Endoscopic therapy has become first-line treatment for Zenker’s diverticulum (ZD). However, evidence comparing rigid and flexible endoscopic approaches remains limited. We therefore retrospectively compared both techniques in a tertiary university hospital. All consecutive patients receiving treatment for ZD from January 2009 to December 2024 were included. Patients underwent either rigid endoscopic CO2 laser myotomy (R-group) or flexible endoscopic myotomy using a needle knife (F-group). The primary endpoint was clinical improvement after completion of all clinically indicated interventions. Secondary endpoints were clinical improvement after the index intervention, procedure time, hospital stay, recurrence, reintervention and adverse events. A total of 156 patients were included (F-group, n = 100; R-group, n = 56). Clinical improvement after completion of all clinically indicated interventions was achieved significantly more frequently in the F-group than in the R-group (89.0 vs. 65.6%; p = 0.0063). In contrast, clinical improvement after the index intervention did not differ significantly between groups (65.8 vs. 56.3%; p = 0.386), while reintervention was more frequent in the F-group (27.4 vs. 18.8%). Mean intervention time (31.7 ± 13.3 vs. 40.8 ± 16.2 min; p < 0.001) and postinterventional hospital stay (4.9 ± 2.3 vs. 7.4 ± 4.4 days, p < 0.0001) were shorter in the F-group. No significant differences in recurrence or complication rates between the two groups were detected. Flexible and rigid endoscopic therapy showed comparable safety. Flexible endoscopy was associated with shorter procedure time and hospital stay and higher clinical improvement after completion of all clinically indicated interventions, although this was not demonstrated after the index intervention and required more frequent reintervention.
Abstract Specimen retrieval after cold snare polypectomy (CSP) for small colorectal polyps can be difficult because resected specimens are often small and soft. We compare the efficacy of simple suction with cap-assisted water-infused suction for specimen retrieval after CSP. This prospective randomized controlled trial enrolled patients undergoing CSP for colorectal polyps ≤10 mm. Patients were randomly assigned to either simple suction (Group A) or cap-assisted water-infused suction (Group B) for specimen retrieval. The primary outcome was specimen retrieval time. Secondary outcomes included retrieval rates and procedure-related complications. A total of 141 patients with 387 colorectal polyps were analyzed. Group A and Group B included 198 and 189 polyps from 66 and 75 patients, respectively. The primary outcome, mean retrieval time, was significantly shorter in Group B than in Group A (17.2 ± 11.7 vs. 35.8 ± 66.4 s; patient-clustered p = 0.0028). Median retrieval times were 15 and 22 s in Groups B and A, respectively (median difference, Group B minus Group A, −7 s; patient-level cluster-bootstrap 95% CI: −11 to −5). Retrieval rates were high in both groups (100 vs. 99.5%, p = 0.488). Immediate bleeding occurred in 2.0% and 4.8% of cases in Groups A and B, respectively, whereas no delayed bleeding or perforation occurred in either group. Cap-assisted water-infused suction significantly reduced specimen retrieval time among successfully retrieved specimens after CSP for small colorectal polyps. Effects on specimen integrity and histologic quality require further evaluation.
Abstract In Western countries without screening programs, Helicobacter pylori infection, gastric atrophy, and intestinal metaplasia must be detected opportunistically during endoscopy, yet real-world data on how reliably this occurs are scarce. We determined their histologic prevalence among biopsied diagnostic gastroscopies and how completely they are recorded in routine endoscopy reports. Retrospective single-center cross-sectional study of all diagnostic gastroscopies with gastric biopsies at a tertiary university hospital (2016–2025). Documentation of each lesion was compared with institutional histopathology reports. As only biopsied examinations were eligible, concordance measures reporting completeness. Prevalence was analyzed at patient level (n = 9,852) and concordance at examination level (n = 11,381). H. pylori infection or any gastric precancerous condition was present in 31.4% of patients (H. pylori 11.5%, atrophy 6.6%, intestinal metaplasia 21.5%). A corresponding finding was recorded in the endoscopy report in 9.6% (95% CI 8.0–11.4) of H. pylori-positive, 9.2% (8.1–10.3) of metaplasia-positive and 49.4% (45.8–52.9) of atrophy-positive examinations. Counting rapid urease tests, which indicate H. pylori testing but not written mucosal suspicion, increased documentation to 46.0%. Results were similar with antrum-and-corpus sampling (90.7%; ≤0.7 percentage points). The publication of MAPS-II or newer endoscopy generations did not increase documentation substantially. H. pylori infection and gastric precancerous conditions affected nearly one-third of biopsied patients, yet most histologically confirmed findings were not explicitly documented at endoscopy. Closing this documentation gap should be a priority for integrating gastric cancer risk assessment into routine endoscopic reporting.
Abstract Accurate evaluation of complex benign esophageal stenosis is essential for successful endoscopic dilation, yet conventional methods are either subjective or involve radiation exposure. This study investigated whether impedance planimetry (EndoFLIP) optimizes stricture geometry assessment compared with conventional nonradiographic methods and whether it improves patient outcomes. Totally 22 adult patients with symptomatic benign esophageal strictures were allocated to either a planimetry group or a control group. In the planimetry group, FLIP measurements were obtained before and after dilation in addition to standard endoscopic evaluation, whereas the control group underwent conventional assessment alone. Symptoms and quality of life were evaluated using the SWAL-QOL questionnaire pre- and 14 days postprocedure. EndoFLIP measurements revealed significant increases in diameter, cross-sectional area, and distensibility following dilation. Compared with FLIP, stricture length was underestimated endoscopically by an average of 14.4 mm and post-therapeutic diameter was overestimated by 1.2 mm based on the final dilator size. G-SWAL-QOL total scores improved in both groups, whereas symptom scores and tolerance of solid food improved significantly in the planimetry group only. The use of impedance planimetry enabled a standardized and radiation-free assessment of complex benign esophageal stenosis and may contribute to optimizing the treatment of complex benign strictures of the upper gastrointestinal tract.
