Background/Aims: Cold snare polypectomy (CSP) technique for polyps <10 mm varies widely among endoscopists. This study aimed to evaluate an online educational intervention for incomplete resections.Methods: This multicenter trial was performed between 2021 and 2024. After a baseline assessment of incomplete resection rates for CSP of lesions <10 mm was completed, participants undertook a 1-hour online course led by an expert senior endoscopist. A second assessment was performed following course completion. Resections were evaluated using two marginal biopsies obtained after CSP, assessed by a single pathologist blinded to polyp histology. Follow-up was conducted by telephone 4 weeks after colonoscopy.Results: A total of 29 endoscopists participated in the baseline assessment, yielding a baseline 4.8% incomplete resection rate, with a median individual rate of 4.3% (interquartile range [IQR], 2.9%–5.7%; range, 0%–15.6%). Thirteen endoscopists completed the course and participated in the second study phase, which included 1,271 polyps in phase 1 and 826 in phase 2. No significant improvement in incomplete resection rate was observed (4.8% in phase 1 vs. 4.0% in phase 2; difference, 0.8%; 95% confidence interval [CI], –1.1% to 2.6%; p=0.4). Among 3,087 polypectomies, intraprocedural bleeding occurred in 288 (9.3%) cases; most were self-limited, with only 45 (1.5%) requiring clipping. Delayed bleeding was observed in five (0.5%) patients, four of whom had mild bleeding and one severe. No perforations were observed.Conclusions: The utility of online endoscopic technique courses appears limited. CSP demonstrates an excellent safety profile (ClinicalTrials.gov number: NCT04636619).

BACKGROUND:Endoscopic forceps biopsy is the primary method for obtaining mucosal tissues, but can lead to false negatives. AIMS:To assess the agreement between endoscopic biopsies and submucosal dissection specimens in esophageal and gastric epithelial lesions and to identify factors associated. METHODS:Cross-sectional study using data from the Spanish national multicenter endoscopic submucosal dissection register. Patients, lesions and technical characteristics were prospectively collected. Prognostic factors for discrepancies were analyzed. RESULTS:604 endoscopic submucosal dissection with previous biopsies were performed between January 2016 and December 2023 across 32 centers. 48.7% presented disagreement between biopsies and endoscopic submucosal dissection; specifically, 40.4% were underestimated by endoscopic biopsy. Carcinoma was detected in 270 endoscopic submucosal dissection specimens, with 54.8% not suspected on the initial biopsy. The carcinomas already diagnosed with the biopsy presented more submucosal and lymphovascular invasion. Notably, a larger lesion (≥ 22 mm) was a significant predictor for histological upstaging. CONCLUSIONS:The high rate of disagreement between endoscopic forceps biopsy and endoscopic submucosal dissection highlights biopsies limitations in accurately diagnosing esophageal and gastric epithelial lesions. In this setting, endoscopic submucosal dissection should be used not only as a treatment option, but also as a valuable diagnostic tool.

Background and study aims:Endocuff Vision (EV) is a disposable device designed to improve polyp detection. The primary aim of this study was to evaluate the effect of EV on adenoma detection rate (ADR) and mean number of adenomas per patient (MAP). Patients and methods:This multicenter randomized controlled trial compared EV-assisted colonoscopy (EAC) and standard colonoscopy (SC). Patients were referred due to a positive fecal immunochemical test (FIT) in a bowel cancer screening program (BCSP), direct screening colonoscopy without prior FIT, surveillance colonoscopy, or family history of colorectal cancer. Results:In total, 1437 patients (55.9% male; median age, 59 years) were randomized at eight Spanish university hospitals. No significant differences were found in either the ADR (EAC vs. SC, 55.8% vs. 54.3%; P = 0.576) or the MAP (1.60 vs. 1.35; P = 0.03). Compared with SC, EAC was not associated with a significant improvement in detection rates for advanced adenomas, sessile serrated lesions, or advanced sessile serrated lesions. There was no difference in cecal intubation rate but the successful ileal intubation rate, among patients in whom it was attempted, was lower with EAC (64.3% vs. 86.5% with SC; P = 0.001). Conclusions:EV did not improve either ADR or MAP. EV may increase difficulty of ileal intubation whenever it is attempted.

BACKGROUND AND AIM:Anti-reflux mucosal ablation (ARMA) is an emerging endoscopic treatment aimed at enhancing the gastroesophageal junction flap valve. This study aimed to evaluate its feasibility, effectiveness, and safety.METHODS:Between May 2018 and December 2022, patients with gastroesophageal reflux disease (GERD) symptoms refractory to acid suppression medications or those dependent on such medications were enrolled for ARMA. This retrospective analysis utilized prospectively collected data from an international bi-center study. GERD questionnaire, upper endoscopy, and 24-h pH monitoring were conducted at 2-6 months and 12 months post-ARMA. Clinical success was defined as a > 50% reduction in a validated GERD questionnaire.RESULTS:A total of 68 patients underwent ARMA. Definitive GERD was diagnosed in 44 (64.7%) patients, while 24 (35.3%) exhibited reflux hypersensitivity. Clinical success rates at 2-6 months and 1 year post-ARMA were 60% (39/65) and 70% (21/30), respectively. The median GERD-health-related quality of life score significantly improved from 26 to 11 at 2-6 months (P < 0.001). Among the 51 patients (71.8%) who underwent 24-h pH monitoring, the median acid exposure time decreased from 5.3% to 0.7% (P = 0.003), accompanied by a significant reduction in esophagitis rates (P < 0.001). Multivariate analysis did not identify predictors of short-term success. Nine (13.2%) patients experienced transient stenosis requiring balloon dilation.CONCLUSIONS:ARMA demonstrates both technical feasibility and reproducibility as a safe procedure that effectively ameliorates GERD symptoms in approximately two-thirds of patients during short-term follow up. Both reflux hypersensitivity and confirmed GERD patients, regardless of their response to acid suppression medication, may be suitable candidates.