Gastrointestinal Endoscopy

BACKGROUND & AIMS: The symptoms of reflux in achalasia patients undergoing per-oral endoscopic myotomy (POEM) are believed to result from gastroesophageal reflux, and the current treatment primarily focuses on acid suppression. Nevertheless, other factors such as non-reflux acidification caused by fermentation or stasis might play a role. This study aims to identify patients with "true acid reflux" who actually require acid suppression and fundoplication. METHODS: In this prospective large cohort study, the primary objective was to assess the incidence and risk factors for "true acid reflux" in achalasia patients undergoing POEM...

No abstract text is available yet for this article.

BACKGROUND & AIMS: The management of dual anti-platelet therapy (DAPT) after percutaneous coronary intervention (PCI) and gastrointestinal bleeding (GIB) remains a clinical dilemma. We sought to identify predictors of a GIB and a rebleed and to determine whether a rebleed increases the risk of major adverse cardiovascular events (MACE). METHODS: In this single-center retrospective study, patients undergoing PCI were identified. The primary and secondary endpoints were a GIB at 180 days, and a rebleed or MACE at 365 days...

BACKGROUND AND AIMS: Bilioenteric anastomotic stricture (BES) is a well-known adverse event after bilioenterostomy. Recently, endoscopic ultrasound-guided antegrade intervention (EUS-AI) has been developed for cases that are difficult to treat by balloon enteroscopy-assisted ERCP. However, there have been no data on the long-term outcomes after EUS-AI. The main goal of the present study was to clarify the long-term outcomes of EUS-AI in such patients. METHODS AND PATIENTS: Between November 2013 and November 2021, 34 patients who were followed for more than 1 year after EUS-AI for BES were identified...

BACKGROUND AND AIMS: The current standard of practice is to use a duodenoscope for the evaluation of major duodenal papilla (MDP). Recently, cap-assisted endoscopy (CAE) which uses a transparent cap at the tip of a standard front-viewing endoscope emerged as an alternative. METHODS: A systematic literature search was performed at several databases from inception to January 2023 to identify studies evaluating the efficacy of CAE for the evaluation of MDP. RESULTS: A total of nine studies including 806 patients met our inclusion criteria...

BACKGROUND AND AIMS: Buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG) tubes. This study compared the newly developed Flamingo device with conventional endoscopic techniques for BBS treatment. METHODS: This prospective, randomized controlled trial compared the Flamingo set (study group) with other endoscopic techniques (control group) for BBS treatment in nine German hospitals. The primary endpoint was procedure time...

BACKGROUND AND AIMS: The efficacy and safety of AI-assisted novices performed colonoscopy remain unknown. Here, we aim to compare the lesion detection capability of novices, AI-assisted novices and experts. METHODS: This multi-center, randomized, non-inferiority, tandem study was conducted across three hospitals in China from May 1, 2022, to November 11, 2022. Eligible patients were randomized into one of three groups: CN group (control novice group, withdrawal performed by a novice independently), AN group (AI-assisted novice group, withdrawal performed by a novice with AI assistance), or CE group (control expert group, withdrawal performed by an expert independently)...

BACKGROUND AND AIMS: Endoscopic suturing is a complex skill with broad applications. This study aims to develop and validate a novel endoscopic suturing simulator and scoring system for the pursestring suture pattern. METHODS: This was a prospective study of an endoscopic suturing simulator, which consists of a circular opening representing a dilated gastrojejunal anastomosis of Roux-en-Y gastric bypass with 12 small target holes around its circumference. Pursestring suturing is performed in a counterclockwise fashion...

BACKGROUND AND AIMS: Mucosal closure adds time but reduces complications associated with endoscopic submucosal dissection (ESD). We aim to assess the closure time, technical success and cost effectiveness between a novel through-the-scope helix tack suture system (TTSS) and the over-the-scope suturing system (OTSS). METHODS: In this single center, prospective, randomized trial, all patients having ESD with anticipated closure were randomized 1:1 to TTSS (study group) or OTSS (control group...

BACKGROUND AND AIMS: Despite the significant morbidity associated with gastric variceal bleeding, there is a paucity of high-quality data regarding optimal management. Endoscopic ultrasound-guided coil therapy (EUS-COIL) has recently emerged as a promising endoscopic modality for the treatment of gastric varices (GV), particularly compared to traditional direct endoscopic glue injection. While data exists on the feasibility and safety of EUS-guided coil therapy in the management of GV, these have been limited to select centers with particular expertise...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND AND AIMS: Video analysis has emerged as a potential strategy for performance assessment and improvement. We aimed to develop a video-based skill assessment tool for per-oral endoscopic myotomy (POEM). METHODS: POEM was deconstructed into basic procedural components through video analysis by an expert panel. A modified Delphi approach and 2 validation exercises were conducted to refine the assessment tool (POEMAT). Twelve assessors used the final POEMAT version to grade 10 videos...

This document from the American Society for Gastrointestinal Endoscopy (ASGE) provides a full description of the methodology used in the review of the evidence used to inform the final guidance outlined in the accompanying Summary and Recommendations document regarding the role of endoscopic submucosal dissection (ESD) in the management of early esophageal and gastric cancers. This guideline used the Grading of Recommendations, Assessment, Development and Evaluation framework and specifically addresses the role of ESD versus EMR and/or surgery, where applicable, for the management of early esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), and gastric adenocarcinoma (GAC) and their corresponding precursor lesions...

BACKGROUND AND AIMS: Capsule endoscopy (CE) is useful in evaluating disease surveillance for primary small-bowel follicular lymphoma (FL), but some cases are difficult to evaluate objectively. This study evaluated the usefulness of a deep convolutional neural network (CNN) system using CE images for disease surveillance of primary small-bowel FL. METHODS: We enrolled 26 consecutive patients with primary small-bowel FL diagnosed between January 2011 and January 2021 who underwent CE before and after watch-and-wait or chemotherapy...

BACKGROUND AND AIMS: Complete closure following endoscopic resection (ER) of large non-pedunculated colorectal lesions (LNPCLs) can reduce delayed bleeding but is challenging with conventional through-the-scope (TTS) clips alone. The novel dual action tissue (DAT) has clip arms that open and close independent of each other, facilitating tissue approximation. We aimed to evaluate the rate of complete closure and delayed bleeding with the DAT clip after ER of LNPCLs. METHODS: Multicenter prospective cohort study of all patients who underwent defect closure with the DAT clip following endoscopic mucosal resection (EMR) or submucosal dissection (ESD) of LNPCLs ≥ 20 mm from July 2022 to May 2023...

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BACKGROUND AND AIMS: There are limited data about how to teach endosonographers needle-based confocal laser endomicroscopy (nCLE)-guided histologic diagnosis of pancreatic cystic lesions (PCLs). Hence, we developed and tested a structured educational program to train early-career endosonographers in nCLE-guided diagnosis of PCLs. METHODS: Twenty-one early-career nCLE-naive endosonographers watched a teaching module outlining nCLE criteria for diagnosing PCLs. Participants then reviewed 80 high-yield nCLE videos, recorded diagnoses, and received expert feedback (phase 1)...

BACKGROUND AND AIMS: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has a risk of serious procedural adverse events (AEs), but few dedicated devices for EUS-HGS are available. We evaluated the feasibility of a new partially covered self-expandable metal stent (PCSEMS) with an anchoring flange for EUS-HGS. METHODS: The feasibility of a stent featuring a proximal radiopaque uncovered portion 1.5 cm in length and a distal anchoring flange 20 mm in diameter was evaluated in consecutive patients undergoing EUS-HGS for unresectable malignant biliary obstruction...