Saowanee Ngamruengphong

• Doctor of Medicine
• Medical Doctor at Johns Hopkins University

Background and Aims We sought to develop a minimally-invasive, robust, accessible nonendoscopic strategy to diagnose Barrett’s esophagus (BE), esophageal adenocarcinoma (EAC), and its immediate precursor lesion, high-grade dysplasia (HGD) based on methylated DNA biomarkers applied to a retrievable sponge-capsule device in a cohort representative of...

Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1–1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco a...

This article from the American Society for Gastrointestinal Endoscopy (ASGE) provides a full description of the methodology used to inform the final guidance outlined in the accompanying summary and recommendations article for strategies to manage endoscopically placed gastrostomy tubes. This article was developed using the Grading of Recommendatio...

Objectives There have been significant advances in the management of large (≥20 mm) laterally spreading tumors (LSTs) or nonpedunculated colorectal polyps; however, there is a lack of clear consensus on the management of these lesions with significant geographic variability especially between Eastern and Western paradigms. We aimed to provide an in...

A major challenge in applying deep learning to medical imaging is the paucity of annotated data. This study explores the use of synthetic images for data augmentation to address the challenge of limited annotated data in colonoscopy lesion classification. We demonstrate that synthetic colonoscopy images generated by Generative Adversarial Network (...

Background and Aims Endoscopic papillectomy (EP) is a minimally invasive therapy for management of ampullary adenomas (AA). We conducted this multi‐center, study to assess the incidence of and factors related to recurrence of AA after EP in patients with Familial Adenomatous Polyposis (FAP) compared to sporadic AA. Methods We included patients who...

Periampullary diverticulum presenting with severe complications, such as perforations, is associated with high morbidity and mortality. Traditionally, only surgical or conservative management has been warranted. In this case, we present a 76-year-old woman with a spontaneously perforated periampullary diverticulum, located within a larger duodenal...

Background: There is limited data on the feasibility of ESD for superficial esophageal neoplasia[SEN] located at or adjacent to esophageal varices [EV]. We aimed to evaluate the outcomes of ESD in these patients. Methods: This multicenter, retrospective study included cirrhotic patients with history of EV with SEN, located at or adjacent to EV a...

Background Delayed bleeding is among the most common adverse events associated with endoscopic mucosal resection (EMR) of nonampullary duodenal polyps. We evaluated the rate of delayed bleeding and complete defect closure using a novel through-the-scope (TTS) suturing system for the closure of duodenal EMR defects. Methods We reviewed the electroni...

Background and aims: Large colon polyps removed by endoscopic mucosal resection (EMR) can be complicated by delayed bleeding. Prophylactic defect clip closure can reduce post-EMR bleeding. Larger defects can be challenging to close using through-the-scope clips (TTSCs) and proximal defects are difficult to reach using over-the-scope techniques. A...

Background: The incidence, severity, and mortality of post-ERCP pancreatitis (PEP) largely remain unknown with changing trends in ERCP utilization, indication and techniques. Aim: To determine the incidence, severity, and mortality of PEP in consecutive and high-risk patients based on a systemic review and meta-analysis of the patients in the pl...

Backgrounds and aims: Recent Western studies support the safety and efficacy of endoscopic submucosal dissection (ESD) for lesions throughout the GI tract. While admission for observation after ESD is standard in Asia, a more selective approach may optimize resource utilization. We aim to evaluate the safety and feasibility of same-day discharge (...

Gastric endoscopic submucosal dissection (ESD) is established for management of early gastric cancer (EGC). Diagnosis of EGC relies on adequate endoscopic assessment involving lesion size, histopathology, presence of ulceration, and depth of invasion. Absolute indications for endoscopic resection of EGC are if patients are presumed to have a less t...

Inactivation of the tumor suppressor genes tumor protein p53 ( TP53 ) and cyclin-dependent kinase inhibitor 2A ( CDKN2A ) occurs early during gastroesophageal junction (GEJ) tumorigenesis. However, because of a paucity of GEJ-specific disease models, cancer-promoting consequences of TP53 and CDKN2A inactivation at the GEJ have not been characterize...

Background: Complete closure of large mucosal defects following colorectal ESD with through-the-scope clips (TTSC) is oftentimes not possible. We aimed to report an early experience of using a novel through-the-scope suturing system (TTSS) for closing large mucosal defects after colorectal ESD. Methods: We performed a retrospective, multi-center...

Background and Aims Endoscopic submucosal dissection (ESD) is an important treatment for gastric neoplasia. Some gastric adenomas with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) on endoscopic forceps biopsy (EFB) are diagnosed as gastric adenocarcinoma (GAC) after ESD. We aimed to identify factors associated with histological diagnosi...

Inactivation of the tumor suppressor genes TP53 and CDKN2A occurs early during gastroesophageal junction (GEJ) tumorigenesis. However, due to a paucity of GEJ-specific disease models, cancer-promoting consequences of TP53 and CDKN2A inactivation at the GEJ have been incompletely characterized. Here we report the development of the first wild-type p...

