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Background The ileocecal valve (ICV) is considered to be one of the most difficult locations for endoscopic submucosal dissection (ESD). The objective of this study was to evaluate the efficacy and safety of traction-assisted ESD in this situation. Methods All patients who underwent traction-assisted ESD for an ICV lesion at three centers were identified from a prospective ESD database. En bloc and R0 rates were evaluated. Factors associated with non-R0 resection were explored. Results 106 patients with an ICV lesion were included. The median lesion size was 50 mm (interquartile range 38–60) and 58.5% (62/106) invaded the terminal ileum. The en bloc and R0 resection rates were 94.3% and 76.4%, respectively. Factors associated with non-R0 resection were lesions covering ≥75% of the ICV (odds ratio [OR] 0.21. 95%CI 0.06–0.76; P=0.02), and involving the anal lip (OR 0.36, 95%CI 0.13–0.99; P=0.04) or more than two sites on the ICV (OR 0.27, 95%CI 0.07–0.99; P=0.03). Conclusion Traction-assisted ESD for treatment of ICV lesions was a safe and feasible option. Large lesions and anal lip involvement appeared to be factors predictive of difficulty. [ABSTRACT FROM AUTHOR]

Introduction The environmental impact of endoscopy, including small-bowel capsule endoscopy (SBCE), is a topic of growing attention and concern. This study aimed to evaluate the greenhouse gas (GHG) emissions (kgCO2) generated by an SBCE procedure. Methods Life cycle assessment methodology (ISO 14040) was used to evaluate three brands of SBCE device and included emissions generated by patient travel, bowel preparation, capsule examination, and video recording. A survey of 87 physicians and 120 patients was conducted to obtain data on travel, activities undertaken during the procedure, and awareness of environmental impacts. Results The capsule itself (4 g) accounted for < 6 % of the total product weight. Packaging (43–119 g) accounted for 9 %–97 % of total weight, and included deactivation magnets (5 g [4 %–6 %]) and paper instructions (11–50 g [up to 40 %]). A full SBCE procedure generated approximately 20 kgCO2 , with 0.04 kgCO2 (0.2 %) attributable to the capsule itself and 18 kgCO2 (94.7 %) generated by patient travel. Capsule retrieval using a dedicated device would add 0.98 kgCO2 to the carbon footprint. Capsule deconstruction revealed materials (e. g. neodymium) that are prohibited from environmental disposal; 76 % of patients were not aware of the illegal nature of capsule disposal via wastewater, and 63 % would have been willing to retrieve it. The carbon impact of data storage and capsule reading was negligible. Conclusion The carbon footprint of SBCE is mainly determined by patient travel. The capsule device itself has a relatively low carbon footprint. Given that disposal of capsule components via wastewater is illegal, retrieval of the capsule is necessary but would likely be associated with an increase in device-related emissions. [ABSTRACT FROM AUTHOR]

Introduction: It is still unclear whether Crohn's disease (CD) might be associated with diminished ovarian reserve (OvR) and factors influencing anti‐Mullerian hormone (AMH) levels in CD are poorly known. Material and Methods: We conducted a comprehensive literature search of multiple electronic databases from inception to June 2022 to identify all studies reporting AMH levels or factors associated with diminished OvR in patients with CD. Results: Of the 48 studies identified in our search, eight (including 418 patients with CD) were finally included. The mean difference (95% confidence interval [CI]) in the AMH level between pooled CD patients and controls was −0.56 (−1.14 to 0.03) (p = 0.06). A history of CD‐related surgery was not associated with a lower OvR (odds ratio, OR [95% CI] 1.34, [0.66–2.7]; p = 0.4). While disease activity and perianal disease seems associated with a low OvR, disease location (L2 vs. L1, OR [95% CI] = 95% CI [0.47–7.4]; p = 0.4) and L3 vs. L1 (OR [95% CI] = 1.44 [0.67–3.12]; p = 0.3), CD medication, and disease behavior were not. Conclusions: Our systematic review and meta‐analysis did not identify a significantly low OvR in patients with CD. Contrary to CD‐related surgery risk factor, active disease was associated lower AMH levels. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the use of an adaptive traction device called ATRACT in endoscopic submucosal dissection (ESD) procedures. The study found that the ATRACT device was effective in achieving successful resections with minimal complications. It provided strong traction and improved access to challenging lesions in the gastrointestinal tract. However, the study suggests that more extensive research is necessary to fully assess the safety and efficacy of the ATRACT device. [Extracted from the article]

