Using a systematic literature search of original articles published during 2024 in Gastrointestinal Endoscopy (GIE) and other high-impact medical and gastroenterology journals, the GIE Editorial Board of the American Society for Gastrointestinal Endoscopy compiled a list of the top 10 most significant topic areas in general and advanced GI endoscopy during the year. Each GIE Editorial Board member was directed to consider 3 criteria in generating candidate topics: significance, novelty, and impact on clinical practice. Subject matter consensus was facilitated by the Chair through electronic voting of the entire GIE Editorial Board. The top 10 identified topics collectively represent advances in the following endoscopic areas: glucagon-like peptide-1 receptor agonists and endoscopy, advances in AI in endoscopy, ergonomics in endoscopy, peroral endoscopic myotomy, bariatric and metabolic endoscopy, endoscopic resection in the colon, gastric intestinal metaplasia and endoscopy, inflammatory bowel disease and endoscopy, GI bleeding risk stratification and endoscopic therapies, and therapeutic EUS. Board members were assigned a topic area and summarized relevant and important articles, thereby generating this overview of the "top 10" endoscopic advances of 2024.

Using a systematic literature search of original articles published during 2023 in Gastrointestinal Endoscopy (GIE) and other high-impact medical and gastroenterology journals, the GIE Editorial Board of the American Society for Gastrointestinal Endoscopy compiled a list of the top 10 most significant topic areas in general and advanced GI endoscopy during the year. Each GIE Editorial Board member was directed to consider 3 criteria in generating candidate topics—significance, novelty, and impact on global clinical practice—and subject matter consensus was facilitated by the Chair through electronic voting and a meeting of the entire GIE Editorial Board. The 10 identified areas collectively represent advances in the following endoscopic spheres: GI bleeding, endohepatology, endoscopic palliation, artificial intelligence and polyp detection, artificial intelligence beyond the colon, better polypectomy and endoscopic mucosal resection, how to make endoscopy units greener, high quality upper endoscopy, endoscopic tissue apposition/closure devices, and endoscopic submucosal dissection. Each board member was assigned a topic area around which summarized relevant important articles, thereby generating this overview of the “top 10” endoscopic advances of 2023.

According to European colorectal screening programs, T1 colorectal cancer accounts for ≤17% of diagnosed cancers.1 Endoscopic resection of suspected T1 colorectal cancer is the standard of care. However, the resected specimen may show unfavorable histologic features with increased risk for lymph node metastasis, as outlined by the latest National Comprehensive Cancer Network (NCCN) guidelines, including tumor grades 3 and 4 (high-grade histologic features according to the World Health Organization in 2019), presence of lymphovascular invasion, and a positive resection margin.

Using a systematic literature search of original articles published during 2022 in Gastrointestinal Endoscopy and other high-impact medical and gastroenterology journals, the 10-member Editorial Board of the American Society for Gastrointestinal Endoscopy composed a list of the 10 most significant topic areas in GI endoscopy during the study year. Each Editorial Board member was directed to consider 3 criteria in generating candidate lists-significance, novelty, and global impact on clinical practice-and subject matter consensus was facilitated by the Chair through electronic voting. The 10 identified areas collectively represent advances in the following endoscopic spheres: artificial intelligence, endoscopic submucosal dissection, Barrett's esophagus, interventional EUS, endoscopic resection techniques, pancreaticobiliary endoscopy, management of acute pancreatitis, endoscopic environmental sustainability, the NordICC trial, and spiral enteroscopy. Each board member was as-signed a consensus topic area around which to summarize relevant important articles, thereby generating this precis of the "top 10" endoscopic advances of 2022.

Albert Civitarese: NO financial relationship with a commercial interest | Neda Khanjari: NO financial relationship with a commercial interest | Scott Levin: NO financial relationship with a commercial interest | Reza Milano: NO financial relationship with a commercial interest | Gaurav Parmar: NO financial relationship with a commercial interest | Neil Sood: NO financial relationship with a commercial interest | Mark McFarland: NO financial relationship with a commercial interest | Krupa Patel: NO financial relationship with a commercial interest | Ussama Ghumman: NO financial relationship with a commercial interest | Jeffrey Tokar: YES financial relationship with a commercial interest;Fujifilm Endoscopy:Consulting | Minhhuyen Nguyen: NO financial relationship with a commercial interest | Jennifer Higa: NO financial relationship with a commercial interest | David Weinberg: NO financial relationship with a commercial interest | Michael Bartel: NO financial relationship with a commercial interest

