INTRODUCTION:Endoscopic ablation is the mainstay of treatment for dysplastic Barrett esophagus (BE), of which radiofrequency ablation (RFA) and argon plasma coagulation (APC) are the most widely available options. OBJECTIVES:We aimed to analyze the safety and outcomes of endoscopic ablation for BE at the Polish centers offering this procedure. PATIENTS AND METHODS:We retrospectively analyzed data from 3 high‑volume endoscopy centers between 2002 and 2024. We included adult patients with confirmed BE who received at least 1 ablation session with either conventional / hybrid APC (APC/h‑APC) or RFA, followed by at least 1 endoscopic follow‑up. The outcomes included the rate of complete remission of intestinal metaplasia (CR‑IM) and dysplasia (CR‑D), and adverse event (AE) rate. Risk factors for treatment failure were analyzed using a multivariable logistic regression model. RESULTS:We analyzed data from 191 patients, of which 160 were included (mean [SD] age, 59.4 [10.8] years; 79.4% men). The overall CR‑IM and CR‑D rates were 80% and 93.8%, respectively. We reported 49 minor AEs (30.6%), and 9 major AEs (5.6%), including 7 esophageal strictures (4.4%). In the early 2000s, APC was the only available ablation modality. However, since 2008, it has been gradually replaced by RFA. Notably, RFA was used for more severe BE cases and carried a higher risk of failed treatment than APC/h‑APC (odds ratio [OR], 7.48; P = 0.001). Other risk factors for treatment failure included the BE length (OR, 1.3; P = 0.002) and diabetes (OR, 7.48; P <0.001). CONCLUSIONS:Endoscopic ablation for BE is safely and effectively provided in Poland at a few expert centers. Patients with diabetes and long‑segment BE are at an increased risk for treatment failure.

Quality markers and patient experience should be implemented to ensure standardization of practice across upper gastrointestinal (UGI) endoscopy procedures. The set benchmarks ensure high quality procedures are delivered and linked to measurable outcomes. In 2016, the European Society of Gastrointestinal Endoscopy (ESGE), via its Quality Improvement Committee's UGI Working Group, set a first list of performance measures, including major (key) and minor performance indicators. This paper provides an update on those performance measures, considering the latest literature.Patients referred for a UGI endoscopy should have an appropriate indication and be fasting for ≥ 2 hours for liquids and ≥ 6 hours for solids.For a diagnostic UGI endoscopy, patients should have an allocated time slot of ≥ 20 minutes; adequate reporting should include a mucosal visibility score according to one of the available standardized and validated scales; adequate photodocumentation should include relevant normal anatomical landmarks and all abnormal findings; adequate inspection should include the esophagus, stomach, and duodenum, and should last ≥ 7 minutes from intubation to extubation; adequate terminology should include the description of any abnormal finding according to the available standardized and validated classifications.For patients with nondysplastic Barrett's esophagus (BE) undergoing surveillance UGI endoscopy, an adequate inspection should take ≥ 1 minute/cm of circumferential extent of Barrett's epithelium and include the use of chromoendoscopy (acetic acid and/or virtual); biopsies should be taken according to the Seattle protocol.Adequate inspection for a diagnostic UGI endoscopy in patients with a history of ear, nose, and throat, or lung tumors treated with curative intent should include the use of virtual chromoendoscopy.Adequate diagnostic UGI endoscopy for patients evaluated for their risk of gastric cancer should include biopsies taken according to the ESGE management of precancerous conditions and lesions in the stomach (MAPS) guideline.Adequate safety after a therapeutic UGI endoscopy should be assessed by monitoring the incidence of complications.Patients undergoing a diagnostic UGI endoscopy should have their experience measured using a validated scale, to promote a patient-centered and quality-driven environment.Patients with nondysplastic BE or gastric precancerous conditions in an endoscopic surveillance program should be monitored for guideline interval adherence.