For lesions of 20-30 mm, the difference was already large, with rates of 83.9 % and 57.1 % for R0 resections in the ESD and FTRD groups, respectively ( I P i = 0.06), and this difference dramatically increased when the lesion size was > 30 mm (93.6 % vs. 33.3 %; I P i = 0.002). The lesions treated by ESD were however statistically larger than those treated by FTRD ( I P i < 0.001), and small lesion size was the only factor associated with en bloc and R0 resection on univariate analysis (Table 2; B Table 1 s, b see online-only Supplementary material). Graph Introduction Endoscopic submucosal dissection (ESD) is a safe and effective technique to achieve R0 resection of superficial colorectal neoplasia, regardless of its size, and is associated with few recurrences [1][2][3][4]. [Extracted from the article]

Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Endoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion. Methods In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15 mm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). Results 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2 %) and, where possible, the en bloc and R0 resection rates were 95.8 % (115/120) and 76.7 % (92/120), respectively. Thirty-three resections (26.2 %) were for very low risk tumors, so considered curative, and 38 (30.2 %) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; n = 8), or significant budding (n = 9), and LVI + budding combination (n = 4). Conclusion ESD is feasible and safe for colorectal lesions with an FDIP ≤ 15 mm. It was curative in 26.6 % of patients and could be a valid option for a further 30.6 % of patients with low risk T1 cancers, especially for frail patients with co-morbidities. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal (GI) fistula is a life-threatening condition and a therapeutic challenge. Endoscopic approaches include mucosal abrasion, clip closure, or stent diversion, with moderate success rates in the long term. We assessed whether fistula endoscopic submucosal dissection with clip closure (FESDC) could lead to complete resolution of fistulas even after failure of previous endoscopic therapy.Methods: Patients with GI fistulas, including those with previous failed treatment, were retrospectively included. The primary outcome was long-term (> 3 months) success of fistula healing. Secondary outcomes included technical success, safety, and factors associated with FESDC success.Results: 23 patients (13 refractory 57 %) were included. Tight immediate sealing was achieved in 19 patients (83 %; 95 % confidence interval [CI] 61 %-95 %). Long-term closure was achieved in 14 patients (61 %; 95 %CI 39 %-80 %), with median follow-up of 20 months. Complications occurred in two patients (9 %). Previous local malignancy (P = 0.08) and radiotherapy (P = 0.047) were associated with a higher risk of failure.Conclusion: This novel FESDC strategy was demonstrated to be safe and feasible for permanent endoscopic closure of GI fistulas. Further studies are warranted to determine the place of this technique in the management of chronic GI fistula. [ABSTRACT FROM AUTHOR]

Background: Among patients with limited ulcerative colitis (UC), 30% ultimately extend to pancolitis and are at increased risk of adverse clinical outcomes. Risk of endoscopic extension has been found to correlate with clinical features such as early age of onset. Aims: We sought to determine whether histologic features correlate with disease extension. Methods: The study population consisted of 40 patients with UC from two large academic centers diagnosed between 2006 and 2017. Eligible cases had a diagnosis of endoscopically limited UC (Montreal E1 or E2) at baseline and ≥ 2 subsequent endoscopic examinations with biopsies. Severity of inflammation was scored using both the Mount Sinai Activity Index and Nancy Histological Index. Results: Patients were divided into two cohorts: those who progressed to pancolitis (Montreal E3) were defined as "Extenders" (n = 21), whereas "Non-extenders" (n = 19) were cases without progression in the follow-up period. The median follow-up time was 58.4 months. The histologic scores in the endoscopically involved mucosa of the index biopsies were not associated with subsequent extension of disease, overall. However, among extender cohort, the index histology scores correlated with biopsy scores at extension (r = 0.455, P = 0.044) and index severity was associated with a shorter time to extension (r = − 0.611, P = 0.003). Furthermore, female patients had a shorter time to extension (P = 0.013). Conclusions: Histological severity of limited UC is not an independent predictor of extension in UC. However, among patients who subsequently extend, severe inflammation at baseline correlates with shorter progression time and severe inflammation when extension occurs. Patients with limited UC but severe histologic inflammation may warrant more frequent endoscopic surveillance. [ABSTRACT FROM AUTHOR]

