BACKGROUND AND AIMS:Western data to help guide surveillance recommendations after colorectal endoscopic submucosal dissection (ESD) remain scarce. In this multicenter study, we evaluate and stratify the risk of local recurrence after colorectal ESD. METHODS:A retrospective analysis of colorectal ESD at 13 centers was conducted between January 2015 and September 2025. Local recurrence was defined as neoplasia at the ESD site detected during surveillance colonoscopy (SC). Recurrence risk was calculated for the following groups: category 1 (R0 resection of low-grade dysplasia [LGD]), category 2 (R0 resection of high-grade dysplasia), category 3 (R1/Rx resection of noninvasive neoplasia), and category 4 (curative resection of T1a cancer). Multivariable logistic regression was performed to identify factors associated with recurrence. RESULTS:In total, 2182 patients underwent colorectal ESD (median lesion size of 34 mm). En bloc and R0 resection rates were 93.6% and 81.1%, respectively. SC data were available in 1478 of the 2182 patients. Local recurrence occurred in 1.5% (22/1478) of patients at a median of 14 months: 1.5% (12/775) in category 1, 0.9% (3/330) in category 2, 2.2% (6/279) in category 3, and 1.1% (1/94) in category 4. Recurrence in very-low-risk lesions (defined as <40 mm in size with only LGD on histology) was 0.8% (4/478). Severe fibrosis was a risk factor for local recurrence (OR, 2.40; 95% CI, 1.12-4.89; P = .019), whereas R0 resection was associated with a lower likelihood (OR, 0.30; 95% CI, 0.15-0.58; P < .001). CONCLUSIONS:In this multicenter non-Asian study, local recurrence after colorectal ESD was 1.5% and 0.8% for very-low-risk lesions. Severe submucosal fibrosis and R1/Rx resection were independently associated with local recurrence. Our data support current recommendations for SC at 12 months after ESD and raise the possibility of a longer interval for very-low-risk lesions.

BACKGROUND AND AIMS:Fully covered self-expandable metal stents (FCSEMSs) palliate distal malignant biliary obstruction (dMBO), but migration remains a limitation. We compared an antimigration stent (AMS) using finned FCSEMSs with a convention stent (CS) using flared FCSEMSs. METHODS:A retrospective cohort (April 2020-2024) of adults with unresectable dMBO undergoing ERCP with AMS or CS was analyzed. Primary outcomes were stent migration and recurrent biliary obstruction (RBO). Time-to-event outcomes were analyzed using inverse probability of treatment weighting (IPTW) Cox models, with propensity score matching (PSM) for sensitivity. RESULTS:Among 276 patients (CS, 172; AMS, 104), crude migration was lower with AMS (0.96% vs 7.6%; P = .02). After IPTW adjustment, migration risk remained directionally lower but was not statistically significant (hazard ratio, 0.23; 95% CI, 0.03-1.80; P = .16). Migration remained numerically lower after PSM (P = .10). RBO risk was similar between groups. CONCLUSIONS:Antimigration FCSEMSs demonstrated lower crude migration with similar patency (RBO risk), but adjusted analyses did not reach statistical significance.

Background and study aims:Achalasia is associated with increased risk of esophageal cancer, particularly squamous cell carcinoma. Although esophageal myotomy improves dysphagia, its impact on cancer risk and mortality remains unclear. Patients and methods:We conducted a retrospective cohort study using the TriNetX research network, including adults (≥ 18 years) with achalasia confirmed by esophageal manometry. Patients were categorized based on treatment of those undergoing esophageal myotomy (peroral endoscopic myotomy [POEM] or laparoscopic Heller myotomy [LHM]) and those managed without myotomy. Patients with prior esophagectomy or malignancies associated with increased esophageal cancer risk were excluded. The primary outcome was incident esophageal cancer; secondary outcomes included all-cause mortality. Propensity score matching balanced baseline characteristics. Associations were assessed using adjusted odds ratios (aORs) and Cox proportional hazards models. Overall survival was assessed using Kaplan-Meier analysis and compared with the log-rank test. Results:Among 18,186 patients with achalasia, 3,758 underwent esophageal myotomy and 14,428 were managed without myotomy. After matching, esophageal cancer incidence was low and did not differ significantly between the myotomy and non-myotomy cohorts (0.29% vs 0.27%; aOR 1.1, 95% confidence interval [CI] 0.47-2.6). In contrast, myotomy was associated with significantly lower all-cause mortality (3.25% vs 7.22%; aOR 0.43, 95% CI 0.35-0.54). Independent predictors of esophageal cancer included male sex, older age, and personal history of gastrointestinal malignancy. Conclusions:In short-term follow-up, esophageal myotomy in achalasia was associated with lower all-cause mortality and similar esophageal cancer incidence. These findings suggest benefits beyond symptom control, including a potential survival advantage.

Background Despite advancements in endoscopic resection (ER), surgery for nonmalignant colorectal polyps remains common. A prior analysis reported increasing surgical rates from 2000 to 2014. Using the TriNetX US Research Network, we aimed to compare the proportion of patients referred for ER versus surgical colectomy for nonmalignant polyps each year from 2015 to 2023. Methods We identified adults (≥18 years) diagnosed with nonmalignant colorectal polyps following colonoscopy using validated ICD-10 and CPT codes. Patients with colorectal cancer or inflammatory bowel disease were excluded. The primary outcome was incidence of ER (EMR or ESD) vs. colectomy between 2 weeks and 6 months post-colonoscopy. Secondary outcomes included 30-day adverse events (AEs) and mortality. Propensity score matching was used to compare groups. Odds ratios (ORs) were calculated for secondary outcomes. Results Of 1,060,302 patients undergoing colonoscopy from 2015 to 2023, 6,295 (0.594%, 95% CI: 0.579-0.609%) were referred for ER and 4,208 (0.397%, 95% CI: 0.385-0.409%) were referred surgery for large nonmalignant colorectal polyps detected and not resected on index colonoscopy. ER incidence rose from 0.26% (2015) to 0.67% (2023), while surgery rates declined from 0.45% to 0.35%. Post-matching, ER was associated with significantly lower 30-day mortality (0.161% vs. 1.304%; OR: 0.122) and fewer AEs, including cardiac events, thromboembolic events, pulmonary complications, sepsis, and surgical site infections. Discussion Over the past decade, ER for nonmalignant colorectal polyps increased while surgical resections declined. ER was associated with significantly lower mortality and morbidity. These findings support continued efforts to promote ER as a safer, effective alternative to surgery.