Endoscopic submucosal dissection (ESD) offers a curative, organ-preserving approach for early-stage gastrointestinal tumors, yet its global adoption remains inconsistent. This review examined the multifaceted challenges hindering wider use of ESD, including the steep technical learning curve, variability in training access, procedural time demands, and risk of complications. We explored recent innovations aimed at improving procedural outcomes and reducing operator dependency, such as enhanced dissection tools, traction techniques, and digital training platforms. In addition, emerging technologies, such as artificial intelligence, robotics, and image-guided systems, are reshaping the procedural landscape and may help streamline both decision-making and execution. Looking forward, addressing the current limitations of ESD will require technical refinement as well as broader investment in training infrastructure and system-level support. This article outlined key areas for development and provided a forward-looking perspective on how ESD may evolve into a more accessible and standardized therapeutic modality.

The role of solid-food diets in managing Crohn disease (CD) is gaining increasing attention in the scientific research community, while current evidence is limited and consists of highly heterogenous methodologies. In this scoping review we aimed to provide a comprehensive analysis of the most important methodological aspects of the available studies on whole-food dietary interventions in adults with CD. Second, this review focuses on describing the nutritional content of the implemented interventions and commenting on their nutritional adequacy. PubMed, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases were searched from inception up to July 2025, to identify all interventional studies in adult patients with CD that examined the effects of solid dietary interventions on various disease outcomes. Studies that targeted adult patients in remission or active CD and involving a well-defined solid diet interventional arm were rigorously considered. In total, 23 studies were eligible for inclusion, including 15 randomized controlled trials (RCTs), 2 pilot RCTs, 5 prospective interventional studies, and a non-randomized clinical trial. Study participants were in active CD (n = 11), in remission (n = 6), or assorted (n = 6) and were followed up for up to 2 years. Nutritional status and adequacy were among the assessed outcomes in 13 out of 23 studies, while adherence to the dietary regimen was described in nearly all of the included studies. The actual nutritional intake of the participants and its adequacy were rarely evaluated. Several methodological challenges in solid-food dietary trials targeting adult CD patients were identified, including study design variability, participant characteristics, criteria for concomitant drug therapies, provided details for the content and adequacy of the dietary regimens, and examined outcomes. This review underscores the methodological challenges and inconsistencies in solid-food dietary intervention studies for adults with Crohn disease, emphasizing that adopting standardized methodologies and outcome measures could strengthen future evidence and clarify the role of diet in multimodal disease management.

Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about potential aspiration risk during upper gastrointestinal (GI) endoscopy. We conducted a systematic review and meta-analysis to evaluate the effect of GLP-1 RA therapy on procedural outcomes in patients undergoing upper GI endoscopy. Methods We searched Medline and Cochrane library up to July 2025 without restrictions. Eligible studies evaluated patients undergoing upper GI endoscopy, comparing those taking GLP-1 RAs with those who were not. Outcomes of interest were the incidence of retained gastric contents (RGC), bronchopulmonary aspiration, and procedure discontinuation. Pooled estimates are expressed as odds ratios (ORs) with 95% confidence intervals (CIs), using a random-effects metaanalysis with inverse variance weighting. Results Twenty-four observational studies, predominantly retrospective, met the inclusion criteria: these comprised 184,707 participants, of whom 59,095 were taking GLP-1 RAs. Mean age was 58.7 years, 48.8% were women, and 51.2% had type 2 diabetes. Use of GLP-1 RAs was associated with higher rates of RGC (OR 4.82, 95%CI 3.66-6.35) and procedure discontinuation (OR 3.93, 95%CI 2.42-6.39) compared with control treatment. In contrast, the incidence of aspiration events was similar between groups (OR 1.1, 95%CI 0.84-1.48). Results remained consistent in a sensitivity analysis based on propensity score matching to control for confounders. Conclusions GLP-1 RA therapy is associated with a greater incidence of RGC and higher rates of endoscopy termination, but not with a higher risk of aspiration. Adjusting the fasting duration, rather than routinely discontinuing GLP-1 RAs, may represent a reasonable management approach.

