This statement conveys the European Society of Gastrointestinal Endoscopy (ESGE) position on the use of computer-aided detection (CADe) with artificial intelligence (AI) during colonoscopy for colorectal cancer (CRC) screening or surveillance. The ESGE position is informed by the BMJ Rapid Recommendation initiative and the approach of the MAGIC Evidence Ecosystem Foundation; these include systematic reviews of currently available evidence, supplemented by microsimulation modeling and patient values and preferences, for the benefits and harms of AI CADe devices during colonoscopy.ESGE convened a panel of European experts for this Position Statement. On December 18, 2024, panel members voted on their preferred recommendation between two choices about CADe during colonoscopy for indications of CRC screening or polyp surveillance. Out of 19 eligible votes, 13 (68.4%) voted to recommend CADe for colonoscopy, and six panel members (31.6%) voted against. Therefore, the current ESGE statement is: RECOMMENDATION: The panel believes that most well-informed patients who have already decided to undergo colonoscopy for screening or surveillance would favor CADe assistance during colonoscopy. This is due to the potential benefits, although limited, of reduction in colorectal cancer incidence and mortality.This recommendation is weak, because the evidence is limited with considerable uncertainty of the evidence estimates, the absolute benefits for colorectal cancer incidence and mortality are small, and there is a patient burden associated with CADe (more polyp overdiagnosis and more colonoscopy surveillance).

Aims EUS is the gold standard to diagnose pancreatic cancer. However, the sensitivity and specificity of EUS is not optimal due to variable echogenicity from one patient to another. On the other hand, some infiltrative forms without hypoechoic mass are difficult to visualize. What's more, the operator can be taken for a ride due to a lack of experience. Finally, fatigue can sometimes lead to poor diagnosis of pancreatic tumors. The aim of our study was to evaluate the performance of AI for the diagnosis of pancreatic cancer in linear EUS.

Aims In chronic pancreatitis (CP), stones and strictures of the main pancreatic duct (MPD) can cause chronic abdominal pain and recurrent acute pancreatitis. In some cases, endoscopic treatment may be indicated with uncertain efficacy due to the high risk of recurrence. This risk is correlated with residual calculi and stenosis in the CP. The aim of this study was to compare the performance of pancreatoscopy versus pancreatography in diagnosing residual calculi and strictures in the MPD at the end of endoscopic treatment.

Aims Next-generation sequencing (NGS) appears to be a useful adjunct for determining the type and risk of degeneration of pancreatic cysts. The aim of this study was to evaluate, prospectively in "real life», the feasibility and performance of NGS performed on pancreatic cyst fluid.

Background and Aims: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) have common features and differences. This real-life study investigated their characteristics, treatment modalities, and prognoses. Meth-ods: This retrospective comparative study was performed in 1,075 patients seen at one tertiary center between January 2008 and December 2020. Overall survival (OS) was estimat -ed by the Kaplan-Meier method. Subclassification of iCCAs af-ter histological and radiological review, and molecular profil -ing was performed. Results: HCCs patients were more likely to have early-stage disease than iCCA patients. iCCA patients were more likely to be female, especially those patients with-out cirrhosis (43% vs. 17%). Cirrhosis was prominent among HCC patients (89% vs. 34%), but no difference in underlying liver disease among cirrhotic patients was found. OS of HCC patients was 18.4 (95% CI: 6.4, 48.3) months, that of iCCA patients was 7.0 (95% CI: 3.4, 20.1) months. OS of Barce-lona Clinic Liver Cancer C HCC patients was 7.8 (95% CI: 4.3, 14.2) months, that of advanced/metastatic iCCA patients was 8.5 (95% CI: 5.7, 12.3) months. In patients treated with sorafenib, OS was longer in HCC patients who received sub-sequent tyrosine kinase inhibitor therapies. No significant OS difference was found between iCCA patients with and without cirrhosis or according to histological subtype. A targetable molecular alteration was detected in 50% of the iCCA pa-tients. Conclusions: In this French series, cirrhosis was com-mon in iCCA, which showed etiological factors comparable to those of HCC, implying a distinct oncogenic pathway. Both entities had a dismal prognosis at advanced stages. However, systemic therapies sequencing in HCC and molecular profiling in iCCA offer new insights.