Esophagogastroduodenoscopy (EGD) is used in the diagnosis of neoplastic and non-neoplastic diseases. The rate of missed cancers remains high and exceeds 8 % for esophageal and gastric cancer. Several quality indicators have been identified to enhance the detection capability and decrease the neoplasia miss rate. Recently, the cleanliness of the mucosa has been identified as one such indicator. To achieve better visibility, premedication with N-acetylcysteine and simethicone should be considered. Advanced imaging modalities, such as virtual chromoendoscopy, may be helpful in the diagnosis of neoplasia and precancerous conditions, such as esophageal squamous cell carcinoma, Barrett's esophagus, and gastric dysplasia. Biopsy protocols, such as the MAPS and Seattle protocols, are another quality indicator, as they aim to identify patients at risk of gastric cancer and Barrett's esophagus-related dysplasia, respectively. Adequate inspection may be reflected in the procedure time or the endoscope withdrawal time. Several indicators have been proposed to monitor operator performance. The endoscopist's biopsy rate, composite detection rate, and Vater's papilla photodocumentation can be useful tools for auditing an endoscopist's performance and any link to neoplasia detection or missed cancers. In addition, monitoring patients' experiences using validated questionnaires is a performance measure of the endoscopy unit along with recording adverse events after therapeutic procedures.

Previously, colorectal polyp computer-aided detection (CADe) systems required on-site high-performance hardware installations (e.g., FPGAs/GPUs), creating practical challenges to upgrades and tying hospitals to legacy hardware. Cloud-based CADe solutions overcome these constraints. Hospitals can use low-specification/low-cost hardware to stream data to the cloud for analysis, enabling frequent AI hardware and algorithm updates. Furthermore, existing CADe systems’ benefits are largely limited to smaller, less clinically relevant polyps ( < 10 mm). This parallel-group RCT evaluated a real-time cloud-deployed CADe-system trained on an enhanced dataset of clinically significant polyps (large polyps( ≥ 10 mm) and sessile-serrated-lesions(SSLs)). Patients from eight centers across four European countries (841 patients, 22 endoscopists) were randomized to standard or CADe-assisted colonoscopy. Co-primary endpoints were (1) superior Adenomas Per-Colonoscopy (APC), (2) non-inferior Positive Percent-Agreement (PPA) (proportion of resections confirmed as clinically relevant polyps). CADe improved (p < 0.05): APC (0.82 vs. 0.62, Ratio 1.33[95% CI 1.06–1.67]), adenoma detection-rate (43.2% vs. 35.9%), SSL (0.08 vs. 0.03, Ratio 3.30[95% CI 1.41–7.57]), and large polyp (0.12 vs. 0.05, Ratio 2.36[95% CI 1.33–4.17]) detection. PPA was non-inferior, and average cloud-network latency was 59.4 ms per minute, with 99.6% under the 100 ms threshold required for real-time use. This RCT demonstrates the feasibility and efficacy of a real-time cloud-based CADe system, with promising outcomes for clinically significant polyps (large polyps and SSLs). Future research should explore optimizing CADe systems' performance. ClinicalTrials.gov (NCT05730192[15/02/2023]).

Upper gastrointestinal (UGI) endoscopy is the mainstay for the diagnosis and staging of precancerous and cancerous conditions of the esophagus, stomach, and duodenum. Despite development of several validated classifications for UGI diseases, endoscopy reports differ between endoscopists and endoscopy departments. This document proposes a standardized high quality UGI endoscopy report, including preprocedural, periprocedural, endoscopic findings, and postprocedural information. Preprocedural details should comprise data on the patient, exam, use of antithrombotic drugs, fasting, and premedication. Periprocedural information should report on medications administered, endoscope used, and the mucosal cleanliness assessment. Endoscopic findings should describe the esophagus, stomach, and duodenum, with any observed abnormalities reported using the most commonly employed classification (provided in the document). Postprocedural details should include data on biopsies and vials, pictures taken during the procedure, and the exam duration. A suggestion for a normal findings report is provided. Standardized reporting could enhance the quality of UGI endoscopy.