Michael Bartel: NO financial relationship with a commercial interest | Thiruvengadam Muniraj: NO financial relationship with a commercial interest | Jordan Anaokar: NO financial relationship with a commercial interest | Neda Khanjari: NO financial relationship with a commercial interest | Gaurav Parmar: NO financial relationship with a commercial interest | Praneet Wander: NO financial relationship with a commercial interest | Ussama Ghumman: NO financial relationship with a commercial interest | Jay Parekh: NO financial relationship with a commercial interest | Reza Milano: NO financial relationship with a commercial interest | Sameer Dawoodi: NO financial relationship with a commercial interest | Jeffrey Tokar: YES financial relationship with a commercial interest;Fujifilm Endoscopy:Consulting | Saraswathi Cappelle: NO financial relationship with a commercial interest | Harry Aslanian: YES financial relationship with a commercial interest;olympus:Consulting;boston scientific:Consulting | Sanjay Reddy: NO financial relationship with a commercial interest

INTRODUCTION:The optimal therapy for bleeding-related gastric varices is still a controversial topic. There is a paucity of literature that comprehensively summarizes the available literature regarding safety and efficacy of thrombin in bleeding gastric varices.METHODS:Four independent reviewers performed a comprehensive review of all original articles published from inception to October 2020, describing the use of thrombin for management of bleeding gastric varices. Primary outcomes were (1) pooled early and late rebleeding rate, (2) pooled gastric variceal related mortality rate, (3) pooled rescue therapy rate, and (4) pooled adverse event rate with the use of thrombin in bleeding gastric varices. The meta-analysis was performed and the statistics were two-tailed. Finally, probability of publication bias was assessed using funnel plots and with Egger's test.RESULTS:Eleven studies were included in the analysis after comprehensive search. This yielded a pooled early rebleeding rate of 9.3% (95% CI 4.9-17) and late rebleeding rate 13.8% (95% CI 9-20.4). Pooled rescue therapy rate after injecting thrombin in bleeding gastric varices was 10.1% (95% CI 6.1-16.3). The pooled 6-week gastric variceal-related mortality rate after injecting thrombin in bleeding gastric varices was 7.6% (95% CI 4.5-12.5). There were a total of four adverse events out of a total of 222 patients with pooled adverse event rate after injecting thrombin in bleeding gastric varices was 5.6% (95% CI 2.9-10.6).CONCLUSION:In summary, the systematic review and meta-analysis on the use of thrombin for bleeding gastric varices suggest low rates of rebleeding and minimal rates of adverse events. While, early and late rebleeding rate and rescue therapy rate are similar to cyanoacrylate-based therapy, the minimal rates of adverse events are perhaps the most important benefit of thrombin. Thus, the current data suggest that thrombin is a very promising therapeutic alternative with low risk of adverse events for bleeding gastric varices.

Background and Aims: EMR and endoscopic submucosal dissection (ESD) are treatment modalities for Barrett's esophagus involving high-grade dysplasia or early cancer. Injectional corticosteroid therapy decreases the risk of procedure-related esophageal stricture (ES) formation. Our aim was to assess the efficacy of topical budesonide on the rate of ES formation after EMR or ESD. Methods: Patients included prospectively from 3 tertiary endoscopy centers received 3 mg budesonide orally twice a day for 8 weeks after esophageal EMR or ESD of 50% or more of the esophageal circumference between January 1, 2014 and June 30, 2018. These patients were matched (1:3 ratio) retrospectively with a consecutive patient cohort who underwent EMR or ESD of 50% or more of the esophageal circumference without concomitant corticosteroid therapy. The primary endpoint was the presence of ES at the 12-week follow-up. Results: Twenty-five patients (budesonide) were matched with 75 patients (no budesonide). Most underwent EMR for Barrett's esophagus with biopsy-proven high-grade dysplasia or suspected T1a cancer. Although most baseline characteristics did not differ significantly, patients in the budesonide cohort tended to have a higher proportion of circumferential EMR. The proportion of patients with ES was not significantly lower in the budesonide cohort (16% vs 28%). On logistic regression analysis, budesonide remained associated with a lower incidence of ES (P = .023); however, when controlling for baseline characteristics with a propensity score weighted logistic regression model, there was no significant effect on ES formation (P = .176). Conclusions: Topical budesonide might be associated with a reduction of ES after EMR or ESD; however, further studies are needed to verify our results.

