Advancements in endoscopic ultrasound-guided tissue acquisition (EUS-TA) for solid pancreatic masses have prompted updates in society guideline recommendations. However, the extent to which these recommendations have been adopted in clinical practice remains unclear. Thus, we sought to characterize current practice patterns and beliefs regarding EUS-TA for solid pancreatic masses in a large, international cohort of endosonographers. We developed and distributed an electronic survey to 1,281 endosonographers worldwide between September and November 2024. The survey aimed to evaluate EUS-TA practices across six domains: A) needle selection, B) sampling technique, C) method guiding the number of passes, D) specimen handling, E) quality indicator (QI) monitoring, and F) factors influencing decision-making. The response rate was 30

BACKGROUND AND AIMS:There are limited data in how U.S.-based endosonographers disclose pancreatic ductal adenocarcinoma (PDAC) diagnoses to patients. Therefore, we conducted a survey study across endosonographers to assess practice patterns, evaluate knowledge gaps and challenges, and explore perceptions of federal regulations that mandate immediate release of test results through electronic portals. METHODS:A 29-item electronic survey was distributed to 684 U.S.-based endosonographers between October and November 2024. RESULTS:One hundred sixteen endosonographers participated (17% response rate). Endosonographers often deliver PDAC diagnoses via phone calls (75%), of 6 to 10 minutes (60%), and without following published protocols (81%). One-third of endosonographers believe more training is needed to deliver bad news. Most work in practices where results are immediately released (60%), which creates clinician dissatisfaction (65%) and frustration (57%). CONCLUSIONS:Endosonographers face communication and training challenges when delivering PDAC diagnoses. Strategies are needed to support endosonographers and minimize the negative impact of immediate test result release.

BACKGROUND AND AIM:Device-assisted full-thickness resection (DA-EFTR) has emerged as a promising therapeutic modality for challenging colorectal neoplasms. More recently, the development of a dedicated full-thickness resection device has expanded its application to upper gastrointestinal (GI) lesions. This study aims to evaluate the clinical outcomes of DA-EFTR for subepithelial lesions (SELs) localized in the stomach and duodenum. METHODS:This study was a multicenter, retrospective analysis conducted across 14 centers in India. Consecutive cases with gastroduodenal SELs who underwent EFTR using a dedicated full thickness resection device from April 2021 to Aug 2024 were enrolled in the study. The main outcome was rate of technical success (macroscopically complete resection). Additional outcomes included histologically complete (R0) resection, procedure time and adverse events. RESULTS:131 cases (58y, 82 males) underwent DA-EFTR during the study period. Majority of the SELs were located in duodenum (79.1 %) followed by stomach (20.9 %). Median size of the SELs was 12 mm (IQR 10-16) and majority (60.2 %) were submucosal in origin. Technical success was achieved in 123 (94 %) cases. Overall, histologically complete resection (R0) was achieved in 77.9 % cases. In duodenal neuroendocrine tumors, R0 resection was achieved in 87.2 % cases. On multivariate analysis, increased procedure duration was an independent predictor of histological incomplete resection. Adverse events included mild or moderate in 13 (9.9 %) patients and severe (massive bleeding) in one case. CONCLUSION:DA-EFTR is a safe and effective treatment modality for upper GI SELs especially duodenal neuroendocrine tumors. Prospective studies are required to confirm its role in minimally invasive management strategies for SELs in the upper GI tract.