INTRODUCTION:The performance of a high quality esophagogastroduodenoscopy (EGD) is dependent on the mucosal cleanliness. Recently, the Polprep: Effective Assessment of Cleanliness in EGD (PEACE) scale was created to assess the degree of mucosal cleanliness during EGD. The aim of this study was to validate this scoring system in a cohort of international endoscopists. METHODS:In total, 39 EGD videos, with different degrees of mucosal cleanliness were retrieved from a previously conducted prospective trial. All experts rated the cleanliness of the mucosa on each video using the PEACE scale. To evaluate agreement of all scores (0-3), intraclass correlation coefficient 2.1 was used. The agreement on adequate (scores 2 and 3) and inadequate (scores 0 and 1) cleanliness was assessed using kappa values. RESULTS:Videos evaluating esophagus, stomach, and duodenum cleanliness were reviewed by 16 endoscopists. The PEACE scores demonstrated good agreement (intraclass correlation coefficient 0.82, 95% CI 0.75-0.89), especially for esophagus (0.84; 95% CI 0.71-0.95) and stomach (0.81; 95% CI 0.69-0.91), while agreement was moderate for the duodenum (0.69; 95% CI 0.51-0.87). The agreement was similar between Eastern (0.86; 95% CI 0.79-0.92) and Western experts (0.80; 95% CI 0.72-0.88). Similarly, agreement regarding adequate cleanliness was comparable between Eastern (0.70; 95% CI 0.55-0.85) and Western (0.74; 95% CI 0.64-0.84) endoscopists being overall 0.75 (95% CI 0.65-0.85). DISCUSSION:The PEACE scoring system is a simple and reliable scale to assess the cleanliness during EGD. The score is now validated among international experts with high concordance, justifying its use in clinical practice.

Aims Upper gastrointestinal (UGI) endoscopy quality depends on the capability to detect mucosal pathologies. Proper visibility is necessary to identify lesions and subtle mucosal abnormalities. The PEACE scale (Polprep: Effective Assessment of Cleanliness in Esophagogastroduodenoscopy) was recently created to assess UGI cleanliness. Cleanliness assessed using the PEACE scoring system was directly related to detection of clinically significant pathologies 1. The aim of this study was to validate the concordance of the PEACE scoring system globally.

Gastric cancer (GC) is still one of the most prevalent cancers worldwide, with a high mortality rate, despite improvements in diagnostic and therapeutic strategies. To diminish the GC burden, a modification of the current diagnostic paradigm, and especially endoscopic diagnosis of symptomatic individuals, is necessary. In this review article, we present a broad review and the current knowledge status on serum biomarkers, including pepsinogens, gastrin, Gastropanel®, autoantibodies, and novel biomarkers, allowing us to estimate the risk of gastric precancerous conditions (GPC)-atrophic gastritis and gastric intestinal metaplasia. The aim of the article is to emphasize the role of non-invasive testing in GC prevention. This comprehensive review describes the pathophysiological background of investigated biomarkers, their status and performance based on available data, as well as their clinical applicability. We point out future perspectives of non-invasive testing and possible new biomarkers opportunities.

Colonoscopy is an endoscopic procedure used to examine the lining of the colon and the terminal ileum. The examination is used in the diagnosis and treatment of colon diseases. In many countries, colonoscopy is employed as a population screening tool to detect colorectal cancer. In Poland, according to data from the Maria Sklodowska-Curie National Research Institute of Oncology, over one million colonoscopies were performed as part of the Screening Program between 2000 and 2021. Although adequate bowel preparation is essential for high-quality colonoscopy, it is performed incorrectly in up to 9.9% of patients, limiting mucosal visualisation and necessitating repeat procedures. The methods used vary in effectiveness, tolerance, and impact on patient comfort. Recent have focused on optimising procedures by adjusting preparation agents, administration protocols, and dietary guidelines. Effective preparation enhances the detection of pathological changes and improves patient acceptance of colonoscopy as a diagnostic and screening tool. The aim of this paper was to discuss the latest guidelines on patient preparation for colonoscopy, including intestinal cleansing, modification of antiplatelet and anticoagulant treatment, which directly translate into the quality of the procedure and patient safety.