Aims Endoscopic necrosectomy is indicated as a first-line procedure in case of symptomatic solid pancreatic collection following a step-up strategy. The use of luminal apposing metal stent (LAMS) to facilitate the procedure is prospectively poorly established. The aim of this study was to validate the effectiveness of LAMS for endoscopic pancreatic necrosectomy

BACKGROUND:European guidelines recommends the use of cold snare polypectomy (CSP) for removal of diminutive colorectal polyps (DCP). However, for DCP < 4 mm cold biopsy forceps (CBF) may be optional. We aimed to compare the efficacy of CSP with CBF for removal of DCP in routine colonoscopy. METHODS:We conducted a multicenter non-inferiority randomized controlled trial. After screening, 123 patients were prospectively included and 180 DCPs were removed by either CBF or CSP after randomization (1:1). The primary end-point was the histological complete resection rate defined by negative additional biopsies taken from the edge of the polypectomy ulcer site. RESULTS:Among DCPs, 121 (67.2%) adenomas or sessile serrated lesions were considered for the analysis. Polyps were 4 [1-5] mm in size, mostly flat (55.4%) and located in the proximal colon (44.6%). The en bloc resection rate was higher in the CSP group than the CBF group (91.7% vs. 42.6%, p < 0.001). The histological complete resection rate was comparable in the two groups (93.33% vs 90.16%; p = 0.527), even for polyps < 4 mm (91.30% vs 91.30%; p = 1). All specimens were retrieved and there was no difference in terms of procedure times and adverse events. Finally, univariate analysis did not identify any potential factor associated with complete resection rate. CONCLUSION:In this study, CSP was comparable to CBF for the removal of DCP. Therefore, CBF may be considered as an alternative technique for resection of DCP, together with CSP, ClinicalTrials.gov registry (NCT04727918).

OBJECTIVES:A single-use duodenoscope (SUD) has been recently developed to overcome issues with endoscopic retrograde cholangiopancreatography (ERCP)-related cross-infections. The aim was to evaluate SUD safety and performance in a prospective multi-centre study.METHODS:All consecutive patients undergoing ERCP in six French centers were prospectively enrolled. All procedures were performed with the SUD; in case of ERCP failure, operators switched to a reusable duodenoscope. Study outcomes were the successful completion of the procedure with SUD, safety and operators' satisfaction based on a VAS 0-10 and on 22 qualitative items. The study protocol was approved by French authorities and registered (ID-RCB: 2020-A00346-33). External companies collected the database and performed statistical analysis.RESULTS:Sixty patients (34 females, median age 65.5 years old) were enrolled. Main indications were bile duct stones (41.7%) and malignant biliary obstruction (26.7%). Most ERCP were considered ASGE grade 2 (58.3%) or 3 (35.0%). Fifty-seven (95.0%) procedures were completed using the SUD. Failures were unrelated to SUD (one duodenal stricture, one ampullary infiltration, and one tight biliary stricture) and could not be completed with reusable duodenoscopes. Median operators' satisfaction was 9 (7-9). Qualitative assessments were considered clinically satisfactory in a median of 100% of items and comparable to a reusable duodenoscope in 97.9% of items. Three patients (5%) reported an adverse event. None was SUD-related.CONCLUSIONS:The use of a SUD allows ERCP to be performed with an optimal successful rate. Our data show that SUD could be used for several ERCP indications and levels of complexity.

