findings highlight the significant role that FLIm could play in enhancing diagnostic accuracy and improving patient outcomes in both oncology and vascular diseases, two of the most significant threats to human health.

• Original Article 2024-11-30

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  Rib segmentation in chest X-ray images with oblique projection data

  Jun-Ha Park , Young Jae Kim , Kwang Gi Kim

  J Innov Med Technol 2024; 2(2): 61-68

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  Background: Because computer-aided diagnoses can identify features that are not easily visible, their application in X-ray images of the chest is continuously increasing. However, most chest X-ray computer-aided diagnosis studies have been conducted using frontal projection,—such as posterior-anterior or anterior-posterior—radiographs, because other projections that might show otherwise obscured characteristic features are not widely accessible. Accordingly, we investigated the rib semantic segmentation in chest X-ray images projected frontally and obliquely.
  Materials and Methods: Chest X-rays were captured in frontal and oblique projections, and three UNet-based models were employed for efficient segmentation. Chest X-ray images may exhibit overlapping tissues, which can negatively affect the results. To overcome this issue, rib enhancement preprocessing was carried out, using a publicly available deep-learning rib suppression model.
  Results: The U2Net model was found to be the most effective model when working with oblique data, achieving a Dice coefficient of 0.89. Significantly outperforming the UNet and attention UNet, the U2Net P-values of 0.03, respectively.
  Conclusion: The difference in performance between oblique and frontal projections was hypothesized to be less pronounced than that between other projections. Despite employing a limited set of data with the frontal projection, we expected a significant performance improvement with the oblique projection. This hypothesis was confirmed, revealing a significant difference with P<0.05. Further research on different projections may serve as a foundation for offering more diversified information to radiologists and researchers.

• Case Report 2024-11-30

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  Arterio-nodo-gastric fistula as an uncommon cause of upper gastrointestinal bleeding

  Han Jo Jeon

  J Innov Med Technol 2024; 2(2): 69-71

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  Gastrointestinal bleeding is an emergency condition requiring immediate intervention. It is essential to localize the bleeding focus in the gastrointestinal tract using endoscopy. Lymph node metastasis in esophageal cancer is common, but it is rare to fistulize the stomach wall. While there are various hemostatic methods available, embolization through the fistula can be highly beneficial. In cases of failed endoscopic hemostasis or hemodynamic instability, embolization could be useful but entails a risk of rebleeding. Therefore, the emergence of new technologies for hemostasis is anticipated.

• Case Report 2024-11-30

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  Endoscopic closure with Padlock clip for iatrogenic duodenal perforation

  Jinwook Jang , Su Jin Kim

  J Innov Med Technol 2024; 2(2): 72-74

  Abstract

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  Although, the incidence of iatrogenic duodenal perforation is not high, it is associated with high morbidity and mortality in elderly patients. Primary surgical repair had been regarded as the treatment of choice for this situation. There have been some case reports in which endoscopic closure using through-the-scope clips with/without endo-loop for an iatrogenic duodenal perforation was successful in Korea. A novel endoscopic clip, Padlock clip has been introduced as the endoscopic closure system for the gastrointestinal perforation. We experienced the case of successful treatment of the iatrogenic duodenal perforation using a Padlock clip. The patient was recovered and discharged with supportive care.

• Case Report 2024-11-30

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  A case of delayed bleeding caused by a stent after endoscopic ultrasound-guided drainage of pancreatic fluid collection

  Jonghyun Lee

  J Innov Med Technol 2024; 2(2): 75-79

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  Pancreatic fluid collections (PFCs) occur in about 50% of acute pancreatitis cases and may necessitate intervention when complications arise. Endoscopic ultrasound (EUS)-guided drainage is a widely accepted treatment but carries risks such as bleeding. A 40-year-old female with alcohol-induced pancreatitis developed a large pancreatic cyst. She underwent EUS-guided drainage with a double pigtail plastic stent. Ten days after the procedure, she presented with gastrointestinal bleeding. Imaging revealed a hematoma near the stent, possibly caused by irritation from the stent. The patient was treated with endoscopic clip hemostasis and conservative management. The stent was removed without further complications. Delayed bleeding is a rare but significant complication of EUS-guided drainage for PFCs. This case emphasizes the need for careful stent placement, close monitoring, and prompt management of any complications that may arise following the procedure.