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Ravindran S, Thomas-Gibson S. Ring-fitted caps: A welcome addition to the endoscopist's tool belt? Gastrointest Endosc 2020; 91:121-123. [PMID: 31865986 DOI: 10.1016/j.gie.2019.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Srivathsan Ravindran
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
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Affiliation(s)
- Masafumi Kitamura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Hirotsugu Sakamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
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Hsieh YH, Leung FW. An overview of deep learning algorithms and water exchange in colonoscopy in improving adenoma detection. Expert Rev Gastroenterol Hepatol 2019; 13:1153-1160. [PMID: 31755802 DOI: 10.1080/17474124.2019.1694903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Among the Gastrointestinal (GI) Endoscopy Editorial Board top 10 topics in advances in endoscopy in 2018, water exchange colonoscopy and artificial intelligence were both considered important advances. Artificial intelligence holds the potential to increase and water exchange significantly increases adenoma detection.Areas covered: The authors searched MEDLINE (1998-2019) using the following medical subject terms: water-aided, water-assisted and water exchange colonoscopy, adenoma, artificial intelligence, deep learning, computer-assisted detection, and neural networks. Additional related studies were manually searched from the reference lists of publications. Only fully published journal articles in English were reviewed. The latest date of the search was Aug10, 2019. Artificial intelligence, machine learning, and deep learning contribute to the promise of real-time computer-aided detection diagnosis. By emphasizing near-complete suction of infused water during insertion, water exchange provides salvage cleaning and decreases cleaning-related multi-tasking distractions during withdrawal, increasing adenoma detection. The review will address how artificial intelligence and water exchange can complement each other in improving adenoma detection during colonoscopy.Expert opinion: In 5 years, research on artificial intelligence will likely achieve real-time application and evaluation of factors contributing to quality colonoscopy. Better understanding and more widespread use of water exchange will be possible.
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Affiliation(s)
- Yu-Hsi Hsieh
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA.,David Geffen School of Medicine, at University of California at Los Angeles, Los Angeles, CA, USA
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Cheng CL, Kuo YL, Hsieh YH, Tang JH, Leung FW. Water exchange colonoscopy decreased adenoma miss rates compared with literature data and local data with CO 2 insufflation: an observational study. BMC Gastroenterol 2019; 19:143. [PMID: 31412789 PMCID: PMC6694537 DOI: 10.1186/s12876-019-1065-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background Reports showed adenoma miss rates (AMRs) of 22.5–27% in the right colon and 23.4–33.3% in the proximal colon. Missed lesions could contribute to postcolonoscopy cancers. Water exchange (WE) with near-complete removal of infused water during insertion increased adenoma detection rate but the impact on AMR had not been reported. We hypothesized that WE could reduce AMRs. Study 1 compared the AMRs of WE with literature data. Study 2 developed local AMR data with CO2 insufflation. Methods The lead author attended a research seminar in 2017 on WE colonoscopy. For performance improvement, study 1 was undertaken. When data in study 1 confirmed WE produced a considerably lower AMRs in the right and proximal colon, study 2 with CO2 insufflation was performed. Results Eighty-six patients completed each study. In study 1, WE removed 89% of infused water upon arrival to the cecum. The AMRs of right colon (17.5%) and proximal colon (15.5%) were considerably lower than those in the literature. Upon completion of study 2, compared with local data of CO2 insufflation, WE showed a significantly lower AMR in the right (17.5% vs. 33.8%, P = 0.034) and proximal (15.5% vs. 30.4%, P = 0.018) colon, respectively. The major limitation was that the investigation consisted of two consecutive observational studies, not a randomized controlled trial (RCT). Conclusions WE with near-complete (89%) removal of infused water during insertion significantly decreased AMRs in the right and proximal colon compared with literature data and those of CO2 insufflation in our hands. The provocative data warrant confirmation in a RCT. Trial registration NCT03832322 (Retrospectively registered on February 2, 2019).