Liver cancer, and in particular hepatocellular carcinoma (HCC) is a disease of rising prevalence and incidence. To date, definitive treatment options include either surgical excision or ablation of the affected area. With increasing research on several pathways that could be involved in the progression of HCC, new elements within these pathways emerge as potential targets for novel therapies. The WNT/β-catenin pathway favors the presence of M2 tumor-associated macrophages which in turn promote tumor growth and metastasis. The inhibition of this pathway is considered a good candidate for such targeted therapeutic interventions. Interestingly, as Huang et al show in their recently published article, Calculus bovis which is used in traditional Chinese medicine can exert an inhibitory effect on the β-catenin pathway and become a potential candidate for targeted pharmacotherapy against liver cancer.

Endoscopic bariatrics has emerged as a minimally invasive alternative to traditional bariatric procedures. Over the last decade, significant progress in endoscopic techniques and technologies has improved the safety, efficacy, and accessibility of these procedures. Current methods, such as intragastric balloons, endoscopic sleeve gastroplasty, and endoscopic-assisted gastrojejunostomy, have promoted weight loss, improving the metabolic health of obese individuals, with emerging evidence suggesting that their combination with pharmacological agents could further maximize their benefit. Emerging technologies, such as robotic-assisted endoscopic devices, advanced imaging systems, and biodegradable implants, could enhance procedural precision, minimize complications, and provide more personalized treatment options. In contrast, novel approaches such as microbiome modulation and tissue regeneration could have an adjunct role in improving patient outcomes. This review provides a brief overview of the current status of endoscopic bariatrics, highlighting the most common procedures and emerging technologies. It also discusses the challenges and future directions for the field, emphasizing the importance of multidisciplinary collaboration, patient selection, and research priorities to establish the long-term benefit and effectiveness of the available endoscopic bariatric interventions.

BACKGROUND & AIMS:Dietary therapies for the management of Crohn's Disease (CD) have recently attracted increasing attention. This is the first thoroughly discussed case documenting the use of the Crohn's Disease Exclusion Diet (CDED) specifically in a patient with perianal CD. We report on clinical and anthropometric outcomes and self-reported Quality of life (QoL) after CDED plus Partial Enteral Nutrition (PEN) administration in an adult with active perianal CD. METHODS:"J" is a 31-year-old man with a history of surgically treated ileocolonic penetrating CD diagnosed at age 20 (A2L3B3p), treated with intensified Infliximab (IFX) dose for three years. The patient experienced relapses with increased bowel movements and fistula discharge in all de-escalation efforts across these years. The multi-phase CDED coupled with PEN was initiated as an adjunctive therapy. RESULTS:After 12 weeks of dietary therapy, the patient reached the lowest biochemical markers of inflammation within the three years of intensified IFX therapy. Remarkably, his fistula drainage all but disappeared. At confirmation of endoscopic improvement, the patient's stable clinical and biochemical situation triggered a de-escalation of IFX dose interval from 4 to 6 and finally to 8 weeks and the seton removal. Two years after the initiation of the CDED protocol, the patient has not experienced any clinical flare up requiring hospitalization or addition of any further drug therapy, is clinically stable and consistently follows the CDED maintenance phase diet. CONCLUSION:This report highlights initial evidence supporting CDED as a potential complementary option in managing perianal CD.

We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology. In this article, the authors reported a novel technique for re-establishing luminal continuity in a completely occluded colorectal anastomosis involving two endoscopes, one for radial electrical incision and the other serving as a guide light. However, this technique can be applied only in selected cases. Given the absence of a standardized guideline-based algorithm for the management of complete anastomotic obstruction, by reviewing the available literature, we provide a brief overview of relevant endoscopic techniques while underlining their importance in the management of this postoperative complication to provide clinicians with the necessary knowledge to improve their daily practice.