Background and study aims Anticoagulation (AC) and antiplatelet (AP) therapy may increase the risk of gastrointestinal bleeding after double balloon enteroscopy (DBE); however, limited data are currently available regarding the incidence. The aim of this study was to assess the incidence and clinical characteristics of post-DBE bleeding in patients on AC and AP therapy. Patients and methods The medical records of patients who underwent DBE between 2009 and 2013 at Mayo Clinic, Florida, were retrospectively reviewed. Patients were divided into three groups: 1) continued AP therapy; 2) AC therapy; and 3) neither AP nor AC at the time of DBE. Follow-up data were collected at 60 days and 1 year. Results A total of 683 patients were identified; 43 on AC, 183 on AP and 457 not on AP or AC therapy. The most common indication for DBE was obscure gastrointestinal bleeding in the groups on and not on AP (85.3 % vs 70.9 %, P < 0.0001). There was no statistical difference in post-DBE bleeding rates in patients on AP vs not on AP at 60 days (11.5 % vs 7.5 %, P = 0.12) or 1 year (19.9 % vs 15.7 %, P = 0.23). Rates of bleeding in patients on AC were 11.6 % within 60 days and 22.5 % within 1 year. Multivariate analysis reflected American Society of Anesthesiologist > 3 and indication for DBE of GI bleeding were independent risk factors for post-DBE bleeding within 1 year. Conclusions Continued antiplatelet use at the time of DBE was not an independent risk factor for bleeding post-DBE at 60 days or 1 year of follow up.

We present a case series of 5 patients who underwent placement of a PEG tube followed by a J extension tube (PEG-J). PEG-J placement is usually performed as a 2-step procedure and is used for a variety of conditions such as gastroparesis. First, the PEG tube is placed using endoscopic transillumination, followed by tube placement with the pull method, and trimming of the PEG tube to approximately 20 cm. This is followed by insertion of the J extension tube through the PEG tube; the J extension tube is grasped by an endoscope and guided through the pylorus to a position distal to the ligament of Treitz. Two common problems related to the length of the PEG tube portion can occur when placing the J tube. A short PEG tube may not allow advancement of the J tube distal enough because of looping. On the other hand, a PEG tube that is too long can prevent adequate J tube insertion. Although the adverse events of PEG tubes are well documented, we did not find any published literature addressing problems with the placement of J tube extensions, although it is a frequently occurring problem in our clinical practice. Therefore, we have tried to address this problem. We present our technique for PEG-J tube placement, which allows optimal PEG tube length independent of the depth of J tube insertion. After PEG tube placement with the pull method, only the introducer is cut, and the entire length of the silicon PEG tube is left in situ. The tip of the J tube is lubricated and inserted into the PEG tube. In parallel, the J tube is grasped, in our cases with an endoclip, and gently maneuvered into the duodenum and eventually into the jejunum while the J tube is threaded into the PEG tube, matching the pull force from the J tube insertion by the endoscope. We use a pediatric colonoscope to achieve deep jejunal intubation; however, either the adult colonoscope or enteroscope are adequate alternative endoscopes. Once the J tube seal reaches the silicon portion of the PEG tube and further introduction is needed, a 5- to 10-cm portion of the silicon is cut using the sharp tip of the scissors provided with the PEG tube kit (Fig. 1). These steps of “peel and advance” are repeated until the J tube is advanced to the desired location and clipped to the jejunum mucosa. This technique allows optimal J tube placement without gastric looping or a too-short jejunal J tube insertion (Fig. 2). We followed all patients over 4 weeks. No PEG-J tube replacement adverse events were noted. Two patients had abdominal imaging at 4 weeks documenting optimal J tube placement without J tube loops or short J tubes resulting in proximal migration of the J tube (Video 1, available online at www.giejournal.org). All authors disclosed no financial relationships. https://www.videogie.org/cms/asset/9bec0238-72be-450f-8dbd-3862997703e4/mmc1.mp4Loading ... Download .mp4 (104.88 MB) Help with .mp4 files Video 1PEG-J tube placement with optimization of J tube insertion.