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Affiliation(s)
- Chi-Liang Cheng
- Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, 150 Huan-Zhong East Rd., Zhongli District, Taoyuan, 320, Taiwan.
| | - Yen-Lin Kuo
- Division of Gastroenterology, Department of Medicine, Evergreen General Hospital, 150 Huan-Zhong East Rd., Zhongli District, Taoyuan, 320, Taiwan
| | - Yu-Hsi Hsieh
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan
| | - Jui-Hsiang Tang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 252 Wuxing St, Xinyi District, Taipei, 100, Taiwan
| | - Felix W Leung
- Division of Gastroenterology, Department of Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, 16111 Plummer St, North Hills, CA, 91413, USA
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Toyoshima O, Yoshida S, Nishizawa T, Yamakawa T, Sakitani K, Hata K, Takahashi Y, Fujishiro M, Watanabe H, Koike K. CF290 for pancolonic chromoendoscopy improved sessile serrated polyp detection and procedure time: a propensity score-matching study. Endosc Int Open 2019; 7:E987-E993. [PMID: 31367679 PMCID: PMC6656549 DOI: 10.1055/a-0953-1909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The benefits of the new-generation CF290 (Olympus, Tokyo, Japan) for pancolonic chromoendoscopy (PCC) for colorectal polyp detection and its procedure time remain questionable. We compared the CF290 with the previous CF260 for PCC. Methods We performed a propensity score-matching study using baseline characteristics such as age, sex, indications, endoscopist, and bowel preparation. We compared the detection of adenomas and sessile serrated polyps (SSPs) and procedure times of two expert endoscopists who performed PCC using the CF290 series (high-quality system with flushing pump) and the CF260 series (high-definition system). Results We matched 374 patients who underwent PCC using the CF290 and 187 patients who underwent PCC using the CF260. The adenoma detection rate of the 290 series was higher than that of the 260 series, but not significantly. The SSP detection rate for the 290 series was higher than that for the 260 series ( P = 0.01). Insertion time required for the 290 series was shorter than that required for the 260 series ( P < 0.0001). Withdrawal time of the 290 series was shorter than that of the 260 series ( P < 0.0001). Conclusion Advanced technology can provide accuracy and help save time, and therefore, should be applied whenever possible.
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Affiliation(s)
- Osamu Toyoshima
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo-Setagaya 157-0066, Japan,Corresponding author Osamu Toyoshima, MD Director, GastroenterologyToyoshima Endoscopy Clinic6-17-5 Seijo, Setagaya-kuTokyo 157-0066Japan+81-3-5429-9511
| | - Shuntaro Yoshida
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo-Setagaya 157-0066, Japan,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo-Bunkyo, Japan
| | - Toshihiro Nishizawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo-Setagaya 157-0066, Japan,Gastroenterology, Tokyo Medical Center, Tokyo-Meguro, Japan
| | - Tadahiro Yamakawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo-Setagaya 157-0066, Japan
| | - Kosuke Sakitani
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo-Setagaya 157-0066, Japan,Gastroenterology, Sakitani Endoscopy Clinic, Chiba-Tsudanuma, Japan
| | - Keisuke Hata
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo-Setagaya 157-0066, Japan,Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo-Bunkyo, Japan
| | - Yoshiyuki Takahashi
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo-Setagaya 157-0066, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo-Bunkyo, Japan
| | | | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo-Bunkyo, Japan
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Gastrointestinal Endoscopy Editorial Board top 10 topics: advances in GI endoscopy in 2018. Gastrointest Endosc 2019; 90:35-43. [PMID: 30928425 DOI: 10.1016/j.gie.2019.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Abstract
The American Society for Gastrointestinal Endoscopy's Gastrointestinal Endoscopy Editorial Board reviewed original endoscopy-related articles published during 2018 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of adenoma detection, bariatric endoscopy, EMR/submucosal dissection/full-thickness resection, artificial intelligence, expandable metal stents for palliation of biliary obstruction, pancreatic therapy with lumen-apposing metal stents, endoscope reprocessing, Barrett's esophagus, interventional EUS, and GI bleeding. This document summarizes these "Top 10" endoscopic advances of 2018.