Abstract Background Despite emerging evidence indicating the critical importance of diet interventions for induction and maintenance of remission of inflammatory bowel disease (IBD), we still lack consistent guidelines for diet recommendations and nutrition therapy. The aim of this in-depth scoping review was to identify evidence-based dietary guidance and clinical guidelines produced by national and international organisations on IBD and summarize their content for diet interventions to induce and maintain remission. Methods An extensive literature search was undertaken on PubMed (January ‘14 to November ‘24), including MeSH terms (“Inflammatory Bowel Disease” OR IBD OR Crohn’s OR Colitis) AND (diet OR diet* OR food OR nutrition OR nutr*) AND (guideline OR consensus OR “expert review” OR “topical review”). Eligible articles included evidence-based dietary guidance and clinical guidelines for adults living with IBD, produced by national and international organisations. Paediatric guidelines and articles not in English were excluded. Results 417 records were identified. After full-text review 10 papers fulfilled eligibility criteria. The eligible evidence-based dietary guidance and clinical guidelines were manuscripts produced by the European Crohn’s Colitis Organisation, International Organization For the Study of Inflammatory Bowel Disease, American Gastroenterological Association, European Society for Clinical Nutrition and Metabolism. Australasian society for parenteral and enteral nutrition, British Society of Gastroenterology, British Dietetic Association and the Dietitian Crohn’s Colitis Australian Network. Thirty different interventions were identified within different guidelines, proposed to induce and/or maintain remission for Crohn’s disease (CD) and/or ulcerative colitis. Exclusive enteral nutrition was recommended for induction of remission in CD by 9 out of 10 guideline articles. Similarly, CDED coupled with Partial Enteral Nutrition (PEN) was recommended for induction of remission in CD by 3 out of 10 guideline articles. Partial enteral nutrition was recommended for maintenance of remission in CD by 3 out of 10 guideline articles. Lastly, probiotic supplementation was recommended for induction of remission in UC by 2 out of 10 guideline articles. The remaining interventions were either recommended within a single guideline or there were inconsistent recommendations for their use between organisations. Conclusion The findings of this scoping review provide an overview of dietary guidelines by national and international professional organizations and can support collaboration between organizations worldwide thus reducing duplication of effort, facilitating reproducibility, and identifying guidance discrepancies.

Symptoms related to difficulty in swallowing and bolus transfer from the oral towards the gastric cavity have been collectively termed “dysphagia”. The etiology, gravity and complications of dysphagia warrant a rigorous, often multidisciplinary diagnostic evaluation and individualized management. The present study aimed to evaluate the prevalence of dysphagia among patients with rheumatic and musculoskeletal diseases (RMDs) and identify associated risk factors. This cross-sectional study included 340 consecutive patients diagnosed with RMDs from the Department of Rheumatology and Clinical Immunology situated at the Larissa University General Hospital. Dysphagia was assessed using the Eating Assessment Tool-10 (EAT-10). Univariate and multivariate analyses were performed to explore the associations between dysphagia, specific rheumatic diagnoses, and other contributing clinical and demographic factors. Based on the EAT-10, dysphagia was identified in 35% of the patients, with the most commonly reported issues being difficulty in swallowing solid foods and the sensation of food sticking in the throat. Patients with systemic sclerosis, primary Sjögren’s syndrome, and rheumatoid arthritis were significantly more likely to develop swallowing difficulties. Furthermore, low serum albumin levels, increasing age, and the presence of gastroesophageal reflux were identified as independent predictors of dysphagia. Both overweight/obesity and a diagnosis of axial spondyloarthritis were negatively associated with dysphagia. Age and years since diagnosis were positively correlated with an EAT-10 score ≥ 3, while body mass index and body fat percentage showed negative correlations. Swallowing dysfunction is prevalent among patients with RMDs, particularly in those with specific rheumatic diagnoses. Given its impact on nutritional status and overall quality of life, routine dysphagia screening in clinical settings is essential for the timely identification and management of the condition.

Gastric cancer remains the fourth leading cause of cancer-related mortality worldwide. Advanced disease is associated with a poor prognosis, emphasizing the critical importance of early diagnosis through endoscopy. In addition to prognosis, disease extent also plays a pivotal role in guiding management strategies. Therefore, accurate locoregional staging (T and N staging) is vital for optimal prognostic and therapeutic planning. Endoscopic ultrasound (EUS) has long been an essential tool in this regard, with computed tomography (CT) and, more recently, positron emission tomography–computed tomography (PET–CT) serving as alternative imaging modalities. EUS is particularly valuable in the assessment of early gastric cancer, defined as tumor invasion confined to the mucosa or submucosa. These tumors are increasingly managed by endoscopic resection techniques offering improved post-treatment quality of life. EUS has also recently been utilized in the restaging process after neoadjuvant chemotherapy, aiding in the evaluation of tumor resectability and prognosis. Its performance may be further enhanced through the application of emerging techniques such as contrast-enhanced endosonography, EUS elastography, and artificial intelligence systems. In advanced, unresectable disease, complications such as gastric outlet obstruction (GOO) severely impact patient quality of life. In this setting, EUS-guided gastroenterostomy (EUS-GE) offers a less invasive alternative to surgical gastrojejunostomy. This review summarizes and critically analyzes the role of EUS in the context of gastric cancer, highlighting its applications across different stages of the disease and evaluating its performance relative to other diagnostic modalities.