Copyright of Hépato-Gastro & Oncologie Digestive is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: An increased risk of dental caries and periodontal diseases has been reported for inflammatory bowel disease (IBD) patients and are challenging conditions to manage. Areas covered: The authors searched international databases to find all studies assessing dental/periodontal outcomes in patients with IBD and other immune-mediated inflammatory disease (IMID), as well as the association between IMID medications and dental/periodontal status. Expert opinion: IBD are associated with a higher risk of both periodontitis and caries. Some evidence from rheumatoid arthritis suggests that periodontitis may be associated with a lower response to anti-TNF. There is no reliable evidence that IBD patients may be at greater risk of complications during routine dental care. On the basis of current data, guidelines can be proposed for the dental management focusing on the detection and eradication of infectious foci prior to the implementation of immunosuppressants/biologics and modified dental treatment protocol for invasive dental procedures that includes antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate the feasibility and safety of PTE-RV performed in a single session. Materials and methods: This is a retrospective review of a prospective database on ERCP between January 2014 and December 2018. PTE-RV was performed in case of second ERCP failure. Technical success was defined as the establishment of an intestinal access to the biliary tract using a PTE-RV procedure allowing an immediate internal biliary drainage. Safety endpoints included intra-operative complications, morbidity and mortality occurring within 30 days after the procedure. Results: Eighty-four patients (44 M/40F) with a median age of 69 years (range 40–91 years) underwent combined PTE-RV. The PTE-RVs were successfully performed in the same session in 80 subjects, resulting in an overall technical success rate of 95.2%. Adverse events were observed in 19% (16/84) of cases. The mortality rate within 30 days after the procedure was 9.5%. Conclusion: Percutaneous transhepatic–endoscopic rendezvous technique is feasible in a single session with acceptable level of risk. A randomized trial is required to compare EUBD and PTE-RV. [ABSTRACT FROM AUTHOR]

Résumé: L'endoscopie est l'examen de référence pour le diagnostic et la surveillance des maladies inflammatoires chroniques intestinales (MICI). À l'heure des stratégies de « tight-control » et de « treat-to-target », le développement de biomarqueurs ou d'examen non invasif, bien toléré, répétable et peu coûteux est indispensable. Comparativement, à l'endoscopie ou à l'imagerie en coupe, l'échographie intestinale s'est avérée performante dans l'évaluation et la surveillance de l'activité de la maladie de Crohn et de la rectocolite hémorragique. Elle peut être réalisée « au chevet du malade » et permettre ainsi une prise de décision clinique en temps réel. L'objectif de cette revue est d'effectuer une mise au point sur la place actuelle et future de l'échographie dans les MICI. The gold standard for the diagnosis and monitoring of inflammatory bowel disease (IBD) is the colonoscopy. In the era of "tight control" and "treat to target" strategies, the development of non-invasive, well-tolerated, repeatable and inexpensive biomarkers are needed. Compared to colonoscopy and Magnetic resonance imaging, bowel ultrasound (US) has shown to have the same level of accuracy in assessing and monitoring disease activity and severity of both Crohn's disease and ulcerative colitis. It can be performed at the point-of-care and therefore allow for real-time clinical decision-making. The aim of this review is to discuss the interest of intestinal ultrasound in the management of patients with IBD. The objective of this review is to provide an update on the current and future place of ultrasound in IBD. [ABSTRACT FROM AUTHOR]

Epstein‐Barr virus‐related mucocutaneous ulcer lymphoma is a rare entity promoted by immunosuppression. It is less described in inflammatory bowel diseases, and mostly these are refractory diseases. CD30 acts to Epstein‐Barr virus (EBV) local proliferation and thus could be an interesting target. Brentuximab vedotin could become a new helpful tool. [ABSTRACT FROM AUTHOR]

Analysis of the polyp confirmed the presence of gastric heterotopia in two patients and a Brunner's gland hyperplasia without dysplasia in one patient. The exploration of the duodenum was performed immediately for two patients, who benefited from a one-step procedure using a transnasal scope to pass through the LAMS and perform the resection using a small-caliber snare by underwater technique. [Extracted from the article]