Objectives Biliary brushings and biopsies obtained during endoscopic retrograde cholangiopancreatography (ERCP) have a low sensitivity for the diagnosis of malignant biliary strictures. While cholangioscopic analysis is useful, visual criteria have not yet been defined. The aim of this study was to identify visual criteria for the diagnosis of indeterminate biliary strictures (IDBS). Methods A multicenter study was conducted based on the analysis of cholangioscopic recordings of IBDS. Diagnostic criteria were identified in a study group and verified in a validation group. Results Four criteria were identified to be associated with malignancy, one negatively (“endobiliary material,” odds ratio [OR] 0.62, 95% confidence interval [CI] 0.41–0.92) and three positively (“vascularized villous projections,” OR 1.52, 95% CI 1.03–2.24; “twisted or dilated vessels,” OR 2.18, 95% CI 1.47–3.24; and “dark color of the mucosa,” OR 1.82, 95% CI 1.23–2.70). Between two playbacks, the mean (95% CI) sensitivity of the observer’s visual diagnosis increased from 66.1% (60–72) to 73.8% (69–78) ( P = 0.004); in the second playback, the kappa value for interobserver agreement ranged between 0.36 (color) and 0.56 (endobiliary material), with a significant improvement ( P = 0.0031–0.0001) between the first and second playbacks. Blind assessment by endoscopists not involved in this study had a diagnostic accuracy of 73% (71.4–74.5). Conclusion The four identified cholangioscopic features are easy to implement in clinical practice and have the potential to increase the level of diagnostic confidence during the workup of IDBS.

BACKGROUND:Antireflux mucosectomy, a new endoscopic treatment for gastroesophageal reflux disease, consists of endoscopic mucosal resection at the esophagogastric junction. This study aim was to evaluate the medium-term efficacy of the antireflux mucosectomy technique for patients with severe gastroesophageal reflux disease symptoms (proton pump inhibitor treatment-dependent or proton pump inhibitor treatment-resistant gastroesophageal reflux disease).METHODS:Between January 2017 and June 2018, 13 patients with severe gastroesophageal reflux disease without hiatal hernia, with positive pH reflux, were included in this monocentric prospective pilot study. The primary outcome was clinical success, defined by improvement evaluated by the Gastroesophageal Reflux Disease Health Related Quality of Life Questionnaire at 24 months. Secondary outcomes were technical success, decreased use of proton pump inhibitors, patient satisfaction, and adverse events.RESULTS:Thirteen patients [females = 8 (62%)], mean age 59 (range, 54-68), were included. The antireflux mucosectomy procedure had technical success in all patients. At 24 months, for 11 patients, gastroesophageal reflux disease symptoms were significantly improved, and mean gastroesophageal reflux disease score decreased from 33 (range, 26-42) to 3 (range, 0-7) (p = 0.001). Ninety-one percent (n = 10) of patients had a lower proton pump inhibitor intake at 24 months. One patient had 3 endoscopic balloon dilatations for EGJ stenosis, two patients had melena ten days after procedure, and seven patients had thoracic or abdominal pain. Patient's satisfaction at 24 months was 81%.CONCLUSIONS:In patients with severe gastroesophageal reflux disease, despite occurrence of several short-term adverse events, antireflux mucosectomy seemed effective in improving gastroesophageal reflux disease symptoms at 24 months. This trial is registered with ClinicalTrials: NCT03357809.

