Background: Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective: This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods: A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results: The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions: Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps.

Background Conventional endoscopic resection of lesions affecting the appendiceal orifice is difficult. Endoscopic full-thickness resection (EFTR) is a novel technique in interventional endoscopy. As EFTR near the appendiceal orifice is associated with a subtotal appendectomy, it remains unclear whether the risk of developing appendicitis is increased. We conducted a retrospective analysis of lesions involving the appendiceal orifice treated by EFTR. Methods This was a multicenter retrospective analysis of patients (n = 50) treated with EFTR for lesions involving the appendiceal orifice between 2014 and 2019. The objective was to evaluate the occurrence of appendicitis. Results Acute appendicitis occurred in seven patients (14%) during follow-up. Conservative treatment was sufficient in four cases, and three patients underwent appendectomy. Conclusions EFTR of lesions involving the appendiceal orifice may be associated with an imminent risk of developing appendicitis and a consecutive need for appendectomy. Patients should be informed about this specific risk prior to resection. It is unclear why some patients develop appendicitis while the majority remains asymptomatic.

Introduction Benign strictures in the upper GI tract are often treated endoscopically using Savary-Gillard bougie dilatators, which provide tactile feedback. However the drawback to this technique is the lack of direct optic feedback and the need for fluoroscopy during the procedure. A novel device, BougieCap (Ovesco, Germany), allows both tactile and optic feedback of the dilatation procedure without the need for fluoroscopy. The aim of this study was to assess the safety and efficacy of this device in a prospective cohort of patients. Methods Patients with benign strictures of the oesophagus and with clinical symptoms of dysphagia were recruited from 3 endoscopy centres in the UK and Germany for planned dilatation with the BougieCap. The device is a single use transparent conical cap which is fixed to the tip of the endoscope. It comes in different sizes to facilitate dilatation to varying diameters. Once in place, the endoscope is inserted and positioned in front of the stricture. Under direct vision, pushing forward and rotating with the endoscope enables the conical cap to dilate the mucosa in the area of the stricture by the conversion of longitudinal force into radial force vectors. Dilatation could be repeated sequentially with a larger sized cap if necessary. The primary outcome measure was technical success of dilatation. Secondary outcome measure was improvement in symptoms of dysphagia as assessed by the Dysphagia Handicap index (DHI) before and 14 day after the bougienage procedure and adverse events. Results 79 patients (M/F 41/38) with benign oesophageal strictures underwent the procedure between February 2018 to January 2019. Aetiology of strictures were peptic 52% (n=40), radiation 25% (n=19), anastomotic 10% (n=8), caustic 7% (n=5), EoE 4% (n=3), post-ESD 3% (n=2). Mean diameter of strictures was 6 mm (±2.9). Endoscopic bougienage was successful in 97.5%. In 2 cases, with a narrow long stricture, bougienage failed because of high resistance at the site of the stricture causing buckling of the endoscope in the pharynx. Symptoms of dysphagia improved after bougienage (53.6 points. d0 v 26.4 points d14, p<0.01). Adverse events were loss of BougieCap in the stomach in 2 cases. No severe adverse events were reported. Conclusions Endoscopic treatment of benign strictures using the BougieCap enables direct visual and tactile control of the bougienage procedure and therefore of mucosal damage within the area of strictures. This might help to adapt treatment even more precisely to the stricture. Symptoms of dysphagia are improved in short-term follow-up.

Background A major limitation of current treatment strategies for nonmalignant upper gastrointestinal stenoses is the lack of either optical or haptic feedback during dilation. Wire guidance and fluoroscopy is often necessary to control the position. Methods A novel device for endoscopic dilation, the BougieCap (Ovesco Endoscopy AG, Tubingen, Germany) was evaluated in a prospective multicenter trial. Primary outcome was successful dilation of stenosis and secondary outcome was alteration in dysphagia symptoms in short-term follow-up. Results 50 patients with benign esophageal strictures were included. Endoscopic bougienage was successful in 96 %. Bougienage failed in two cases because of high resistance. Symptoms of dysphagia decreased significantly after bougienage (59.0 points at Day 0 vs. 28.6 points at Day 14; P < 0.001). Adverse events were loss of BougieCap into the stomach in two cases; no severe adverse events were reported. Conclusions Endoscopic treatment of benign stenoses using the BougieCap enabled direct visual control of the bougienage procedure. This might help to adapt treatment more precisely to the stricture. Symptoms of dysphagia were improved in short-term follow-up. Additional wire guidance may be used for selected cases (e. g. narrow lumen, pediatric scope).

Background En-bloc resection of large, flat lesions or early stages of cancer is challenging. No bimanual tasks are possible using standard endoscopes. Dual-channel endoscopes are not available everywhere and have a small distance between the channels. Patients and methods A new external additional working channel (AWC) (Ovesco, Tuebingen, Germany) was designed and developed potentially enabling bimanual tasks. Fixed to the tip of a standard gastroscope or pediatric colonoscope, a second endoscopic tool can be inserted through the AWC and used for tissue retraction during endoscopic resection. Results In the upper and lower gastrointestinal tract, endoscopic mucosal resection (EMR) with a modified grasp-and-snare technique and endoscopic submucosal dissection (ESD) were performed successfully using the AWC in eight patients. Complications were acute arterial bleeding post-EMR in two cases treated by endoscopic clipping. Conclusions We conclude that a newly developed external additional working channel (AWC) enables endoscopic resection of large lesions in the upper and lower gastrointestinal tract. Potential benefits are its suitability for EMR and ESD, no need for a dual-channel endoscope and an adjustable distance of working channels.

Conventional endoscopic resection techniques of adenoma arising from the appendiceal orifice have certain limitations. Endoscopic full-thickness resection (EFTR) is a novel technique for complete resection of adenomas when standard methods are likely to fail. As full thickness resection near the appendiceal orifice is associated with subtotal appendectomy the risk for development of subsequent appendicitis or mucocele remains unclear. We present the results of a retrospective analysis of patients with adenomas arising from the appendiceal orifice treated with the FTRD system (Ovesco Endoscopy, Tuebingen, Germany). Retrospective analysis of patients treated at 2 centers with experience in EFTR for more than 3 years. 17 patients were included, all of whom had histologically verified adenomas in the appendiceal orifice that could not be removed by standard polypectomy techniques. Median age was 67.0 (48-82) yrs., follow up was available after a median time of 11 (6-32) months. All patients received prophylactic antibiotic treatment for 3 to 7 days in a row started perintenventionally. Patients were monitored for evaluation of post treatment complications in acute and long term follow up (appendicitis, mucocele?). EFTR was successfully performed in all patients with subtotal appendectomy verified by histologically proven full thickness resection. A single patient underwent appendectomy already two days after EFTR due to clinical signs of appendicitis. A further patient developed appendicitis 5 months after EFRT and laparoscopic resection of the remaining appendix had to be performed. The remaining 15 patients (88%) remained asymptomatic. No development of a mucocele was reported. We conclude that full thickness resection of adenomas arising from the appendiceal orifice is associated with a rather low risk even on a long term perspective. The reason why few patients develop appendicitis and the majority remains free of such complications has to be further elucidated.