EndoGel (Fujifilm, Tokyo, Japan) is a new non-animal training model for endoscopic submucosal dissection (ESD) that seems a good option for initial training. We hypothesize that such a dedicated model, which is ecologically acceptable with no animal components, could facilitate ESD training with adaptive traction strategies. [Extracted from the article]

Résumé: Les biothérapies utilisées pour le traitement des maladies inflammatoires chroniques de l'intestin sont associées à un risque de réactions immédiates (< 24 h). L'infliximab (IFX) a rapidement été associé à un risque de réaction à l'injection potentiellement grave. Les biothérapies sous-cutanées (adalimumab, golimumab et ustékinumab) peuvent être responsables de réactions locales, qui justifient exceptionnellement l'arrêt du traitement. Les incertitudes sur les mécanismes physiologlogiques engagés et le peu d'études d'intervention ont abouti à des protocoles d'administration et de prise en charge des réactions multiples et empiriques. Biologics used for the treatment of Inflammatory Bowel Diseases are associated with a risk of immediate reaction (< 24h). Infliximab (IFX) was associated with a potentially serious infusion reaction risk. Subcutaneous biologics (adalimumab, golimumab and ustekinumab) may be responsible for local reaction, which exceptionally justifies stopping treatment. Uncertainties about the physiopathological mechanisms involved and the lack of interventional studies have led to different empirical protocols for their administration and their management. [ABSTRACT FROM AUTHOR]

Summary: Background: The significance of endoscopic activity in asymptomatic ulcerative colitis (UC) patients with an ileal pouch is unknown. Aim: To investigate the association of endoscopic pouch activity in asymptomatic patients with the subsequent development of pouchitis. Methods: We analyzed a retrospective cohort of patients with UC or IBD‐unspecified who underwent a total proctocolectomy with ileal pouch anal anastomosis (IPAA). Asymptomatic patients with a Pouchitis Disease Activity Index (PDAI) symptom sub‐score of zero who underwent an index surveillance pouchoscopy were included. Endoscopic pouch body activity was graded as 0: normal, 1: mucosal inflammation, or 2: mucosal breaks (ulcers and/or erosions). The primary outcome was primary acute idiopathic pouchitis defined as PDAI score ≥ 7 with symptoms lasting less than four weeks and responsive to standard antibiotics, not otherwise meeting criteria for secondary pouchitis. The secondary outcome was chronic idiopathic pouchitis defined as PDAI score ≥ 7 with symptoms lasting greater than four weeks despite standard antibiotics. Predictors of pouchitis were analyzed using Kaplan‐Meier and Cox regression methods with hazard ratios (HR) and 95% confidence intervals (CI) reported. Results: 143 asymptomatic pouch patients were included. Index endoscopic pouch body activity was 0 in 86 (60.1%) patients, 1 in 26 (18.2%) and 2 in 31 (21.7%). The median length of follow‐up after index surveillance pouchoscopy was 3.03 [IQR 1.24‐4.60] years. Primary acute idiopathic pouchitis occurred in 44 (31%) patients and chronic idiopathic pouchitis in 12 (8.4%). Grade 2 endoscopic pouch activity was associated with the development of acute pouchitis (HR 2.39, 95% CI 1.23‐4.67), although not chronic pouchitis (HR 1.76, 95% CI 0.53‐5.87). Histologic inflammation in endoscopically normal pouch mucosa was not associated with acute or chronic pouchitis. Conclusions: Mucosal breaks are present in nearly a quarter of asymptomatic patients with IPAA and are associated with an increased risk of acute pouchitis. [ABSTRACT FROM AUTHOR]

Abdominal computed tomography (CT) and magnetic resonance enterography (MRE) showed a thickening of the small bowel at the junction between the jejunum and ileum, at 30 cm, suggesting Crohn's disease. Small-bowel capsule endoscopy and enteroscopy are relevant tests to explore suspected refractory celiac disease [2][3]. [Extracted from the article]

Bougies and balloons are two instruments commonly used for endoscopic dilation of benign strictures in the upper gastrointestinal tract, with similar efficacy [1]. Endoscopic dilation with bougies versus balloon dilation in esophageal benign strictures: systematic review and meta-analysis. [Extracted from the article]