Acute pancreatitis is an inflammatory condition of the exocrine pancreas that is a common indication for hospital admission and has had an increasing incidence in the last few decades. The diagnosis of acute pancreatitis requires the satisfaction of two out of three criteria: (1) abdominal pain radiating to the back, (2) serum lipase or amylase levels three or more times the upper limit of the normal level, and (3) findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI). The different etiologies include gallstones, autoimmune disorders, alcohol abuse, smoking, hypertriglyceridemia, obesity, drugs, and post-endoscope retrograde cholangiopancreatography (ERCP). The initial investigation includes serum amylase and lipase analysis, a lipid panel including triglycerides, analysis of immunoglobulins, a full blood count, electrolyte analysis, a hemoglobin A1c test, a complete metabolic panel, and transabdominal ultrasound. The initial therapy includes oxygen supplementation, the provision of intravenous fluids, pain control, and a nutrition regime. Early oral feeding is encouraged if tolerated; if not, liquid supplement provision or enteral tube feeding within 48 h of admission has shown better outcomes. Some complications of acute pancreatitis are necrosis, infection, insulin resistance leading to diabetes mellitus, and pancreatic exocrine insufficiency requiring enzyme supplementation. Patients need to attend regular follow-ups and abstain from alcohol and smoking (if warranted) to prevent the recurrence of acute pancreatitis. The mortality rate of acute pancreatitis has decreased in the past few decades because of better management skills, but the recent rise in acute pancreatitis episodes is concerning. Sustained endeavors through clinical trials are required to establish a broad variety of drugs that can be used for acute pancreatitis episodes.

Gastric perforations and leaks are significant complications that can arise from various gastrointestinal disorders and surgical interventions. Over the past decade, endoscopic techniques have emerged as an effective method for managing these conditions. Furthermore, as endoscopic resection techniques have grown in popularity, the risk of acute and delayed perforations has also grown. This review aims to provide an in-depth analysis of the endoscopic management strategies employed in the management of gastric perforations and leaks. We will discuss the etiology, diagnostic modalities, and various endoscopic techniques utilized, as well as emerging trends in endoscopic management. Our attempt in writing this review paper is to educate and guide clinicians in making informed decisions when faced with gastric perforations and leaks.

Background and Aims: Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas >= 1 cm. Methods: This was a multicenter retrospective study of patients with nonampullary duodenal adenomas >= 1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence. Results: A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n = 28). Adverse events occurred in 3.9% (n = 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent Conclusions: This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR. (Gastrointest Endosc 2024;99:971-80.)

Chronic pancreatitis (CP) is an irreversible and progressive inflammation of the pancreas that can involve both pancreatic parenchyma and pancreatic duct. CP results in morphological change in the gland in the form of fibrosis and calcification along with functional impairment in the form of exocrine and endocrine insufficiency. Studies on the natural history of CP reveal the irreversibility of the condition and the resultant plethora of complications of which pancreatic adenocarcinoma is the most dreaded one. (1,2) In Japanese population-based studies by Otsuki and Fuzino et al, CP was clearly shown to reduce lifespan among males and females by 10.5 years and 16 years, respectively. (3) Most of these patients had occult pancreatic malignancies which were diagnosed late and were detected to be the commonest cause of mortality among these patients with a standardized mortality rate of 7.33. (3) This dismal prognosis is superadded with significant morbidity due to pain and poor quality of life rendering a significant burden on health and health-related infrastructure. These factors have led researchers to conceptualize early CP which theoretically is a reversible stage in the disease spectrum characterized by ongoing pancreatic injury with the presence of clinical symptoms and absence of classical imaging features of CP. Subsequently, the disease is thought to go through a compensated stage, a transitional stage, and culminating into decompensated stage with florid evidence of functional impairment of the gland. (4) In this focused review, we will discuss the definition and concept of early CP, risk factors and natural history of the development of CP, and the role of various modalities of EUS in the timely diagnosis of early CP.

Treatment of anastomotic ulcers, also known as marginal ulcers, is challenging, especially when established techniques have failed. PuraStat is a biocompatible synthetic peptide gel that is indicated for hemostasis of bleeding in the gastrointestinal tract and vascular anastomoses. We aim to evaluate the feasibility of PuraStat in the setting of nonhealing anastomotic ulcers when used alongside standard therapies. This is a multicenter case series of adult patients who had PuraStat applied with a follow-up repeat endoscopy. Nine out of 10 patients showed clinical improvement. We concluded that PuraStat is an effective agent to aid in healing of anastomotic ulcer.