Global warming and the rising prevalence of obesity are well described challenges of current mankind. Most recently, the COVID-19 pandemic arose as a new challenge. We here attempt to delineate their relationship with each other from our perspective. Global greenhouse gas emissions from the burning of fossil fuels have exponentially increased since 1950. The main contributors to such greenhouse gas emissions are manufacturing and construction, transport, residential, commercial, agriculture, and land use change and forestry, combined with an increasing global population growth from 1 billion in 1800 to 7.8 billion in 2020 along with rising obesity rates since the 1980s. The current Covid-19 pandemic has caused some decline in greenhouse gas emissions by limiting mobility globally via repetitive lockdowns. Following multiple lockdowns, there was further increase in obesity in wealthier populations, malnutrition from hunger in poor populations and death from severe infection with Covid-19 and its virus variants. There is a bidirectional relationship between adiposity and global warming. With rising atmospheric air temperatures, people typically will have less adaptive thermogenesis and become less physically active, while they are producing a higher carbon footprint. To reduce obesity rates, one should be willing to learn more about the environmental impact, how to minimize consumption of energy generating carbon dioxide and other greenhouse gas emissions, and to reduce food waste. Diets lower in meat such as a Mediterranean diet, have been estimated to reduce greenhouse gas emissions by 72%, land use by 58%, and energy consumption by 52%.

Introduction: EUS-PD (EUS guided pancreatic duct drainage) is classified into two types: EUS-guided rendezvous techniques and EUS-guided PD stenting. Prior studies showed significant variation in terms of technical success, clinical success and adverse events. Methods: Three independent reviewers performed a comprehensive review of all original articles published from inception to June 2020, describing pancreatic duct drainage utilizing EUS. Primary outcomes were technical success, clinical success of EUS-PDD and safety of EUS-PD in terms of adverse events. All meta-analysis and meta-regression tests were 2-tailed. Finally, probability of publication bias was assessed using funnel plots and with Egger's test. Results: A total of sixteen studies (503 patients) described the use of EUS-PD for pancreatic duct decompression yielded a pooled technical success rate was 81.4% (95% CI 72-88.1, I 2 = 74). Metaregression revealed that proportion of altered anatomy and method of dilation of tract explain the variance. Overall pooled clinical success rate was 84.6% (95% CI 75.4-90.8, I 2 = 50.18). Meta-regression analysis revealed that the type of pancreatic duct decompression, proportion of altered anatomy and follow up time explained the variance. Overall pooled adverse event rate was 21.3% (95% CI 16.8-26.7, I 2 = 36.6). The most common post procedure adverse event was post procedure pain. Overall pooled adverse event rate of post EUS-PD pancreatitis was 5% (95% CI 3.2-7.8, I 2 = 0). Conclusion: The systematic review, meta-analysis and meta-regression provides answer to the questions of the overall technical success, clinical success and the adverse event rate of EUS-PD by summarizing the available literature. (c) 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.

ABSTRACT A tissue floater or extraneous cross-contamination tissue on a microscopic slide is rare; however, it is a potential cause of diagnostic error. Occasionally, on collecting and processing of specimens, cross-contamination of tissue occurs leading to pathologic findings that are inconsistent with endoscopic findings. If the extraneous tissue is neoplastic, it can lead to a false-positive diagnosis. We present a case of discordant pathological and endoscopic diagnosis of invasive squamous carcinoma of the esophagus.

Stauffer's syndrome is a paraneoplastic phenomenon associated with renal cell carcinoma (RCC) characterized by cholestatic hepatitis. We explore the effects of perioperative immunotherapy in a case of Stauffer's syndrome. A 70-year-old female with a locally advanced clear cell RCC (ccRCC) developed severe hyperbilirubinemia. The patient's cholestasis progressed despite initial systemic immunotherapy, but improved after cytoreductive nephrectomy. The patient continued immunotherapy post-operatively and regained normalized hepatic function. To our knowledge, this is the first case reporting use of systemic immunotherapy with surgery in Stauffer's syndrome, and we provide clinical insight into a treatment regimen which may be employed in future cases.

Endoscopic Retrograde Cholangiopancreatography often leads to mortality and morbidity with complications such as post procedure bleeding, post procedure laceration and post procedure hematoma. Currently, there are no national studies to determine the incidence of these complications and impact on health care utilization in terms of readmissions. Therefore, we aim to assess the national incidence of post ERCP hemorrhage, laceration and hematoma. The secondary aims of the study were to identify the readmissions associated with such complications and evaluate differences in the index admissions in terms of demographics, procedural differences.