Background During endoscopic retrograde cholangiopancreatography (ERCP), access to the common bile duct (CBD) can be problematic after unintentional insertion of the guidewire into the pancreatic duct. We conducted a prospective, randomized study in order to compare biliary cannulation success rates of early double-guidewire (EDG) and repeated single-guidewire (RSG) techniques in patients with inadvertent passage of the guidewire into the pancreatic duct. Methods Patients with a native papilla were randomly assigned to either the EDG or RSG groups after unintentional insertion of the guidewire into the pancreatic duct. The primary outcome was successful selective CBD cannulation within 10 minutes. The secondary outcomes were successful final selective bile duct cannulation, time to bile duct cannulation, and frequency of post-ERCP pancreatitis (PEP). Results 142 patients were randomized and selective bile duct cannulation was achieved in 57/68 patients (84%) in the EDG group and in 37/74 patients (50%) in the RSG group within 10 minutes (relative risk 1.34; 95% confidence interval 1.08-6.18; P <0.001). The overall final selective bile duct cannulation rate was 99.3%. The time to access the CBD was shorter using the EDG technique (6.0 vs. 10.4 minutes; P =0.002). Mild PEP was not observed more frequently in the EDG group than in the RSG group. Conclusion The EDG technique significantly increased the success rate of biliary duct cannulation within 10 minutes compared with an RSG approach.

Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for pancreatic neuroendocrine tumors (NETs) and intraductal pancreatic mucinous neoplasia (IPMN) with worrisome features or high-risk stigmata (WF/HRS) has been evaluated in few series with short-term outcomes. This studyʼs primary endpoint was to assess the long-term efficacy of EUS-RFA in patients with NETs or pancreatic cystic neoplasms (PCNs) over at least 3 years. Patients and methods Twelve patients had 14 NETs with a mean 13.4-mm size (10–20) and 17 patients had a cystic tumor (16 IPMN, 1 MCA) with a 29.1-mm mean size (9–60 were included. They were treated with EUS-guided RFA, evaluated prospectively at 1 year, and followed annually for at least 3 years. Results The mean duration of follow-up was 42.9 months (36–53). Four patients died during follow-up (17–42 months) from unrelated diseases. At 1-year follow-up, and 85.7 % complete disappearance was seen in 12 patients with 14 NETs. At the end of follow-up (45.6 months), complete disappearance of tumors was seen in 85.7 % of cases. One case of late liver metastasis occurred in a patient with initial failure of EUS-RFA. At 1-year follow-up, a significant response was seen in 70.5 % of 15 patients with PCNs. At the end of the follow-up, there was a significant response in 66.6 % with no mural nodules. Two cases of distant pancreatic adenocarcinoma unrelated to IPMN occurred. Conclusions EUS-RFA results for pancreatic NETs or PCNs appear to be stable during 42 months of follow-up.

Duodenoscope contamination was suggested to be the potential source of ERCP-related cross-infections. Several strategies and solutions have been proposed to avoid the risk of duodenoscope-transmitted infections. A single-use duodenoscope (SUD) has been recently developed to overcome issues with ERCP-related infections. The aim was to evaluate SUD safety and performance in a prospective multi-center study.

In March 2020, a week after the first lockdown in France, during the first wave of the SARS-CoV-2 pandemic, the French Society of Digestive Endoscopy (Société Française d’Endoscopie Digestive, SFED) sent gastroenterologists practicing endoscopy a web-based survey that included 35 questions about their endoscopic activity during 1 week [1]. The survey concluded that 91% of the endoscopies were cancelled, and underscored the poor level of personal protective equipment (PPE) available, with difficulties obtaining masks reported by 14% of respondents and 57% of endoscopies eventually performed without a mask. In addition, 13% of the respondents reported symptoms compatible with COVID-19 and 2% had a positive polymerase chain reaction (PCR) test for it. The onset of a second wave of contaminations led the health authorities to declare a second lockdown, beginning on October 30, 2020. The SFED conducted a second survey, from November 23, 2020 to November 27, 2020, to monitor changes in endoscopic practice, based on the lessons from the first wave. One hundred and twenty-four gastroenterologists took the survey, of whom, 61% were males, with a mean age of 50 years (range 29–69); 39% worked in a public hospital. Ninety-six percent had read the SFED recommendations on endoscopy and COVID-19 [2]. However, only 63% performed a routine SARS-CoV-2 PCR test on patients before endoscopy, 32% wore a mask when performing endoscopies, and only 1% reported difficulty obtaining masks. Sixty-nine percent of the healthcare facilities were involved in the care of patients with COVID-19, in 62% of centers, anesthesiologists were requisitioned, and 25% of the respondents were personally involved in the care of patients with COVID-19 patients. Twenty-one percent of the consultations were cancelled and 31% of the respondents performed consultations by telephone or video. Sixty-five percent of the respondents had to cancel endoscopies and 39% of endoscopies were cancelled. During the week of the survey, the mean number of endoscopies performed on patients with COVID-19 was 4.6. ▶Table 1 shows a comparison between data for the first and second wave. Four percent of the respondents had positive SARS-CoV-2 serology. During the second wave, 12% of respondents reported symptoms compatible with COVID-19 and 4% had a positive PCR test. In conclusion, the second wave of SARS-CoV-2 in France did not affect gastrointestinal endoscopy activity as significantly as the first wave. Uncertainty