Gastroparesis, a chronic condition with complex etiopathogenesis, is associated with considerable symptom burden and significant morbidity. Dietary modifications and pharmacotherapy exhibit limited long-term efficacy, while surgical interventions are characterized by higher morbidity and variable efficacy. Endoscopic procedures, because of their less invasive nature, have been the focus of past and ongoing research. The majority of endoscopic treatment modalities target the pylorus: e.g., gastric peroral endoscopic pyloromyotomy, botulinum toxin injection, pyloric balloon dilatation, and transpyloric stent placement. Endoscopic feeding tube placement, endoscopic gastric electrical stimulation, and endoscopic ultrasound-guided gastroenterostomy have also been used to treat gastroparesis; however, these procedures are less well-studied. This critical review provides a detailed overview of the available endoscopic procedures for the management of gastroparesis, with emphasis on their pros and cons, quality of data and overall efficacy.

Administration of sedation by non-anesthesiologists during gastrointestinal endoscopy remains highly controversial in Greece. The aim of this set of 16 position statements prepared by experts in the field on behalf of the Hellenic Society of Gastroenterology is to aid gastroenterologists in their everyday clinical practice and provide evidence for the best use of drugs for the sedation of patients who undergo an endoscopy. The statements address issues such as the level of sedation required, the best drugs used, their mode of action, their side-effects and possible ways to counter their action, and were adopted if at least 80% of all participants agreed upon them.

Rationale: Malnutrition in cancer patients has been associated with poor disease outcome. The purpose of the present study was to assess the nutritional status of patients with metastatic cancer before the onset of first-line chemotherapy, using two different assessment tools and to explore and compare potential associations with overall survival. Methods: Patients with metastatic primaries referred for initiation of 1st line systemic therapy in a single center were eligible. The MNA and PG-SGA tools were used to assess the nutritional status of the patients, while medical history, anthropometric and biochemical parameters as well as survival data were recorded. Results: The present study included 50 patients (60% males) with median age 65.0 years (58.8-71.0). According to the MNA 28% of the patients were already malnourished (N=14) while 30% were at risk of malnutrition (N=15). Similarly, according to PG-SGA, 28% of the patients (N=14) were severely malnourished (stage C) and 26% (N=13) had moderate/suspected malnutrition (stage B). Survival analysis showed that the mean survival of the patients differed significantly between the different categories of MNA (10.8 months vs 8 vs 3.5 months, P < 0.001) and PG-SGA (9.6 months for stage A and B vs 3.0 months for stage C, P = 0.004). Multivariate analyses showed that the presence of malnutrition according to MNA was associated with a higher than 9-fold increased risk for death (HR: 9.48, p=0.01) and almost 5-fold increased risk for death (HR: 4.82, p=0.01) for malnourished patients according to the PG-SGA. Conclusion: The majority of patients were malnourished or at risk of malnutrition already at the time of diagnosis. Malnutrition was associated in both cases with reduced overall survival with MNA showing slightly better prognostic value than PG-SGA. Disclosure of Interest: None declared

Background Total proctocolectomy (TPC) followed by ileal pouch-anal anastomosis (IPAA) remains the only viable option whenever different treatment modalities fail in patients with ulcerative colitis (UC). Objective Prospective cohort pre/post study examining the anal defecatory function and competence in UC patients undergoing TPC plus IPAA using high-resolution anorectal manometry (HR-ARM). Patients Patients undergoing TPC and IPAA were enrolled in the study and subjected to HR-ARM prior to and 6 months after surgery. The anal resting, squeeze and push pressures were recorded, together with the rectal sensation and the rectal balloon expulsion test. The number of bowel movements, symptoms/signs related to fecal incontinence, as well as the IBDQ-32 quality of life questionnaires were documented during both HR-ARM visits. Results A total of 20 consecutive UC patients were recruited in our study. The mean (SD) number of bowel movements before the TPC plus IPAA was 10.1 (2.8), while the same number after the pouch surgery was 7.7 (3.1) [ P = 0.01]. Symptoms or signs of fecal incontinence were noted in one of our patients prior to the operation; however, none of our patients reported any such symptoms after the pouch surgery. The median (IQR) IBDQ-32 questionnaire scores before and after surgery were 121.5 (13.5) and 142.5 (16.0) respectively. At the same time, the anorectal function remained intact since both the anal resting and squeeze pressures were not significantly changed. Conclusion UC patients subjected to TPC-IPAA exhibit improved bowel movements and a normal anal defecatory function and competence post-surgery.