B Video 1 b Endoscopic closure of an ulcer bed following endoscopic resection using the "mucosal adaptive ring to close an endoscopic artificial ulcer" (MARCEAU) procedure. We describe the use of a new closure device known as the "mucosal adaptive ring to close an endoscopic artificial ulcer" (MARCEAU) that is both easy to use and fully internalized through the endoscope channel, providing an easy way to meet the objective of sealing an ulcer when required (Video 1). [Extracted from the article]

Brunner's gland hamartoma: Case report on a rare duodenal lesion and exhaustive literature review. A duodenal Brunner's gland hamartoma is an extremely rare benign tumor of the duodenum, representing less than 1 % of primary tumors of the small intestine [1]. [Extracted from the article]

1 Strategies of dilatation with the available devices and weight of waste. a Bougie cap device. b Weight of the bougie cap with its package. c Balloon dilation kit with balloon and manometer and its weight. d Conventional bougies. Different modalities exist (balloon dilatation, bougie dilatation) with similar efficacy [1], but their different ecological impact should be considered during endoscopic procedures [2][3]. [Extracted from the article]

Peroral endoscopic myotomy for Zenker's diverticulum (zPOEM) was first described by Li et al. in 2016 and involves the same technique as the endoscopic myotomy used in the treatment of achalasia [4]. Submucosal tunneling endoscopic septum division: a novel technique for treating Zenker's diverticulum. Zenker's diverticulum is considered a pulsation diverticulum developed in an area of weakness, known as the Killian's triangle. [Extracted from the article]

En bloc endoscopic mucosal resection (EMR) with a snare is the standard resection technique for adenomas < 25 mm [1]. 1 Schematic representation of traction-assisted endoscopic mucosal resection: a, b using the magnetic clip traction method; and c showing why the classic traction method (double clip and rubber band) is not applicable. [Extracted from the article]

In the field of colorectal lesion resection, a resection is considered R0 when the tumor is removed in a single piece (en bloc) with tumor-free lateral and vertical margins. For resection of a superficial lesion to be considered curative, an R0 en bloc resection with histology no more advanced than a well-differentiated adenocarcinoma and submucosal invasion of less than 1 mm without lymphovascular invasion is currently required [2]. After reanalysis and new cut of slices, the resection was reclassified R1, and final histology of the resection specimen was in favor of a deep tumor deposit. [Extracted from the article]

Zenker's diverticulum is a pulsion diverticulum developed in an area of weakness known as the Killian's triangle. B Video 1 b Effective treatment of incipient Zenker's diverticulum using Zenker's diverticulum peroral endoscopic myotomy. [Extracted from the article]

1 Endoscopic images of a subepithelial round lesion in the sigmoid colon seen on: a white-light imaging; b narrow-band imaging. B Video 1 b Endoscopic ultrasound scanning and endoscopic submucosal dissection with a multitraction device are performed for a colonic submucosal lesion that was found on histopathology to be a benign colonic lymph node. Where there is suspicion of a submucosal neuroendocrine tumor (NET), en bloc resection is advised [1] because complete resection allows for better histopathological characterization and, in low risk cases, no endoscopic follow-up. [Extracted from the article]

We present here the case of a colonic dissection for a laterally spreading tumor with and without the IPEFIX pedal device (Innovative Pedal Fixator, Lab 3 D HCL, Hospices Civils de Lyon). For example, water immersion colonoscopy [1] and underwater endoscopic mucosal resection (EMR) [2] require the parallel use of two foot pedals, one to control the electrosurgical unit and the other to control the peristaltic pump to fill the colon with water. [Extracted from the article]

1 White light view of the laterally spreading tumor with no detection by computer-aided detection (yellow arrows show the real boundaries of the lesion). In terms of image analysis, AI is indeed able to perform many tasks automatically, including lesion detection, classification, and segmentation, and to combine them [1]. Large-scale studies have demonstrated the superiority of AI-assisted detection over the usual detection by gastroenterologists, mainly for the detection of sub-centimeter polyps [2][3]. [Extracted from the article]