BACKGROUND AND AIMS:Cleanliness of the mucosa of the upper GI (UGI) tract is critical for performing a high-quality EGD. The aim of this study was to validate a recently developed UGI cleanliness scale (the Polprep: Effective Assessment of Cleanliness in Esophagogastroduodenoscopy [PEACE] system) in the detection of clinically significant lesions (CSLs) in the UGI tract. METHODS:Patients who underwent a complete diagnostic EGD were prospectively enrolled from August 2021 to October 2022. The UGI tract (esophagus, stomach, and duodenum) cleanliness was scored from 0 to 3 for each segment. The primary outcomes were the detection of CSLs and PEACE scores. RESULTS:Of 995 patients enrolled from 5 centers, adequate cleanliness (AQ; all scores ≥2) was found in 929 patients. In multivariate regression analysis, AQ was associated with the number of diagnosed CSLs (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.06-3.01; P = .03). Other factors related to CSL detection were duration of EGD (OR, 1.29, 95% CI, 1.23-1.35, P < .001), male sex (OR, 1.33, 95% CI, 1.04-1.71; P = .025), and EGD indication (dyspepsia, alarm symptoms, gastritis surveillance, other indications vs GERD) (OR, 0.43 [95% CI, 0.31-0.6, P < .001], OR, 0.44 [95% CI, 0.28-0.67, P < .001], OR, 0.44 [95% CI, 0.25-0.76; P = .004], and OR, 0.44 [95% CI, 0.31-0.62; P < .001], respectively). Twenty-seven patients were diagnosed with UGI neoplasia, all in patients with adequate cleanliness of the UGI tract. CONCLUSIONS:Adequate cleanliness of the UGI tract as assessed with the PEACE system was associated with a significantly higher detection rate of CSLs during EGD. The relationship of this scale with UGI neoplasia detection warrants further investigation.

Slaski Uniwersytet Medyczny w Katowicach, Poland; H-T. Centrum Medyczne, Poland; Academy of Silesia, Poland; Narodowy Instytut Onkologii im Marii Sklodowskiej-Curie Panstwowy Instytut Badawczy w Warszawie, Poland; Centrum Medyczne Sonomed, Poland; Uniwersytet Medyczny w Bialymstoku, Poland; Hospital of the Ministry of Internal Affairs in Szczecin, Poland; Pomorski Uniwersytet Medyczny w Szczecinie, Poland; Centre of Postgraduate Medical Education, Poland; University of Kansas School of Medicine, USA; Kansas City VA Medical Center, USA; Universitetet i Oslo, Norway.

INTRODUCTION Precancerous conditions for esophageal (EA) and gastric adenocarcinoma (GA) are Barrett's esophagus (BE) and atrophic gastritis (AG), respectively. Their surveillance is crucial for the detection of early lesions.OBJECTIVES The study aimed to assess whether one-time esophagogastroduodenoscopy (EGD) in search for precancerous conditions would be effective in the population with low-to -moderate esophageal and gastric cancer risk.PATIENTS AND METHODS A total of 5984 individuals who underwent diagnostic EGD in 3 endoscopic centers, from March 2018 to October 2019, were analyzed to assess the age of occurrence of precancerous conditions and cancers. Age distribution of the patients with malignant gastric and esophageal tumors registered in the national cancer registry from 2014 to 2017 was analyzed. RESULTS In comparison with individuals below 40 years old, the risk of EA and GA diagnosis increased at the age of 60 to 64 years (odds ratio [OR], 12.1; 95% CI, 1.5-98.6), gastric and esophageal dysplasia at the age of 55 to 59 years (OR, 3.6; 95% CI, 1.3-9.7), and BE and AG at the age of 40 to 44 years (OR, 1.6; 95% CI, 1.04-2.4). The number of procedures per 1 cancer that could be potentially avoided was 236, 235, 290, 360, 394, and 344 for the age groups of 40-44 years, 45-49 years, 50-54 years, 55-59 years, 60-64 years, and 65-69 years, respectively. The assessed potential benefit-to-harm ratio was 47, 38, 31, 28, and 32 for the age groups of 40-49 years, 50-54 years, 55-59 years, 60-64 years, and 65 -69 years, respectively. CONCLUSIONS One-time EGD in search for precancerous conditions could be potentially applicable in individuals between 40 and 69 years of age.

Aims No widely accepted cleanliness score has been validated for esophagogastroduodenoscopy (EGD) so far. The aim of our study was to assess the relationship between the presence of UGI lesions and a recently created polprep upper-gastrointestinal cleanliness scale (PUCS)1.