A major challenge in applying deep learning to medical imaging is the paucity of annotated data. This study demonstrates that synthetic colonoscopy images generated by Generative Adversarial Network (GAN) inversion can be used as training data to improve the lesion classification performance of deep learning models. This approach inverts pairs of i...

Purpose: Little is known about the outcomes of endoscopic resection (ER) for patients with colorectal adenomas (CRAs) with high-grade dysplasia (HGD) or intramucosal cancer (IMCA). This study aimed to estimate the rate of local/malignant recurrence, identify the predictive factors for local recurrence (LR) and evaluate the treatment outcomes of rec...

Background and aims Conventional endoscopic submucosal dissection (C-ESD) is a technically demanding procedure with prolonged procedure times and higher risk of adverse events. To overcome the procedural difficulty of ESD, several traction-assisted techniques (T-ESD) have been developed to improve visualization of the submucosa in hopes to facilita...

Simple Summary Rectal cancer accounts for one-third of colorectal cancer cases annually. It is preventable with early screening and appropriate management of precancerous lesions. Advancements in diagnostic and therapeutic strategies are ongoing and have contributed to improving patient outcomes. In this review, we summarize the available minimally...

BACKGROUND AND AIMS Endoscopic ablation can eradicate neoplastic Barrett's esophagus (BE) without visible lesions. Cryoballoon ablation (CBA) is an established but relatively newer ablative technique that can eliminate BE but data on the durability of its treatment effects are lacking. We assessed the durability of CBA treatment for neoplastic BE....

Background and Aims There are limited data on the role of endoscopic submucosal dissection (ESD) as a potential diagnostic/staging tool in Barrett’s esophagus (BE) neoplasia. We aimed to evaluate the frequency and factors associated with change of histologic diagnosis by ESD compared with pre-ESD histology. Methods Multicenter prospective cohort s...

Background and study aims Transoral incisionless fundoplication (TIF) is a safe and effective minimally invasive endoscopic technique for treating gastroesophageal reflux disease (GERD). The learning curve for this technique has not been reported. We studied the learning curve for TIF when performed by a gastroenterologist by identifying the thresh...

Background Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngeal dysphagia. Symptomatic patients are managed with endoscopic dilation or surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to CPBs. This study evaluated technical success, clinical success, a...

Background and Aims Zenker’s diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions. Methods We review the rationale and key technique for various endoscopic treatment m...

Background The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia. Methods We included patien...

Video 1Rubber band-assisted closure of a mucosal defect after duodenal EMR.

Background: Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngealdysphagia resulting fromfibrous replacement of the cricopharyngeal muscle(CPM) due to acid reflux or mechanical injury. Dysphagia due to CPBs mimicsmanifestations of Zenker’s diverticula (ZD). While no medical therapy is required inasymptomatic patients, symptomatic patie...

Barrett’s esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Recently, long noncoding RNAs (lncRNAs) have been identified as key regulators of biological pathways. However, involvement of lncRNAs in the development of BE and EAC has not been well-studied. The aims of the current study were: (1) to study involvement of the lncRNA, miR...

Purpose Weight regain after balloon retrieval is a concern with all intra-gastric balloons (IGBs). The aim of this study was to evaluate the efficacy of liraglutide, a glucagon-like peptide-1 (GLP-1) agonist, to prevent weight regain following IGB retrieval. Materials and Methods This was a case-matched study of patients undergoing Spatz3 adjustab...

A dilated gastrojejunal anastomosis (GJA) diameter is an independent predictor of weight regain following Roux-en-Y gastric bypass (RYGB). Despite this, there is no standardized method for GJA diameter measurement. We performed a retrospective analysis to compare endoscopic visual estimation and endoluminal functional impedance planimetry (EndoFLIP...

Background and Aims Endoscopic submucosal dissection (ESD) in Asia has been shown to be superior to endoscopic mucosal resection (EMR) and surgery for the management of selected early gastrointestinal cancers. We aimed to evaluate technical outcomes of ESD in North America. Methods Multicenter prospective study on ESD across 10 centers in the Unit...

Gastroparesis is a neuromuscular disease of the gastrointestinal tract that presents with a significant alteration in the normal function of the stomach. The condition presents with symptoms of early satiety, bloating, nausea, vomiting and abdominal pain, which are known to affect patient’s nutritional status and quality of life. Understanding of t...

While data-driven approaches excel at many image analysis tasks, the performance of these approaches is often limited by a shortage of annotated data available for training. Recent work in semi-supervised learning has shown that meaningful representations of images can be obtained from training with large quantities of unlabeled data, and that thes...

Background and aims: Endoscopic therapy (ET) have been used to treat nonampullary duodenal neuroendocrine tumors (NAD-NETs) that is ≤10 mm in size, but data on long-term outcomes are limited. In addition, management of 11to 19 mm NAD-NETs is not well defined because of variable estimates of risk of metastasis. We aimed to determine the prevalence...

Background and aims: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly being used as an alternative to surgery and enteral stenting to manage gastric outlet obstruction (GOO). However, no data are available on the learning curve (LC) for EUS-GE. Defining it is necessary for the creation of adequate subspecialty training progr...