The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of gastrointestinal (GI) endoscopy. Evidence-based methods are used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a Manufacturer and User Facility Device Experience (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events (AEs) of a given technology. Both are supplemented by accessing the "related articles"feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and web-basedpublications, proprietarypub-lications, and informal communications with pertinent vendors. Technology status evaluation reports are drafted by 1 or2 members of the American Society for GastrointestinalEndoscopy Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through November 2023 for articles related to endoscopic closure of perforations, leaks, and fistulas by using additional relevant key words such as "intestinal fistula," "perforation," "over-the-scope clip," "endoscopic clips," "endoscopic suturing," and "endoscopic closure," among others. Technology status evaluation reports are scientific reviews provided solely for educational and informational purposes. Technology status evaluation reports on emerging technologies are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasia but remains technically demanding because of limited traction, lack of triangulation, and high operator workload, contributing to a steep learning curve. We evaluated a novel endoluminal robotic platform designed to provide surgical-like bimanual triangulation, stable traction/counter-traction, and improved ergonomics while preserving compatibility with standard gastroscopes. The robotic system (Intilume System, Agilis Robotics, Hong Kong, SAR) uses an external positioning cart to drive two 3.5-mm flexible robotic instruments mounted onto a native gastroscope via a cap-and-sheath interface and controlled by compact pen-style motion-tracking controllers enabling seated operation. Available instruments included a bipolar T-knife and a tissue grasper. In a randomized crossover ex vivo porcine stomach study, two gastroenterology fellows without prior ESD experience and two interventional endoscopy fellows with early experience each performed four ESDs (two robotic, two conventional), for a total of 16 procedures. Outcomes included en bloc resection, procedure time, specimen surface area, dissection speed, tissue injury, and operator workload assessed using NASA-TLX, with exploratory OSATS and GEARS evaluations. All procedures were completed (8 robotic, 8 conventional). Robotic ESD achieved 100

INTRODUCTION:Endoscopic submucosal dissection (ESD) is a promising technique for early-stage gastrointestinal neoplasms; however, its use for periappendiceal lesions poses challenges because of anatomical complexities and the potential risk of appendicitis or perforation. As a result, these lesions are often managed surgically. This systematic review and meta-analysis evaluate the safety and efficacy of ESD for periappendiceal lesions. METHODOLOGY:A systematic search across multiple databases was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies focused on adult populations undergoing ESD for periappendiceal lesions. The primary outcome was a technical success, and secondary outcomes included R0 resection, en-bloc resection, adverse events, and need for surgery. Data were reported using percentages with associated confidence intervals (CIs) and heterogeneity ( I ²). RESULTS:Six studies comprising 298 patients were included. Technical success was achieved in 98% (95% CI: 97-100%, I2  : 4.63%), with R0 resection and en-bloc resection rates of 84% (95% CI: 77-91%, I2  : 61.86%) and 92% (95% CI: 86-97%, I2  : 66.11%), respectively. The overall rates of polyp recurrence, appendicitis, and bleeding were 0.1% (95% CI: 0-2%, I2  : 0%), 3% (95% CI: 0-4%, I2  : 0%), and 1% (95% CI: 0-3%, I2  : 0%), respectively. Conversely, perforation exhibited a relatively high incidence of 11% (95% CI: 3-19%, I2  : 84.55%); however, the need for surgical intervention was 6% (95% CI: 1-10%, I2  : 74.12%). CONCLUSION:ESD provides a safe and effective alternative to surgical resection for managing periappendiceal lesions.

Objective:To evaluate the safety and feasibility of single-port endorobotic submucosal dissection (ERSD) using the Da Vinci SP platform for the management of rectal neoplasms.Background:Endoscopic submucosal dissection (ESD) offers a potential organ-sparing treatment for advanced colorectal neoplasms but demands high technical skill and a steep learning curve. Advances in semiflexible robotic platforms, such as the Da Vinci SP, promise to simplify this procedure, potentially offering improved outcomes for patients with benign rectal neoplasms.Methods:A retrospective analysis of 28 patients who underwent ERSD using the Da Vinci SP platform between 2020 and 2023 was performed. Patient demographics, lesion characteristics, procedure details, outcomes, and complications were reviewed. The primary endpoint was successful en-bloc resection.Results:The cohort had a median age of 60.5 years and a median BMI of 28.2 kg/m(2), predominantly male (67.8%) with ASA categories 2 or 3 (82%). Lesions had a median size of 38 mm and were located a median of 9 cm from the anal verge. The median procedure time was 87.5 minutes. En-bloc resection was achieved in all cases (100%), with no intraoperative complications or mortality. One patient experienced urinary retention, and 1 had late bleeding requiring blood transfusion. Pathology outcomes included 46.4% tubulovillous adenomas, 21.4% adenocarcinomas, and high-grade dysplasia in 53.6% of patients.Conclusions:Single-port ERSD using the Da Vinci SP platform is safe and feasible for the management of colorectal neoplasia, ensuring a high rate of en-bloc resection. It potentially offers advantages over conventional ESD, including shorter dissection times, although further studies are necessary for a definitive comparison.

BACKGROUND AND AIMS:Data on outcomes of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal (UGI) subepithelial lesions (SELs) in Western countries are limited. This study assesses the outcomes of STER for UGI SELs in U.S. CENTERS: METHODS:This retrospective analysis included UGI SELs referred for STER at 8 U.S. CENTERS:The study included lesions originating or inseparable from the muscularis propria (MP) layer, SELs with symptoms, potential malignancy on endoscopic ultrasonography (EUS), or inconclusive EUS fine-needle aspiration (EUS-FNA) but suspected gastrointestinal stromal tumor (GIST). RESULTS:A total of 47 patients with 51 SELs (median size, 25 mm) were included; 42 (82.3%) had prior sampling. Median procedure time was 89.8 minutes. Submucosal fibrosis (SF) was present in 19.6% of the lesions, all with prior sampling history. En bloc resection and retrieval were achieved in 94.1% of the lesions. Transmural resection (TMR) was needed in 21.6% of the lesions and was significantly associated with extraluminal extension (odds ratio [OR], 8.4), GIST histology (OR, 6.0), and SF (OR, 5.8). TMR was linked to a higher rate of R1 resection (OR, 4.1) and longer procedural time (>90 minutes, OR, 8.6), without an increased risk of adverse events (AEs). AEs occurred in 7 of 47 (14.8%) patients and were managed conservatively. No lesion recurred within a median follow-up of 17 months. CONCLUSIONS:STER is a safe and effective approach for selected UGI SELs. Extraluminal extension, GIST histology, and SF predict the need for TMR. R1 resection was more common with TMR with increased procedural time. Minimizing pre-resection sampling may reduce fibrosis and optimize outcomes.