OBJECTIVES:Peroralcholangio-pancreatoscopy (POCP) is used for diagnosis and treatment of biliopancreatic disease when standard endoscopy (ERCP) or pre-operative imaging workup failed. We aimed to evaluate the diagnostic and therapeutic performance of POCP in complex biliary and pancreatic diseases. MATERIALS AND METHODS:Patients with indeterminate biliary or pancreatic duct (PD) strictures, and patients with failure of complex biliary or pancreatic stones removal, were enrolled (six centers). The primary endpoint evaluated malignancy diagnostic performances (accuracy, sensitivity, specificity) and therapeutic performances (biliary or pancreatic stones extraction). Secondary endpoints evaluated: technical success in lesion visualization, ease of maneuvering, image quality and 30-days complications. RESULTS:From November 2016 to March 2018, 66 patients were included: 29/37 women/men, median age (IQR): 73 (64-82). Fifty-three patients had diagnostic POCP and 13 patients therapeutic POCP. One endoscopist with one or two endoscopy nurses performed 94% of the POCP. The 'POCP visual impression' of malignancy showed 92.0% sensitivity, 92.9 % specificity and 92.5 % overall accuracy compared with the final diagnosis. 'POCP-guided samples histological analysis' showed 75.0 % sensitivity and 91.6% specificity. The technical success for lesion visualization was 98.5%. The median VAS scores for insertions in bile and PD were respectively 9.0 (8.1-9.6) and 9.0 (8.8-10.0). Median VAS score for access to the lesion and image quality were respectively 9.0 (7.7-9.6) and 9.0 (7.9-9.7). Only three 30-day minor complications occurred without any major complications. CONCLUSIONS:POCP was an effective, safe and easy-to-use tool in routine clinical practice for the management of complex diagnostic and therapeutic biliary and pancreatic diseases (NCT03190343).

BACKGROUND AND STUDY AIMS: The SARS-CoV-2 pandemic has strongly affected medical activity around the world. We sought to measure the impact of the COVID-19 pandemic on the gastrointestinal endoscopic activity in France. METHODS: We performed a web-based survey, including 35 questions on the responders and their endoscopic practice, from March 23rd to March 27th 2020, sent to the 3300 French gastroenterologists practicing endoscopy. RESULTS: 694 (21%) gastrointestinal endoscopists provided analyzable data. 29.4% (204/694) were involved in the management of COVID-19 patients outside the endoscopy departments, and 98.7% (685/694) of the endoscopic procedures were canceled. 12.8% (89/694) of the gastroenterologists reported symptoms compatible with COVID-19 infection, and a positive PCR was recorded in 12/197 (6.1%) vs. 3/497 (0.6%) patients in the high vs. low prevalence areas, p<0.0001. CONCLUSIONS: The COVID-19 pandemic led to a major reduction in the volume of gastrointestinal endoscopies performed in France in March 2020. The prolonged limited access to gastrointestinal endoscopy could lead to a delay in the management of patients with gastrointestinal cancers.