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Thomas-Gibson S, Matharoo M. Patient position change in colonoscopy: Dogmatic or pragmatic? Gastrointest Endosc 2019; 89:1202-1203. [PMID: 31104750 DOI: 10.1016/j.gie.2019.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/23/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Siwan Thomas-Gibson
- The Wolfson Unit for Endoscopy, St. Mark's Hospital, London, Untied Kingdom; Imperial College, London, Untied Kingdom
| | - Manmeet Matharoo
- The Wolfson Unit for Endoscopy, St. Mark's Hospital, London, Untied Kingdom
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Shi H, Chen SY, Huang H, Huang R, Jiang Y, Huang JY, Lin J. Impact of patient education on bowel preparation quality before water-aided colonoscopy. Shijie Huaren Xiaohua Zazhi 2019; 27:632-636. [DOI: 10.11569/wcjd.v27.i10.632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Water-aided colonoscopy may relieve patients' discomfort and increase adenoma detection rate, but this technique requires excellent bowel preparation. In order to ensure bowel preparation quality, split-dose polyethylene for colonoscopy preparation is implemented at our hospital, and educational interventions are given, including a short video and an instruction article released through our official public WeChat account.
AIM To evaluate the effectiveness of patient educational interventions on quality of bowel preparation among patients asked to follow split-dose bowel preparation before water-aided colonoscopy.
METHODS A total of 400 outpatients who were scheduled to receive water-aided colonoscopy were randomly divided into a control group and an observation group. Both groups received routine oral and written notifications to inform the bowel preparation method. The observation group also received educational interventions including a short video and an article released through our official public WeChat account. Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS) and categorized as either adequate vs inadequate (BBPS ≥ 7 vs BBPS < 7).
RESULTS More patients in the observation group achieved regimen completion and adequate bowel preparation than did patients in the control group. Patients who had previous colonoscopies and adopted single-dose bowel preparation method were more likely to follow newly implemented split-dose bowel preparation instructions after receiving educational interventions.
CONCLUSION Patient educational interventions may improve bowel preparation quality and patient compliance. Educational interventions emphasizing the benefits of split-dose bowel preparation in patients with a prior colonoscopy may help ensure compliance and discard the habitual use of day-before preparations.
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Affiliation(s)
- Hong Shi
- Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China,Department of Gastrointestinal Endoscopy, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Su-Yu Chen
- Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China,Department of Gastrointestinal Endoscopy, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - He Huang
- Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China,Department of Gastrointestinal Endoscopy, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Rui Huang
- Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China,Department of Gastrointestinal Endoscopy, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Yan Jiang
- Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China,Department of Gastrointestinal Endoscopy, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Jian-Yun Huang
- Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China,Department of Gastrointestinal Endoscopy, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Juan Lin
- Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China,Department of Gastrointestinal Endoscopy, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
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Siau K, Beintaris I. My approach to water-assisted colonoscopy. Frontline Gastroenterol 2019; 10:194-197. [PMID: 31205663 PMCID: PMC6540304 DOI: 10.1136/flgastro-2018-101143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 02/04/2023] Open
Abstract
The goal of diagnostic colonoscopy is to achieve procedural completion while maximising effectiveness, patient acceptance and safety. In recent years, international interest in water-assisted colonoscopy (WAC) has been steadily gathering pace. A plethora of high-quality randomised controlled trials and meta-analyses now offer incontrovertible evidence into the benefits of WAC, both for the endoscopist and the patient. Despite this, uptake of WAC within the UK has been limited, with the lack of educational resources representing a significant barrier. This practical step-by-step guide is aimed at both existing practitioners and trainees, with a view to promoting familiarity with WAC and potentially for incorporation into daily practice which may ultimately have a positive effect on quality of colonoscopy and patient experience.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Iosif Beintaris