Rationale: The last years researches have focused on the administration of postbiotics as alternatives to probiotics. The aim of this review was to study the mechanisms of action of postbiotics and their applications in therapeutic and diagnostic practice.

Background:Difficult cannulation represents a common obstacle during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the efficacy and adverse events of transpancreatic sphincterotomy (TPS), and investigated potential associated confounders.Methods:All patients referred to our department for ERCP during 2015-2020 were eligible if they had intact papilla and visceral anatomy. In addition to standard measures, TPS was combined with pancreatic stent placement. Apart from demographics, we retrieved data related to the indication, periampullary anatomy, necessity for TPS or fistulotomy, their outcomes and complications. Chi-square test was employed to investigate associations between TPS and independent variables. When significance was observed, the respective variables were inserted into a regression model.Results:A total of 1082 individual patients were eligible, with an equal female: male ratio and a mean age of 72.7±15.82 years. Seventy-three patients (6.7%) underwent TPS, with a 95.9% successful cannulation rate. Papilla morphology or regional diverticulum did not affect the decision to perform TPS, though it was significantly associated with malignant common bile duct (CBD) obstruction as the ERCP indication (P=0.001). Considering adverse events, TPS did not increase the incidence of post-ERCP pancreatitis (PEP), though it affected bleeding (P=0.005). Regression analysis revealed a protective role of TPS against PEP (risk ratio [RR] 0.015, 95% confidence interval [CI] 0.23-5.05; P<0.001), while the aforementioned risk of hemorrhage was attributed to previous precut attempts (RR 3.02, 95%CI 1.42-6.43; P=0.004).Conclusion:TPS combined with pancreatic stenting is an effective and safe modality in difficult cannulation cases and could be the first-choice alternative in malignant CBD obstruction.

Aims Difficult cannulation represents a common condition during endoscopic retrograde cholangiopancreatography (ERCP). This study assessed the efficacy and adverse events during transpancreatic sphincterotomy (TPS), and investigated confounders associated with those outcomes.

Opinion statement Gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) comprise a heterogeneous group of slow growing tumors arising from the neuroendocrine cells of the gastrointestinal (GI) tract. Although they are considered relatively rare, their incidence is rising and it is believed that the more frequent use of endoscopy and imaging studies have at least in part contributed to the increased diagnosis especially of localized neoplasms. The management of these neoplasms should be guided by a multidisciplinary NEN team following appropriate staging investigations. Localized neoplasms of the GI tract may be suitable for endoscopic therapy, while patients with pancreatic NENs, unsuitable for surgery, should be considered for endoscopic ultrasound (EUS)-guided ablation. In this review, we discuss the evidence regarding endoscopic resection of luminal NENs and EUS-guided therapy of pancreatic NENs. The efficacy, safety, and other longer-term outcomes of these techniques are summarized. In conclusion, this review of endoscopic therapies for localized NENs may be a useful guide for NEN clinicians and endoscopists who are considering these therapeutic options for the management of focal GEP NENs.

An inpatient treated for COVID-19 was referred for esophagogastroduodenoscopy,after cross-sectional imaging demonstrated a ‘left-lower-lobe lung abscess’,spontaneously draining into the stomach.Gastroscopy revealed a paradoxical torsion of the proximal stomach and engulfment of converging proximal gastric folds through a diaphragmatic defect.Contrast was infused into the ‘presumed abscess cavity’ via a through-the-scope catheter.Upon fluoroscopy,no contrast leak was documented.The presence of a well-demarcated cavity became evident.The endoscope was advanced into the cavity revealing ulcerated gastric mucosa.The findings were compatible with the occurrence of a ‘paraesophageal’ hiatal hernia,following traumatic diaphragmatic laceration during a car accident 14 months ago.The patient was referred for surgical management.

Endoscopic submucosal dissection (ESD) is a widely used technique associated with high en bloc resection rates for colorectal lesions [1], but at the cost of a higher incidence of adverse events, such as delayed bleeding and perforation, compared with endoscopic mucosal resection [2]. To prevent such complications, closure of ESD-induced mucosal defects is pursued, although this task can become challenging owing to their large size [3]. Herein, we report a new closure method for ESD-induced defects using endoclips and an elastic-rubber ring designed for orthodontics, which we have called the closure method with an elastic-rubber ring (CMER).