Artificial intelligence (AI) and especially deep learning have recently shown promising results in various medical fields involving endoscopic images [1][2]. Among the difficult lesions to detect, non-granular laterally spreading tumors (LST-NGs) represent a challenge because, in addition to their flat macroscopic form, which is difficult to identify, they are associated with advanced histology, with 27 % of invasive cancers being found in the elevated non-granular forms and 47 % in the pseudodepressed ones [4]. [Extracted from the article]

However, recent findings have found that ESD is effective and safe in that situation [2][3], even for lesions deeply invading the appendiceal orifice (Toyonaga 3 lesions) with the help of traction device [4][5]. B Video 1 b Endoscopic submucosal dissection of a lateral spreading tumor involving the appendiceal orifice using a multi-traction device. [Extracted from the article]

1 In a 71-year-old man who 3 years ago had undergone ESD for high-grade dysplasia and focal intramucosal carcinoma in the left colon, high-grade dysplasia recurrence was detected in the area previously treated. ESD for dysplasia in IBD is feasible, but long-term follow-up data are lacking especially for the management of dysplasia recurrence in an area previously treated by ESD [2][3][4][5]. [Extracted from the article]

After the procedure, the scar was closed by anchoring the clips: small mucosal incisions were performed around the scar (Fig. B Video 1 b Endoscopic submucosal dissection of a subepithelial neuroendocrine tumor located in the duodenum using a countertraction technique. [Extracted from the article]

However, colorectal lesions are not homogeneous: a malignant component can sometimes occupy only a small area of the whole lesion and be relatively difficult to detect, especially for inexperienced endoscopists. These cases show that the malignant component within a large colorectal lesion can have a green-colored area that is easily detectable on a distant view of the lesion, without the need to analyze the entire surface under magnification. [Extracted from the article]

Artificial intelligence using a convolutional neural network for automatic detection of small-bowel angioectasia in capsule endoscopy images. Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study. [Extracted from the article]

B Correction: Surgical Endoscopy (2022) 36:9469-9475 b https://doi.org/10.1007/s00464-022-09623-x In the original version of this article, the given and family names of Clara Yzet, Sami Hakim, Mathieu Pioche, Jean-Phillipe Le Mouel, Constance Deschepper, Pierre Lafeuille, Richard Delcenserie, Thierry Yzet, Eric Ngyuen-Khac, Mathurin Fumery, and Franck Brazier were incorrectly structured. The original article can be found online at https://doi.org/10.1007/s00464-022-09623-x. [Extracted from the article]

This step is usually performed with a routine single-use sclerotherapy needle [2]; however, a DualKnife could also be used for the same purpose, allowing the use of one disposable injection needle to be spared. B Video 1 b A method to reduce the ecological impact of gastric peroral endoscopic myotomy by performing the injection with the DualKnife, rather than with a sclerotherapy needle. 118478927-e34e7c81.mp4 This case illustrates that, even if the DualKnife is shorter than the sclerotherapy needle, it can have the same efficacy and performance for submucosal injection as the latter. [Extracted from the article]

This technique involves an initial submucosal injection, followed by a circumferential incision and, finally, the resection of the central tissue with a snare [1]. This strategy can be applied to lesions under 20 mm in diameter, and allows the visualization and inclusion of the whole lesion, with certainty of complete en bloc resection [2]. 18420486-715f1ec0.mp4 With this method, we have demonstrated that underwater H-EMR is feasible and can be useful in selected cases, by assuring complete resection of difficult-to-access and nonlifting lesions. [Extracted from the article]

However, its use for the treatment of local recurrence after previous duodenal adenoma resection is yet to be well established. Studies show that underwater endoscopic mucosal resection (EMR) is an efficient technique for the treatment of these kinds of lesions, with 87.5 % to 100 % complete endoscopic resection [3]. [Extracted from the article]

Nevertheless, the use of the snare to remove the traction is still useful if the knife were to be re-used for endoscopy teaching because the knife would be damaged from removing the traction. We report a technique to remove traction using the knife during an endoscopic ubmucosal dissection (ESD). This technique will not change the patient tumor prognosis but will contribute to reduce waste and lessen our environmental impact. [Extracted from the article]

LINKED CONTENT This article is linked to Yang et al papers. To view these articles, visit https://doi.org/10.1111/apt.15719 and https://doi.org/10.1111/apt.15919. [ABSTRACT FROM AUTHOR]