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
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Leung FW, Jia H. Water infusion without near-complete removal during insertion by any other name is still water immersion. Gastrointest Endosc 2019; 89:599-601. [PMID: 30784500 DOI: 10.1016/j.gie.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/09/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Felix W Leung
- Division of Gastroenterology, Department of Medicine, Sepulveda Ambulatory Care Center, VAGLAHS and David Geffen School of Medicine at UCLA, North Hills and Los Angeles, California, USA
| | - Hui Jia
- Division of Gastroenterology, Department of Medicine, Sepulveda Ambulatory Care Center, VAGLAHS and David Geffen School of Medicine at UCLA, North Hills and Los Angeles, California, USA; Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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Ahmad A, Thomas-Gibson S. Optimum colonoscopy withdrawal: Is time everything? Gastrointest Endosc 2019; 89:531-532. [PMID: 30784499 DOI: 10.1016/j.gie.2018.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Ahmir Ahmad
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, United Kingdom
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Xu X, Ni D, Lu Y, Huang X. Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials. J Int Med Res 2019; 47:515-527. [PMID: 30632431 PMCID: PMC6381515 DOI: 10.1177/0300060518819626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.
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Affiliation(s)
- Xiufang Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dongqiong Ni
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuping Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuan Huang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Hsieh YH, Koo M, Tseng CW, Yang HW, Leung FW. Reduction of multitasking distractions underlies the higher adenoma detection rate of water exchange compared to air insufflation - blinded analysis of withdrawal phase videos. United European Gastroenterol J 2018; 7:230-238. [PMID: 31080608 DOI: 10.1177/2050640618817105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/09/2018] [Indexed: 01/15/2023] Open
Abstract
Background Experts have hypothesized that a reduction of multitasking distractions and improved bowel cleanliness can explain why insertion water exchange enhances adenoma detection rate. Objective The purpose of this study was to test the role of both distractions during withdrawal and bowel cleanliness in enhancing adenoma detection rate using coded video records of colonoscopy. Methods The withdrawal phase of videos of 299 consecutive colonoscopies from two randomized controlled trials comparing water exchange versus air insufflation at a regional hospital in Taiwan were coded. The primary outcome was distractions; activities that preclude full attention being paid to inspection of the mucosa for polyps. A single blinded reviewer collected the data. Results There were significant agreements in inter-rater reliability indexes. Compared to air insufflation, water exchange had significantly fewer distractions; higher diagnostic yield (intervention time and number), adenoma detection rate, and Boston Bowel Preparation Scale score. Water exchange had a higher withdrawal technique score (predominantly adequacy of cleaning). The association between increased adenoma detection rate and water exchange was mediated by the number of distractions and withdrawal time, but not the Boston Bowel Preparation Scale score. Conclusion The speculation by experts that a reduction of multitasking distractions underlies the significantly higher adenoma detection rate of water exchange is supported by the current study. Increased bowel cleanliness did not contribute to the increased adenoma detection rate by use of water exchange.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Chih-Wei Tseng
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Hsiu-Wen Yang
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, USA.,David Geffen School of Medicine at UCLA, Los Angeles, USA
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Leung FW, Jia H. Expert endorsement, a prerequisite to general acceptance, marked a significant milestone in the history of water exchange colonoscopy. Gastrointest Endosc 2018; 88:598-600. [PMID: 30217238 DOI: 10.1016/j.gie.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Felix W Leung
- Departments of Gastroenterology and Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, California, USA; David Geffen School of Medicine at UCLA, North Hills and Los Angeles, California, USA
| | - Hui Jia
- Departments of Gastroenterology and Medicine, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, California, USA; David Geffen School of Medicine at UCLA, North Hills and Los Angeles, California, USA; Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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